Treatment can cause physical and emotional changes. Some people experience many side effects, while others have few. Most side effects are temporary, but some may be permanent.
It is important to tell your treatment team about any new or ongoing side effects you have, as they will often be able to help you manage them.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for ovarian cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
It is common to feel very tired and lack 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 people who have chemotherapy will start treatment before they have had time to fully recover from their operation. Fatigue may continue for a while after chemotherapy has finished, but it is likely to gradually improve over time. In some cases, it may take a year or two to feel well again.
Surgery or radiation therapy for ovarian cancer may mean you are unable to conceive a child (infertility).
Before treatment starts, ask your doctor or a fertility specialist about what options are available to you. If you have stage 1 ovarian cancer and have not yet reached menopause, it may be possible to leave the uterus and one ovary in place (unilateral salpingo-oophorectomy).
Being told that your reproductive organs will be removed or will no longer work and that you won’t be able to have children can be devastating. Even if your family is complete or you did not want children, you may still feel a sense of loss and grief.
Speaking to a counsellor or gynaecological oncology nurse about your feelings can be helpful.
If you were still having periods (menstruating) before surgery, having your ovaries removed will mean you no longer produce the hormones oestrogen and progesterone, and your periods will stop (menopause).
When menopause occurs naturally, it is a gradual process that usually starts between the ages of 45 and 55, but menopause after surgery is sudden. Symptoms of menopause can include:
- hot flushes
- dry or itchy skin
- mood swings
- trouble sleeping (insomnia)
- vaginal dryness.
These symptoms are usually more intense after surgery than during a natural menopause because the body hasn’t had time to get used to the gradual decrease in hormone levels.
Managing menopause symptoms
- Check your cholesterol levels – cholesterol levels can change after menopause, which can lead to heart disease. You can manage cholesterol levels with regular exercise and a balanced diet. Ask your doctor about cholesterol-lowering drugs.
- Use a vaginal moisturiser – this will help with vaginal discomfort and dryness. You can buy a vaginal moisturiser over the counter from chemists.
- Learn meditation and relaxation techniques – these may help reduce stress and lessen symptoms.
- Ask about menopause hormone therapy (MHT) – previously called hormone replacement therapy (HRT), there are benefits and risks to managing menopause with MHT. Ask your doctor if MHT is safe for you to use after treatment for ovarian cancer.
- Have your bone density checked – menopause can increase your risk of developing thinning of the bones (osteoporosis). Talk to your doctor about having a bone density test or taking medicines to prevent your bones becoming weak. Regular exercise will help keep your bones strong. Learn more about bone health from Healthy Bones Australia.
Sexuality and intimacy
Ovarian cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on many factors, such as treatment and side effects, your self-confidence, and whether you have a partner.
It is important to feel that your sexuality is respected when discussing how cancer treatment will affect you. Whatever your gender identity or sexual orientation, your medical team should be able to openly discuss your needs and support you through treatment. Try to find a doctor who helps you feel at ease talking about sexual issues and relationships.
Physical and emotional changes
Treatment can cause dryness and scarring of the vagina, and internal scar tissue (pelvic adhesions). These side effects can make sexual penetration painful, and you may have to find different ways to climax (orgasm). The experience of having cancer may mean you lose interest in intimacy and sex (low libido).
For most people, sex is more than arousal, intercourse and orgasms. It involves feelings of intimacy and acceptance, as well as being able to give and receive love. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.
Changes to your body can affect the way you feel about yourself (your self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. Give yourself time to get used to any changes. Try to see yourself as a whole person (body, mind and personality) instead of focusing on the parts that have changed.
You may find this resource on intimacy and sexuality for women with gynaecological cancer from Cancer Australia helpful.
After surgery or during chemotherapy or radiation therapy, some people notice changes with how their bowel works. You may have diarrhoea, constipation or stomach cramps. Pain medicines may also make you feel constipated. Diarrhoea and constipation can occur for some time, but are usually temporary.
Sometimes tissues in the pelvis stick together after surgery. This is called a pelvic adhesion, and it can be painful and cause ongoing bowel problems. In rare cases, you may need further surgery.
To help manage bowel changes, ask your doctor, nurse or dietitian for advice about eating and drinking.
Treating a blockage in the bowel
When food can’t pass through the bowel it can become blocked. This is known as a bowel obstruction. Causes may include surgery or radiation therapy or the cancer coming back. Symptoms may include feeling sick, vomiting, or a swollen and painful stomach.
