If you or a loved one will be undergoing chemotherapy (chemo) as part of your treatment for ovarian cancer, you may be nervous, scared, and curious about what to expect. Chemotherapy is a common ovarian cancer treatment that may be used before or after surgery to shrink tumors and eliminate lingering cancer cells. It’s also used as palliative care to relieve uncomfortable symptoms.

In this article, we’ll cover what you need to know about chemotherapy treatment for ovarian cancer. We’ll cover how chemotherapy works, what drugs you may receive, and common side effects you may experience. Be sure to talk to your cancer care team if you have specific questions about your treatment plan. It’s important to feel educated and empowered throughout your treatment.

What Is Chemotherapy, and How Does It Work?

Your cells grow and divide in a process known as the cell cycle. While this process is usually tightly controlled, cancer cells find new ways to hijack it and grow uncontrollably. Chemotherapies are powerful drugs that target the cell cycle, preventing cancer cells from growing and dividing and triggering their death.

These chemicals target rapidly dividing cells in the body — including both cancer cells and some fast-growing normal, healthy cells. In most cases, cancer cells divide faster than normal cells. Chemotherapies can still harm your healthy cells, leading to some unwanted side effects. Fortunately, most side effects go away over time after chemo is completed.

Types of Chemotherapy Used To Treat Ovarian Cancer

Many chemotherapy drugs are used to kill cancer cells. Alkylating agents damage DNA, preventing cells from growing and dividing. Examples include carboplatin (Paraplatin) and cisplatin (Platinol).

Mitotic inhibitors are another type of chemotherapy made from natural substances such as plant compounds. They block mitosis (the process of cell division). Examples include docetaxel (Taxotere) and paclitaxel (Abraxane, Taxol).

Some antibiotics are used to treat cancer — and they’re not the same as those used in treating infections. Known as antitumor antibiotics, these drugs damage the DNA in cancer cells so they can’t divide properly. One example is bleomycin.

Certain types of ovarian cancer may also be treated with topoisomerase inhibitors. Topoisomerase is a type of protein known as an enzyme. It helps separate DNA strands so cells can make new copies. These drugs block topoisomerase 1 or 2 in cancer cells to stop them from growing and dividing. An example of a topoisomerase 2 inhibitor is etoposide or VP-16 (Etopophos, Toposar, VePesid).

When Is Chemotherapy Used in Ovarian Cancer?

There are several reasons why your oncologist and cancer care team would recommend chemotherapy. Your treatment plan may depend on your ovarian cancer stage, details about your cancer cells, your age, and specifics about your health condition.

If you have stage 1 or 2 ovarian cancer, you’ll likely have surgery first to remove the tumor. Chemotherapy is used as a follow-up treatment after surgery to kill off remaining cancer cells. This is known as adjuvant chemotherapy, and it lowers the risk of relapse (your disease returning later).

Chemotherapy is also used before surgery to shrink ovarian tumors in people with stage 3 or 4 breast cancer. Known as neoadjuvant chemotherapy, this treatment helps your surgeon remove as much of the tumor as possible.

If you have stage 3 ovarian cancer but aren’t strong enough for surgery, you may receive chemotherapy as a first-line (or first-round) treatment. It can give you a chance to fight your cancer and get stronger before surgery.

Palliative Care

Chemotherapy can also be used in palliative care, providing relief from uncomfortable ovarian cancer symptoms. Ovarian cancer often causes fluid buildup in the abdomen, known as ascites. Your doctor may place a thin tube in your abdomen, known as a catheter. This helps drain fluid to relieve uncomfortable symptoms like abdominal pain and bloating.

A port is placed on your skin, providing access to the catheter. Chemotherapy can also be delivered through the port and directly into your abdomen — known as intraperitoneal (IP) chemotherapy — to slow the buildup of fluid.

Common Chemotherapy Regimens

The chemotherapy regimen your oncologist will prescribe depends on the type of ovarian cancer you have. Treatments are done in cycles or rounds — during each cycle, you’ll receive chemotherapy and then have a rest period.

Treating Epithelial Ovarian Cancer

If you have epithelial ovarian cancer, you’ll likely be treated with a combination of two chemotherapy drugs. The first is a platinum-based drug, typically carboplatin or cisplatin. The second is a taxane drug like docetaxel or paclitaxel. This combination treatment is given intravenously in a vein in your arm.

Treatments are typically given every three to four weeks, according to the American Cancer Society. The number of cycles you’ll receive depends on your cancer stage:

• Stage 1 — Three to six cycles following surgery
• Stage 2 — At least six cycles following surgery
• Stage 3 — Six cycles following surgery, or three cycles before surgery and at least three after
• Stage 4 — Three cycles before surgery and at least three cycles after

If you have stage 3 ovarian cancer and have had surgery to remove as much of the tumor as possible, you may receive IP chemotherapy along with intravenous chemotherapy. The drugs paclitaxel and cisplatin are injected into the port and delivered directly to the tumor.

Treating Germ Cell and Stromal Cell Tumors

If you have a germ cell tumor, you’ll be treated with a different combination of chemotherapy drugs. The most common is known as BEP, consisting of bleomycin, etoposide, and cisplatin (the P stands for the brand name Platinol).

One type of germ cell tumor — known as a dysgerminoma — is very sensitive to chemotherapy. If you have this type, you may instead be treated with etoposide and carboplatin. In general, germ cell tumors are treated with at least three cycles of chemotherapy, regardless of stage and type.

Stromal cell tumors typically aren’t treated with chemotherapy. If your doctor decides it’s a good option for you, you may receive BEP or a combination of paclitaxel and carboplatin.

Chemotherapy Side Effects

Chemotherapy is a powerful treatment for fighting cancer because it targets rapidly growing cancer cells. One downside to this approach is that chemotherapy drugs can’t tell the difference between cancer and normal, healthy cells. Many of the side effects you’ll experience are because your healthy cells become damaged.

Common side effects of chemotherapy you may experience include:

• Hair loss
• Loss of appetite
• Nausea
• Vomiting
• Rashes on your hands and feet

Chemotherapy drugs can also affect your bone marrow (the soft spongy tissue inside your bones). Since bone marrow produces your body’s new blood cells, you may develop one or more of the following types of low blood cell counts:

• Anemia (low red blood cell count), which can cause fatigue, an irregular heartbeat, and shortness of breath
• Leukopenia (low white blood cell count), which raises your risk of infections and can lead to the development of mouth sores
• Thrombocytopenia (low platelet count), which can cause you to bruise or bleed more often or more easily than normal

Other long-term or even permanent side effects of ovarian cancer chemotherapy drugs include:

• Neuropathy (nerve damage), causing numbness, tingling, or pain in your hands and feet
• Kidney damage
• Hearing loss from nerve damage in the ears
• Infertility
• Early menopause

If you’re concerned about side effects, your doctor can talk with you about your risks and how they can be managed.

Report Side Effects to Your Cancer Care Team

When going through chemotherapy and cancer treatment in general, your cancer care team is there to support you. Be sure to let your cancer care nurse know about any side effects you’re experiencing. Chemotherapy is an intense treatment, and your comfort is important. Your team can offer tips and supportive treatments to help you feel your best as you fight your ovarian cancer and heal.

Talk With Others Who Understand

On MyOvarianCancerTeam, the social network for people with ovarian cancer and their loved ones, more than 6,400 members come together to ask questions, give advice, and share their experiences with others who understand life with ovarian cancer.

Have you gone through chemotherapy treatment for ovarian cancer? Do you have any tips for ways to manage side effects or feel more comfortable during chemo? Share your story in the comments below, or start a conversation by posting on your Activities page.