Managing side effects of ovarian cancer

Friday 1 April, 2016

Download PDF Order FREE booklet

On this page: Fatigue | Menopause | Infertility | Bowel changes | Fluid build-up | Lymphoedema | Feeling low or depressed | Key points


Treatment will cause some physical and emotional changes. Some women experience many side effects, while others have few.

Most side effects go away in time, but some may be permanent. This chapter includes ways to reduce or manage the discomfort that side effects may cause.

Fatigue

It is common to feel very tired and lacking energy during or after treatment. Fatigue for people with cancer is different from tiredness as it doesn’t always go away with rest or sleep.

Most women who have chemotherapy start treatment before they have had time to fully recover from their operation. Travelling to and from hospitals and clinics for treatment can be tiring. Fatigue may continue for a while after treatment has finished. For some women, it may take up to 1–2 years to feel well again.

Tips for managing fatigue
  • Set small manageable goals for the day and rest before you get too tired.
  • Ask for and accept offers of help with tasks such as cleaning and shopping.
  • Eat nutritious food to keep your energy levels up.
  • Plan to exercise, with your doctor’s approval. Even a walk around the block can boost your energy levels.

Menopause

If you were still having periods before surgery, having your ovaries removed will mean you no longer produce the hormones oestrogen and progesterone and you will stop menstruating (having periods). This is called menopause. For most women, menopause is a natural and gradual process that starts between the ages of 45 and 55.

Symptoms of menopause can include hot flushes, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. Sudden menopause causes more severe symptoms than natural menopause, because the body has not had time to get used to a gradual decrease in the levels of oestrogen and progesterone.

The following tips may help you manage the symptoms of menopause:

  • Ask your doctor about suitable moisturisers to relieve vaginal dryness. You may need to avoid products containing oestrogen.
  • Use extra lubrication to make intercourse more comfortable. To reduce irritation, choose a water- or silicone-based gel without perfumes or colouring.
  • Talk to your gynaecological oncologist about the benefits and risks of hormone replacement therapy (HRT). HRT containing oestrogen may increase the risk of some diseases, such as breast cancer. If you were already on HRT when the cancer was diagnosed, you will need to weigh up the risks of continuing it.
  • Talk to your doctor or call Cancer Council 13 11 20 for details about medicine to relieve the symptoms of menopause.

Infertility

Treatments that affect the reproductive organs, such as hysterectomy and radiotherapy, will cause infertility. This means it is no longer possible to become pregnant.

Before treatment starts, ask your doctor or fertility specialist about what options are available to you. Women under 40 who have stage I ovarian cancer may be able to have surgery that leaves their uterus and one ovary in place.

Many women experience a sense of loss when told that their reproductive organs will be removed or will no longer function. You may feel extremely upset if you are no longer able to have children, and may worry about the impact of this on your relationship or future relationships. Even if your family is complete or you were not planning to have children, you may feel some distress.

If you have a partner, talk to them about your feelings. Speaking to a counsellor or gynaecological oncology nurse may also help.

Fore more information see Fertility and Cancer or call Cancer Council 13 11 20.

"My advice to other women is: be kind to yourself, this is really tough. Don’t feel like you have to be strong all the time. It is okay to be sad at times. You don’t always have to ‘keep it together’." – Patricia

Bowel changes

After surgery or during chemotherapy or radiotherapy, some women have bowel problems, such as diarrhoea, constipation or cramps. Pain relief medicines may also make you feel constipated. Diarrhoea and constipation can occur for some time, but often these bowel changes are temporary.

Ask your doctor, nurse or dietitian for advice about eating and drinking, and see the tips below for suggestions on preventing or relieving these side effects.

Tips for managing bowel changes
  • Prevent or manage constipation by eating more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables.
  • Drink plenty of liquids to replace fluids lost through diarrhoea or to help soften stools if you are constipated. Warm and hot drinks work well, but avoid alcohol and caffeinated drinks.
  • Avoid fried, spicy or greasy foods, which can cause pain and make diarrhoea and constipation worse.
  • Ask your pharmacist or doctor about medicines to relieve symptoms of diarrhoea or constipation.
  • Eat small, frequent meals instead of three big ones.
  • Rest as much as possible as diarrhoea can be exhausting.
  • For more information see Nutrition and Cancer.
Treating a blockage in the bowel

Surgery for ovarian cancer sometimes causes the bowel to become blocked (bowel obstruction). A bowel obstruction can also occur if the cancer comes back. Because waste matter cannot pass through the bowel easily, symptoms may include feeling sick, vomiting, or abdominal discomfort and pain.

To relieve the symptoms, you may have a small tube (stent) put in to help keep the bowel open. The stent is inserted through the rectum using a flexible tube called an endoscope.

