People often want to know what symptoms to expect when they have cancer that is no longer responding to treatment. The symptoms that you experience will vary from person to person, but some might be uncomfortable.
One of the key people to support your individual needs will be a community palliative care nurse or hospice nurse, acting as part of the symptom control treatment team. Their goal is to help you feel as well as you possibly can through improving and maintaining your quality of life. You can request a referral to a palliative care or hospice nurse at any stage of your illness from your GP or hospital team, whenever you feel you might need some extra support.
The following are some common symptoms that women with ovarian cancer experience. We have also included some strategies to help you manage these.
- Abdominal ascites
- Loss of appetite
- Nausea (feeling sick) and vomiting
- Shortness of breath
- Bowel obstruction
Fatigue is not just a question of feeling quite tired, but actually feeling exhausted most of the time. This may be due to a reversible cause such as anaemia (low levels of health red blood cells) or low magnesium, but is more often due to treatments (such as chemotherapy or radiotherapy) or most commonly, the illness itself, as well as the draining emotions you are experiencing.
Although it may sound strange, a beneficial approach to managing fatigue is gentle exercise, and your Clinical Nurse Specialist (CNS) should be able to direct you to a 'fatigue programme' which can guide you through the right kind of activity, as well as other ideas on how to adapt and cope with your changing energy levels.
Experiencing fatigue can mean you have to adjust your lifestyle or limit your activities which can be frustrating. Be kind to yourself as you find a pace you can cope with. An occupational therapist can give you tips to help during this time as well as aids that will help you conserve your energy.
There are also certain medications that act as stimulants and may help your energy and alertness. You can speak to your CNS about what might help.
This is a collection of fluid in the abdominal cavity (tummy area) which is caused by the cancer and can result in abdominal swelling, shortness of breath, indigestion, feeling or being sick, reduced appetite and worsened fatigue. You can have an ultrasound scan to confirm that any abdominal swelling is caused by fluid (ascites) and this fluid can usually be easily drained using a procedure called paracentesis.
Paracentesis can often be done as a day case either in hospital or some hospices. It involves a local anaesthetic and insertion of a very thin soft tube into the abdomen. This tube will be connected to a bag into which the ascites fluid will slowly drain over a few hours - the tube is then removed. This drainage can be repeated if the fluid collects again. Your doctor will discuss with you the right time for you to have this procedure.
If the fluid is collecting again quickly, an indwelling drain may be a suitable option for you. This is a clever semi-permanent tube that enables you to manage your excess ascites at home. This means that you can drain small amounts of fluid on a more regular basis.
Some women have loculated ascites. This is when the fluid is sectioned off into small pockets of fluid and drainage might not be possible. You will be given advice if this occurs by your GP and CNS and if you are finding this painful then they will be able to help with painkillers.
This leads to weight loss and reduced energy. You can help by eating high calorie snacks (smoothies are ideal) little and often to avoid feeling bloated. If eating is really difficult you can try nutritious supplement drinks which your GP or CNS can recommend. Try not to get obsessed with your weight as this can fluctuate throughout your illness with fluid retention (see ascites, above). If your appetite is really poor and you are very tired, a short course of steroids can be recommended to enhance your appetite and energy.
You can also ask to see a dietician who can advise on the best way to keep up your food intake when your appetite is small.
This is also known as heartburn or reflux and is due to the stomach acid coming back up the gullet (the tube which food passes from the mouth to the stomach). It can feel painful or uncomfortable and will often be the cause of a cough. Indigestion can be caused by anxiety, steroids, anti-inflammatory drugs, ascites and oral thrush (a fungal infection in the gullet or mouth). If thrush has been ruled out, you can help by trialling over the counter antacids such as Gaviscon, eating little and often, ensuring your evening meal is more than two hours before going to bed, sitting upright when eating, and avoiding hot drinks, alcohol and foods that are acidic or spicy. If these measures do not work, your GP or palliative care nurse can prescribe medication to reduce stomach acid.
These symptoms can be caused by ascites, indigestion, constipation and medication (strong pain killers, antibiotics, chemotherapy) and can lead to loss of appetite and weakness if not eased quickly. Eating small, easily digestible meals such as soups can help, as well as trying to avoid the smells of food. Acupuncture, aromatherapy, use of sea sickness bands and crunching ice can also reduce nausea, and there are many medications which help to alleviate these symptoms, depending on the cause. These are definitely worth trying, so speak to your CNS or GP about what might help you.
If you are vomiting frequently and unable to keep food and drink down it is really important to alert your CNS or GP as you can quickly become dehydrated and quite unwell without treatment.
