We answer your questions about treatment for ovarian cancer.
- Who will be looking after me?
- Making decisions about your treatment
- Treatment: surgery, chemotherapy, other drugs
- Clinical trials
You will be looked after by a ‘multi-disciplinary team’ (MDT). This team will involve all of the people caring for you, such as your oncologist and clinical nurse specialist (CNS).
The MDT meets up regularly to discuss your care and treatment, review test results and recommend treatment plans.
Who is your key worker and how do you find them?
The main person looking after your care and treatment. This is usually a CNS. You should be given contact details for your key worker so you can get in touch with questions or problems.
Who’s who in the team looking after you
The main hospital staff you will come across will be:
- Gynae-oncology clinical nurse specialist (CNS): A senior nurse who has had extra training to look after women with gynaecological cancers, such as ovarian cancer. In some areas a gynae-oncology CNS may not be available, so you’ll be cared for by a gynaecology nurse. A CNS should help you navigate your way throughout the healthcare system from your diagnosis onwards. Your relationship with them can transform your care.
Watch this video interview with Debbie Fitzgerald, a CNS, to get a better idea of how your CNS will support you:
- Chemotherapy nurse: Depending on your treatment plan, your chemotherapy nurse will help you through your chemotherapy treatment and any side effects you may experience.
- Oncologist: An oncologist is a doctor who specialises in cancer. Depending on your treatment plan you will meet. A surgeon who is in charge of your operation or surgery. Surgeons are sometimes referred to as gynaecological oncologists. An oncologist who organises chemotherapy and other treatments. Oncologists are sometimes referred to as clinical or medical oncologists.
Some women have detailed discussions about treatment choices, while others prefer to ask the oncologist to recommend an option. You may find yourself caught up in a medical whirlwind, talking with health professionals about what happens next. Take a moment and think about what you want, making sure you have the information you need to make any decisions or choices put to you.
Whatever your feelings it can be useful to share your thoughts about the following with your oncologist or CNS:
- How much do you want to know?
- When do you want to know it?
- How do you want to make your decisions? Do you like time to absorb information, or need to talk it through with others first?
- Is the expectation / intention of the treatment that you will achieve a cure, control of the cancer or comfort in terms of managing symptoms?
The key decisions
These are likely to be about treatment options, including the timing of surgery and/or types and timing of chemotherapy. Asking some of the following questions may help you decide what you want to do:
- Where can I be treated?
- What treatment options are available?
- What are the benefits of a particular treatment and what is the evidence that it is effective?
- Are there potential side effects?
- Which side effects are common and which are less likely?
- How long are these side effects expected to last?
- What might help to reduce, control or recover from these side effects?
- How is any treatment likely to affect my life and health in general?
- Will I be able to go on holiday or return to work?
- What are the risks involved in having the treatment now and in the long term?
- How might it affect me physically and sexually?
- Are there clinical trials available?
Make sure you ask for help
Your CNS has a special role to play to make sure your views are represented so let them know how you feel, and what is affecting your decision making. This may include things that are going on outside the hospital, in your home or work life.
It might help to take along a friend or family member and ask them to write down the answers to questions you ask. Health professionals might slip into medical jargon – just ask them to explain it another way.
If you wish to get a second opinion to help you with your treatment decisions, your CNS should be able to tell you how to go about it.
In England, you can find and compare NHS cancer services near you at MyCancerTreatment.nhs.uk. The reports available on My Cancer Treatment provide information to help you decide where to go for your cancer treatment, or seek a second opinion. Type your postcode, cancer type or hospital into the Find Your Treatment search box.
It is common to treat ovarian cancer with surgery to remove as much of the cancer as possible (sometimes called ‘debulking’) and chemotherapy (drugs that aim to kill cancer cells).
Occasionally, if the cancer is very early stage, it may be treated by surgery alone. In some cases, surgery is considered too risky, in which case chemotherapy will act as your main treatment.
Your oncologist should discuss what treatments are available, based on your individual clinical needs and what is available locally, and discuss your personal preferences.
You may have surgery before starting chemotherapy treatment or your oncologist may recommend starting chemotherapy first as this can help shrink your cancer and make it easier to remove during surgery. In this case, your chemotherapy will continue once you have recovered from surgery.
For some rarer forms of ovarian cancer or primary peritoneal cancer your treatment may also include radiotherapy.
Before your surgery
You will be examined and given a series of tests to check that you are fit enough to have surgery. Your surgeon will explain what will happen during the operation. It is often difficult for the surgeon to know exactly how much surgery is needed as this will depend on the size and type of the cancer so they may discuss different possibilities and options with you.
In some cases, in order to ensure that all of the cancer is removed, surgery may include removal of a part of the bowel. This may result in the creation of a stoma.