Occasionally, the blockage in the bowel is treated with a stoma. A stoma is a surgically created opening in the abdomen that allows faeces to leave the body. Part of the bowel is brought out through the opening and stitched onto the skin. A small bag is worn on the outside of the body to collect the waste. This is called a stoma bag or appliance. The stoma is usually temporary and is later reversed.

There are two types of stomas for a bowel obstruction:

  • colostomy – made from part of the colon (large bowel)
  • ileostomy – made from the ileum (part of the small bowel).

People often have many questions after a stoma. A specially trained stomal therapy nurse can show you how to look after the stoma. For more information, contact the Australian Association of Stomal Therapy Nurses, visit the website of the Australian Council of Stoma Associations, or call Cancer Council 13 11 20.

Fluid build-up

Sometimes fluid can build up in the body.

Ascites

This is when fluid collects in the abdomen. It causes swelling and pressure, which can be uncomfortable. A thin needle is inserted into the abdomen to drain the fluid and relieve discomfort. This is called paracentesis or ascitic tap.

Pleural effusion

For some women, fluid may build up in the area between the lung and the chest wall (pleural space), which can cause pain and breathlessness. The fluid can be drained using a procedure called thoracentesis or pleural tap. You will have a local anaesthetic and a needle will be inserted into the pleural space to drain the fluid.

Lymphoedema

If lymph nodes in the pelvic area have been removed during surgery (lymphadenectomy), lymph fluid may not drain properly from your legs. This causes the fluid to build up and the legs to swell, which is called lymphoedema. Radiotherapy to the area may also cause lymphoedema. It can occur at the time of treatment or months or years later.

Lymphoedema may make movement and some activities difficult. It is important to manage lymphoedema symptoms as soon as possible. Gentle exercise, compression stockings, and a type of massage called manual lymphatic drainage can all help to reduce the swelling.

A physiotherapist trained in lymphoedema management will be able to give you further advice.

To find a practitioner who specialises in the management of lymphoedema, visit the Australasian Lymphology Association website. Cancer Australia’s booklet Lymphoedema - what you need to know is also a good source of information.

Feeling low or depressed

It is natural to feel low or depressed after a cancer diagnosis, during treatment or when you are recovering. Some women feel sad or depressed because of the changes the cancer has caused. Others are frightened about the future.

There is a difference between feeling down and feeling depressed. If you have continued feelings of sadness, have trouble getting up in the morning, or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression.

Talk to your GP, as counselling or medication – even for a short time – may help. Some women are able to get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Your local Cancer Council may also run a counselling program. The organisation beyondblue has information about coping with depression and anxiety. Visit their website or call 1300 22 4636 to order a fact sheet.

Key points

  • Some women experience few side effects from treatment, while others have many. There are ways to reduce or manage the discomfort that side effects may cause.
  • The most common side effect is fatigue. This may continue for a while after treatment has finished. It may help to plan your activities so you can take regular rest breaks.
  • If your ovaries have been removed, you will go through menopause. This means that your periods will stop and it will no longer be possible to become pregnant.
  • If you are unable to have children as a result of treatment (infertility), you may feel very distressed. Talking about your feelings with your family, friends or a counsellor may be helpful.
  • After treatment, some women have bowel problems such as diarrhoea, cramps or constipation. Surgery can also cause the bowel to become blocked (bowel obstruction).
  • Sometimes fluid can build up in your abdomen, lungs or chest wall. Your medical team will drain the fluid.
  • If fluid build ups in the legs (lymphoedema), try gentle exercise, compression stockings or visit lymphoedema.org.au to find a specialised practitioner.
  • Some women feel sad or depressed during or after cancer treatment. Depression is when you are in a low mood for most of the time, or if your sadness lasts two weeks or more. If you are depressed, speak to your doctor for support and/or treatment.

Reviewed by: Prof Martin K Oehler, Director Gynaecological Oncology, Royal Adelaide Hospital, SA; Dr Serene Foo, Medical Oncologist, Mercy Hospital for Women, Austin Health and Epworth Eastern Hospitals, VIC; Maira Kentwell, Senior Genetic Counsellor and Manager, Department of Genetic Medicine and Familial Cancer Centre, The Royal Melbourne Hospital, VIC; Jane Lucas, Consumer; Cindy Morgan, Consumer; Shannon Philp, Nurse Practitioner – Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; Lea Rawlings, Perth Support Coordinator, Ovarian Cancer Australia; Deb Roffe, 13 11 20 Consultant, Cancer Council SA, SA; and Merran Williams, Clinical Nurse, Bloomhill Cancer Care, QLD.
Updated: 01 Apr, 2016