Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells.

Chemotherapy is often given after surgery if it was not possible to remove all the cancer at the operation, or if the surgeon feels there is a high risk of tiny (microscopic) cancer cells having been left behind. This is known as adjuvant chemotherapy. About 4–6 sessions of chemotherapy are usually given, which lasts 3–6 months.

Before the surgery, if the surgeon feels that the tumour will be difficult to remove, chemotherapy may be given for a few months before the operation. This aims to shrink the cancer and make the operation easier and more effective. It is known as neo-adjuvant chemotherapy.

If the cancer has spread to the liver, or beyond the abdomen, chemotherapy is the main treatment used. Chemotherapy is also used if the cancer comes back after surgery.

Chemotherapy drugs are sometimes given as tablets or, more usually, by injection into a vein (intravenously).

The most commonly used drugs to treat ovarian cancer in the first instance are carboplatin or cisplatin, which may be given with Taxol® (paclitaxel). Other drugs that may be used are gemcitabine, topotecan, doxorubicin and liposomal doxorubicin (Caelyx®).

Intravenous chemotherapy is given as a session of treatment, usually over several hours, but sometimes over a few days. This is followed by a rest period of a few weeks, which allows your body to recover from any side effects of the treatment. Together, the treatment and the rest period is known as a cycle of chemotherapy. The number of cycles you have will depend on the type of cancer you have and how well the chemotherapy seems to be working.

Chemotherapy can often be given to you as an out-patient but it will sometimes mean spending a few days in hospital.

Chemotherapy may also be given directly into the abdomen through a small tube. This is known as intraperitoneal chemotherapy and is only carried out as part of cancer research trials for the treatment of stage 3 ovarian cancer. It is given alongside intravenous chemotherapy. The trials are trying to find out whether giving intraperitoneal chemotherapy as well as intravenous chemotherapy is better for ovarian cancer than intravenous chemotherapy alone. Some trials seem to show that it may increase survival but it can also cause unpleasant side effects. Your doctor can discuss whether intraperitoneal chemotherapy may be an appropriate treatment for you.

Our section on chemotherapy discusses the treatment and its side effects in more detail. Information about individual drugs and their particular side effects are also available.

Chemotherapy can cause unpleasant side effects, but any side effects that occur can often be well controlled with medicines.

Lowered production of blood cells

While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal cells in your blood. When these cells are reduced, you are more likely to get an infection and you may tire easily. During chemotherapy, if you have any signs of infection you will be given antibiotics. Less commonly, people may need a blood transfusion if they become anaemic due to the chemotherapy.

Nausea and vomiting

Some of the chemotherapy drugs used to treat cancer of the ovary may cause nausea and vomiting. There are now very effective anti-sickness drugs (anti-emetics) to prevent or reduce nausea and vomiting. Your doctor will prescribe these for you.

Sore mouth and loss of appetite

Some chemotherapy drugs can make your mouth sore and cause small mouth ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.

Hair loss

Unfortunately, some chemotherapy drugs used to treat ovarian cancer can make your hair fall out. You can ask your doctor if the drugs you are taking are likely to cause hair loss or other specific side effects. People who lose their hair often cover up by wearing wigs, bandanas, hats or scarves. Most patients are entitled to a free wig from the National Health Service. Your doctor or nurse will be able to arrange for a wig specialist to visit you. If your hair does fall out, it will grow back over a period of 3–6 months, once the chemotherapy has finished.

Numbness or tingling in hands or feet

This is due to the effect of some chemotherapy drugs on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. The problem usually improves slowly a few months after treatment is over, but for some people it can be permanent.

Although they may be hard to bear at the time, most of these side effects will disappear once your treatment is over.

Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Many women are nervous of having chemotherapy, because of the possible side effects, and ask what would happen if they did not have it.

Early-stage ovarian cancer

In women with early-stage ovarian cancer, the chemotherapy is given in addition to surgery and aims to reduce the chance of the cancer coming back. It does this by killing any tiny groups of cancer cells that may be left behind after an operation, which are too small to be picked up by any scans or medical tests.

Chemotherapy cannot guarantee that the cancer will not come back, but it can reduce the chance that it will recur. The risk of the cancer coming back varies according to each woman’s situation. Your doctor can usually give you an idea of whether your cancer is likely to come back or not. They can also give you information about the likely side effects of chemotherapy in your situation.

If the chance of your cancer coming back is small, chemotherapy may only slightly reduce the risk of the cancer coming back. The benefit of the chemotherapy would be small and the chance of doing well without the treatment would still be good. If the risk of the cancer coming back is high, chemotherapy may greatly reduce the chance of recurrence, and increase the chance of cure.

It is important for each woman to talk to her specialist about:

• her individual chance of the cancer coming back
• the chances of a cure without the chemotherapy
• how much the chemotherapy is likely to improve things.

This information can help each woman to decide whether the benefit of the chemotherapy is worth the side effects of the treatment.

Advanced ovarian cancer

When the cancer has spread to other parts of the body, such as the abdomen or pelvis, the aim of chemotherapy is to try and shrink the cancer. This can reduce symptoms, maintain a good quality of life and sometimes prolong life. For many women the chemotherapy will shrink the cancer. However, for some women the chemotherapy will not have any effect on the cancer and they will have the side effects of the treatment without any benefit. The fitter a woman is, the more likely she is to benefit and the less likely to have side effects.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you want to have chemotherapy. If you choose not to have chemotherapy, you can still be given medicines to control any symptoms that you have. This is known as supportive care (or palliative care).