If you find the prospect of surgery frightening you are not alone. Be sure to talk to the surgeon and CNS about your fears. A lot of the fear can be reduced if you are given the facts about what to expect.
If you have any questions or concerns about your surgery, don’t be afraid to raise them. If you think of questions later you can also ask your CNS or key worker about anything you didn’t understand.
After your surgery
Surgery puts your body through a great deal of stress, so you’ll need to allow time to heal and recover. You should not do any strenuous activity, work (including heavy housework), or lift anything heavy for at least three months after your operation.
It is usual to feel tired after your surgery as your body is working hard to recover. You may experience extreme tiredness or fatigue, which can occur very suddenly. Try to build up activity gradually to help you deal with this.
If you are in pain, you will be given medication to ensure you are as comfortable as possible.
What chemotherapy will you have?
Platinum based chemotherapy is widely used to treat ovarian cancer. Most commonly carboplatin is used, and sometimes cisplatin or paclitaxel (also known as Taxol®)
It is standard practise to give chemotherapy once every three weeks for six cycles.
However, giving smaller weekly doses over an 18 week period is becoming more common, as there appears to be some clinical benefit and increased tolerance.
What happens when you have treatment?
Most women go to the chemotherapy unit at their local hospital. You will usually spend most of the day at the hospital so take a relative or friend to keep you company, or a couple of magazines and a good book to help pass the time.
At the hospital a number of blood samples will be taken for testing before each cycle of chemotherapy. These test different parts of the body to check you are healthy enough to receive treatment. Once your blood test results are available, your treatment can start.
The chemotherapy nurse will place a needle into one of the veins on your hand or arm and attach a drip so that the drugs can enter your blood stream. This might feel a bit uncomfortable as the drip goes in.
If you are having carboplatin and paclitaxel then the nurse will give you the paclitaxel first, followed by the carboplatin.
Will you have any side effects?
Many women experience mild side effects that can be easily treated; it is rare for side effects to be severe. The side effects do not usually start straight away and most people are able to drive home from hospital.
Many women find that as treatment continues they become used to the effects and can plan around them. If you are unlucky and are badly affected, do not hesitate to get in touch with your hospital as they will be able to help you.
Chemotherapy reduces the number of white cells in your blood, which means your ability to fight infections may be affected. You’ll need to contact the hospital immediately if you get a temperature or feel ill in the days or weeks following treatment. There is no need to avoid family, friends and other members of the public, but you should avoid people with serious infections.
Your hospital should give you a 24 hour helpline number to ring if you are feeling ill at any time during your chemotherapy and in the weeks after treatment.
Common side effects of chemotherapy can include:
- Tiredness and fatigue: most women feel very tired during chemotherapy so make sure you plan time to recover your energy.
- Hair loss: paclitaxel usually causes temporary hair loss, which will usually start two to four weeks after treatment begins. You may be offered a cold cap to help minimise hair loss. Cold caps can be uncomfortable and treatment takes longer, however some women find they work really well. Your hospital may also offer a free wig service. Ask your CNS for more details about cold caps and wig services.
- Feeling or being sick: you will be given anti-sickness medication to take home. If you are sick you need to contact your chemotherapy team and they will change your prescription.
- Tingling or numbness in hands and/or feet: chemotherapy can affect your nerves, which may cause your feet or hands to tingle or feel numb.
Depending on individual circumstances such as the type of tumour, whether surgery is possible and where you live you may be able to access drugs that are not approved for routine use on the NHS. In England, access is made possible by the Cancer Drugs Fund (CDF), which runs until 2016. Through the CDF in England, a drug called bevacizumab (Avastin) is available to some women with advanced stage ovarian cancer (stage 3C/4) if you meet the criteria. Access outside England may not be as straight forward. All applications for ‘non-standard’ drugs have to be made by your oncologist, so ask him/her what is possible.
Clinical trials are research studies that investigate potential new treatments and compare them to the current standard treatments. Often studies are randomised, so you will not know whether you are receiving the new or standard treatment. However research has shown that taking part in a trial can be beneficial, even if you do not have the drug/procedure being tested.
There is a strict criteria for joining clinical trials but you may be eligible. Your oncologist should know what is possible, but sometimes you may need to ask them specifically.
You might want to ask about:
- the location and size of the trial
- the evidence that this new treatment might be effective
- the possible risks and benefits of taking part
- what taking part would involve compared to not taking part
Remember, if you are suitable, it is your decision whether or not to join a clinical trial.
Find out more
This content is primarily taken from What happens next?
Our expert guide answers your questions following a diagnosis, providing information on everything from treatment to clinical trials, and advice on where to find support in the months ahead.
Target Ovarian Cancer is an accredited member of the Information Standard Scheme. The information on this page has been developed following the schemes core principles to ensure that it is accurate and high-quality information.
Last reviewed: August 2014
Next review: Currently under review