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.
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.
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:
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
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.
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:
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.
Sometimes fluid can build up in the body.
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.
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.
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.
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.