Chemotherapy for ovarian cancer

• A quick guide to what's on this page
• Chemotherapy into a vein
• Chemotherapy into the abdomen
• Drugs used for ovarian cancer
• Drugs used if ovarian cancer comes back
• Monitoring treatment
• CA125 blood test
• Scans
• Diet supplements and chemotherapy
• More information about chemotherapy

Chemotherapy for ovarian cancer is most often given through a vein into the bloodstream. You are most likely to be offered chemotherapy after your surgery if your cancer is a high grade stage 1 or above. You can also have chemotherapy for ovarian cancer that has come back (recurred) after you were first treated.

Some research has looked at giving chemotherapy into the abdomen for ovarian cancer. This is known as intraperitoneal chemotherapy. The doctor or nurse gives the chemotherapy through a tube inserted through the abdominal wall.

A review of all the studies that looked at intraperitoneal chemotherapy (IP) compared to intravenous chemotherapy found that IP chemotherapy helps a small number of women to live longer. But giving chemotherapy in this way also causes side effects, such as pain in the abdomen, blockage of the tube used to give the chemotherapy, digestive problems and infection. So, this way of giving chemotherapy is not commonly used and is only done as part of research trials. The review is on the Cochrane Collaboration website.

A number of different treatment plans are used. When you are first diagnosed, you usually have chemotherapy using

• Carboplatin alone OR
• Paclitaxel (Taxol) and carboplatin

after surgery for ovarian cancer. There is information about treatment with these drugs in this section of CancerHelp UK.

A great deal of research is being done into chemotherapy for ovarian cancer to see which are the most effective drugs for

• stopping ovarian cancer from coming back after surgery
• shrinking or slowing down advanced ovarian cancer

You may be offered treatment in a clinical trial to find better ways of stopping the cancer coming back or shrinking it.  For more information about clinical trials in general, and ovarian cancer trials specifically, visit our searchable database on clinical trials in the UK.

If ovarian cancer comes back after the initial surgery and chemotherapy, different chemotherapy drugs may be used from the first chemotherapy that you had. In May 2005 NICE reviewed the newer treatment options for ovarian cancer that has come back. They advise that you may have

• More platinum drug treatment (carboplatin or cisplatin), with paclitaxel (Taxol)
• Paclitaxel (Taxol) on its own
• Liposomal doxorubicin (Caelyx or Doxil)
• Topotecan (Hycamtin)

Other drugs such as etoposide or gemcitabine may also be used, either alone or in combination. The treatment cannot usually cure ovarian cancer that has come back but can help to control it for months or sometimes years. There is information about treatment with these drugs in this section of CancerHelp UK. Some small studies have shown that a hormonal therapy called letrozole can stop the growth of ovarian cancer for some time in women with oestrogen receptor positive ovarian cancers. Larger studies are needed though to find out how helpful letrozole is in treating ovarian cancer that has come back.

If ovarian cancer spreads to other parts of the body this is called advanced or metastatic ovarian cancer and there is information about treating advanced ovarian cancer in this section.

There are various ways your doctor can find out how well your chemotherapy has worked. You may have

• CA125 blood tests
• CT scans or ultrasound scans

CA125 is a protein made by some ovarian cancer cells. It circulates in the blood stream. Your doctor will have measured your CA125 level before you started your treatment. If you had high levels, your doctor will expect the level to fall as the cancer cells are killed by the chemotherapy drugs. So you may have CA125 blood tests before each chemotherapy treatment or when your course of treatments is finished. This can show how well the treatment is working.

Note: Not all women with ovarian cancer have raised CA125 levels. If you did not have raised CA125 when you were first diagnosed, this blood test cannot be used to monitor your treatment or during follow up.

If you had a tumour that could be seen and measured on a scan, your doctor may want to repeat the scan after your treatment to see if the tumour has shrunk.

If your cancer can still be found after your chemotherapy has finished, more of the same chemotherapy is unlikely to get rid of it completely. It will almost certainly grow back, although it could be a long time before it begins to cause any symptoms. It is not clear whether having more treatment immediately is helpful. So you may be monitored by your specialist for the time being. Or you may be offered experimental treatment as part of a clinical trial. This might be a new type of chemotherapy into a vein, or intraperitoneal chemotherapy, or other types of experimental treatment. If you have symptoms, external radiotherapy may be used to shrink tumours and reduce the symptoms.

There is more about controlling symptoms of ovarian cancer in this section of CancerHelp UK.

Doctors are worried about people with cancer taking dietary supplements and herbal medications. They don't know what people with cancer are buying over the counter or getting from alternative and complementary therapy practitioners. We don't know enough scientifically about how some supplements may interact with chemo and they may harm you.

You should talk to your specialist about any other tablets or medicines you take while you are on active treatment. It may not be a good idea to take anything that claims to boost your immune system, for instance.

There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

For more about chemotherapy look at the chemotherapy section in CancerHelp UK. It explains the treatment in detail including

• What it involves
• How chemotherapy is planned and given
• General side effects
• Living with chemotherapy

If you would like more information about chemotherapy, contact one of the cancer information organisations. They would be happy to help.