Managing this symptom depends upon the cause of your breathing problems. For instance, it may be due to ascites fluid pushing up the diaphragm, which can be eased by draining the fluid, or anaemia (low red blood cell count) which can be helped by a transfusion. Deep breathing, relaxation and pacing yourself can also help as anxiety and breathlessness are closely linked. Sitting near a fan or an open window will also reduce the sensation of feeling breathless. Your local hospice may have clinics to help with breathlessness. Low dose oral morphine syrup or medicine for anxiety will help with your breathing and you will feel calmer. Tell your GP or CNS if your breathing is getting worse. It is also important to contact your medical team if your shortness of breath is associated with a new cough or chest pain as this may be due to a chest infection, fluid around the lung or a blood clot. All these complications can be treated.
This is an excess of fluid in body tissues cause by a blockage of the lymph system (which clears excess body fluid). In women with ovarian cancer this fluid is most likely to collect in your legs or possibly your pelvic area. Lymphoedema can cause swollen heavy legs, reduced mobility and changes in your appearance which may be difficult to cope with. Elevating your legs, gentle exervise, good skin care and eating a high protein diet (including lots of fish, meat, eggs and cheese) can help, and your CNS can give you practical advice on how best to cope. If the lymphoedema worsens you can be referred to a lymphoedema specialist practitioner who may suggest massage to help drainage, together with support stockings and bandages.
This can occur in any area affected by the cancer. For mild pain you can try paracetamol, a warm bath, a heat pack or relaxation techniques including specific movements or stretches. If the pain becomes more sever you should monitor where it is in your body, when it occurs and whether anything makes the pain worse or better. This will help your clinical team prescribe the best pain relief. For more severe pain, a stronger pain killer will be suggested such as morphine. Make sure you have medication to avoid constipation and sickness with this type of medication. Strong painkillers come in a variety of ways and you can discuss the best one for you with your CNS or GP.
Many people are frightened of strong pain killers such as morphone or worry about becoming addicted or immune to the effectiveness of the drug. But the dosage can be adapted to manage your pain and can be increased or decreased - and there are no additional problems when morphone is used in the right dose for the pain. In the right dose morphone is safe and really effective and being free of pain means you will have more energy and can do so much more.
This can mean different things to different people but essentially it is a reduction in how regularly you open your bowels, or a change in the consistency of your stool (ie the stool is hard, requires lots of straining or is painful to pass). Constipation can be caused by the cancer narrowing the bowel, ascites or some medications. Not drinking enough water, a poor diet and inactivity can also contribute to constipation. It is very important that you take an active role in managing your bowels with regular drinks, fruit and vegetables and gentle exervise such as a short walk.
Most importantly if you do become constipated and the above measures do not help, then you must seek advice from your CNS. Laxatives can be very effective in the right dose and should not cause loss of control or explosive bowel actions. If the oral route is not successful then suppositories or an enema (an injection of fluid or gas into the lower bowel by way of the rectum) administerd by yourself or a nurse may be needed. The important message is to keep bowels moving and if they stop seek medical advice sooner rather than later.
If constipation develops and is associated with symptoms of nausea, vomiting, abdominal pain or a swollen abdomen this could indicate that the bowel is blocked. This can be caused by something on the inside of the bowel blocking it (ie cancer or faeces), something compressing it from the outside (ie cancer or ascites fluid) or irritation to the nerves of the bowels causing them to 'go on strike'. Often the obstruction can be eased by resting the bowel, giving steroids, draining the ascites or using laxatives. Your palliative care or symptom control team will be able to explore medication to reduce any abdominal pain or nausea associated with the blockage. These medicines may ned to be given by injection or a pump rather than by mouth to ensure they are absorbed properly. A nastrogastric tube may also be used to alleviate nausea and vomiting. This is a tube that is inserted from the nose into the stomach and allows fluid to drain away. You can say no to this if you do not want one - it is easily removed once the bowel starts working again.
Sometimes the bowel can move in and out of obstruction. If this does occur, it is important to actively manage your bowels and reduce the likelihood of constipation and obstruction with lots of fluid and a soft, easily digestible diet and the right laxatives to keep the motion soft and the bowel open.
Sometimes going to a hospice or hospital can be really helpful to get this condition under control.
If your episode of bowel obstruction doesn't clear with the measures discussed in this secion, and there is a single clear blockage, you may be offered surgery to remove a part of the bowel. This is often a difficult decision and not taken lightly. Read more about surgical options for bowel obstruction.
Controlling difficult symptoms is possible with the right palliative support and will really improve your quality of life, helping you to make the most of every moment.
Find out more
- Living with your condition
- Hospice and palliative care
- Thinking about the future - advance care planning
- Relationships, sex and intimacy
The information on this page is approved by the Information Standard scheme to ensure that it provides accurate and high-quality information.
Last reviewed: May 2017
Next review: April 2020