Side effects of treatment

Wednesday 30 June, 2010

Reviewed by: Dr Deborah Neesham, Gynaecological Oncologist, Royal Women's Hospital  

 On this page: Tiredness | Premature menopause | Feeling low or depressed | Bowel problems | Lymphoedema | Fluid build-up (ascites and pleural effusion)

It may take some time to recover from treatment. You will find that there are physical and emotional changes. This section discusses ways to cope with these changes.

Tiredness

Many women say that tiredness (or fatigue) is a major problem. This is not surprising, as most women start chemotherapy soon after their operation. Travelling to and from hospitals and clinics for treatment is also very tiring. If you start work again during the treatment and/or you have a home and family to care for, you will almost certainly find that you are very tired. If you are on your own and have to do everything yourself, tiredness will be a major problem.

‘I felt so guilty because I couldn't do much - it helped when I realised that this tiredness was normal.'


Your tiredness may continue for quite a while even after treatment has finished. Recovery is different for everyone. Many women feel ‘normal' within a couple of months of finishing chemotherapy; for others, it can take longer. It may help to talk with your family and friends about how you feel. Talk about how they can help you. You may need to plan your activities during the day so that you get regular periods of rest.

The Cancer Council has information on cancer treatment-related fatigue. Phone 13 11 20 for a copy.

Premature menopause

If you have had both your ovariesand your uterus removed, you will no longer have your periods and it will not be possible to become pregnant. If you have not been through menopause already, you may experience premature menopause. Because your ovaries have been removed, menopausal symptoms such as hot flushes, mood swings and vaginal dryness could be more sudden than they would be with a natural menopause. You will need to talk with your doctor about the need for hormone replacement therapy.

Hormone replacement therapy may be taken to control the symptoms of menopause. Oestrogen, a hormone normally produced by the ovaries, is taken to replace your natural oestrogen. Hormone replacement therapy can also reduce the risk of osteoporosis (thinning of the bones).

Using hormone replacement therapy for more than five years increases the risk of some diseases including some cancers. However it also decreases the risk of some other diseases and cancers.

You will need to discuss the issues with your doctor and weigh up the benefits and possible risks for yourself. There are also many useful books about menopause that may help you with your decisions.

Feeling low or depressed

It isn't uncommon to feel very low or depressed after a cancer diagnosis. Don't be too surprised if you do feel fed up and unhappy at certain times. It may help to think about why you feel like you do. Some people feel sad or depressed because of the changes that their cancer has caused. Others become very down because they are frightened about the future. Whatever it is that is causing you to feel down, you need to get support.

There is a difference between feeling down and sad for a while and feeling very depressed for long periods. Depression can go on for a long time if you don't get the right help. If you have had one or more of these signs for a few weeks or more you should see your GP:

  • feeling very sad and low most of the time
  • not being able to enjoy life as you usually do
  • having negative thoughts about yourself a lot of the time
  • changes in eating habits: eating much more or less than usual
  • weight gain or loss
  • feeling very tired a lot of the time
  • loss of concentration
  • loss of interest in sex
  • changes in sleeping habits: not being able to get to sleep, waking in the early hours of the morning or sleeping more than usual
  • feeling very anxious and often upset
  • feeling like you want to die or end your life.

If you have some of these signs or think you may be depressed, you must get some help. Be honest with your doctor about how bad you feel. This will help your doctor advise you about the type of support and care you need.

Bowel problems

It is common to have bowel problems after surgery for ovarian cancer. These can occur for some time after treatment. They may include diarrhoea, cramps or constipation. In particular, it is important not to become constipated. Talk with your doctor, nurse or dietitian about ways you can prevent constipation, and relieve any other symptoms.

Sometimes the bowel becomes blocked because of the surgery you have had. It may also occur because the cancer has come back. This blockage is called a bowel obstruction. If you have symptoms such as nausea (feeling sick), vomiting, abdominal discomfort or pain you should see your doctor or specialist as soon as possible. Quite often a bowel obstruction can be relieved with simple treatment in hospital. Occasionally you may need another operation to relieve your symptoms.

Lymphoedema

Lymphoedema is swelling of a part of the body, usually the arms or legs. It may occur after treatment for ovarian cancer if you have had some of the lymph nodes in your pelvis removed (lymph node dissection). Removal of the nodes may prevent normal draining of the fluid from the legs. As a result fluid can build up in one or both legs, causing swelling. This usually does not occur until some time after the operation.

It is not possible to predict whether you will have problems with lymphoedema. You should seek advice from your doctor or nurse. You may be given special stockings to wear after your operation.

For further information about lymphoedema contact the Cancer Council Helpline on 13 11 20.

Some hospitals have a specialist physiotherapist or nurse who can advise you on how you may be able to reduce your risk of lymphoedema. They can also help you manage if lymphoedema does occur in the future.

Fluid build-up (ascites)

Ascites is a collection of fluid in the abdomen. This can be uncomfortable because of swelling and pressure. If it becomes a problem there is a simple procedure to drain away the fluid and relieve discomfort. This is called a paracentesis. It is usually done on the hospital ward and you may need to stay overnight.

Sometimes fluid collects in the lining of the lungs. You may feel short of breath and have some pain. This fluid can be drained away to give you relief.

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