Bowel obstruction can be serious. How it is treated will depend on its cause, where it is in the bowel, and your general health. Options may include:
- Resting the bowel – a bowel obstruction can sometimes be treated by resting the bowel, which means not eating or drinking and having fluid through an intravenous drip until the blockage clears.
- Taking medicines – your doctor may prescribe an anti-inflammatory medicine to reduce the swelling around the obstruction.
- Inserting a stent – surgery may help clear some bowel obstructions. If only one area is blocked, you may have a small tube (stent) put in to help keep the bowel open and relieve symptoms. The stent is inserted through the rectum using a flexible tube called an endoscope.
- Creating a stoma – if the bowel is blocked in more than one spot, you may have a stoma. This surgically created opening in the abdomen removes bowel movements from the body. A small bag called a stoma bag or appliance is worn on the outside of the body to collect the waste. The stoma may be reversed when the blockage is cleared, or it may be permanent.
Sometimes ovarian cancer can cause fluid to build up in different parts of the body.
This is when fluid collects in the abdomen. It causes swelling and pressure, which can be uncomfortable and make you feel breathless.
If you have ascites, your doctor may inject a local anaesthetic into the abdomen and then insert a needle to take a sample of the fluid. This is called a paracentesis or ascitic tap. The fluid sample is sent to a laboratory to be examined under a microscope for cancer cells.
Sometimes, to make you feel more comfortable, the doctor will remove all the remaining fluid from your abdomen. It will take a few hours for the fluid to drain into a drainage bag and then the tube will be removed from your abdomen.
If the cancer has spread to the lungs, fluid builds up in the area between the lung and the chest wall (pleural space). It can cause pain and breathlessness. The fluid can be drained using a procedure called a thoracentesis or pleural tap. Your doctor will inject a local anaesthetic into the chest area, and then insert a needle into the pleural space to drain the fluid.
If you have lymph nodes removed from the pelvis as part of surgery, you may find that one or both legs become swollen. This is known as lymphoedema. It can happen if lymph fluid doesn’t circulate properly and builds up in the legs. It may also be caused by radiation therapy in the pelvic area.
Lymphoedema can make movement and some types of activities difficult. The swelling may appear at the time of treatment or months or years later. It is important to seek help as soon as possible because early diagnosis and treatment lead to better outcomes.
Life after treatment
After treatment ends, you will have regular appointments with your gynaecological oncologist and medical oncologist to monitor your health, manage any long-term side effects and look for any signs that the cancer has come back or spread. They may perform a physical examination, which may include an internal examination, and arrange blood tests or scans.
There is no set follow-up schedule for ovarian cancer, but it’s common to see a specialist every three months for the first few years, and then every four to six months for up to five years. Some people prefer not to follow a schedule but to see their specialist if they experience symptoms. Your check-ups will become less frequent if you have no further problems.
What if ovarian cancer returns?
If ovarian cancer is advanced at diagnosis, it often does come back after treatment and a period of improvement (remission). This is known as a recurrence and it is why regular follow-up appointments are important.
In some cases, there may be a number of recurrences, with long gaps in between when cancer treatment is not needed. Early-stage ovarian cancer is less likely to come back than advanced ovarian cancer.
Learn more about advanced cancer
Treatment for ovarian cancer that has come back
The most common treatment for epithelial ovarian cancer that has come back is more chemotherapy or targeted therapy. The drugs used will depend on:
- what drugs you had initially
- the length of remission
- the aim of the treatment
- your general health
- any side effects from previous treatments.
The drugs used the first time may be given again if you had a good response to them and the cancer stayed away for six months or more.
New drugs are constantly being developed and there have been a number of important developments in recent years. Genetic tests and targeted therapy are offering new treatment options for people with ovarian cancer. Talk with your doctor about the latest developments and whether a clinical trial may be right for you.
Having CA125 blood tests
Your specialist will also talk to you about the advantages and disadvantages of having regular blood tests for the tumour marker CA125. This test is optional.
There is some research to suggest that waiting until new symptoms develop before starting treatment is just as effective as starting treatment earlier because of a rise in CA125. Not having treatment until you have new symptoms may mean that your quality of life is better for longer because side effects of further treatment are delayed.
For germ cell tumours or stromal tumours, you may have tests for tumour markers other than CA125.
Understanding Ovarian Cancer
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Expert content reviewers:
Dr Nisha Jagasia, Gynaecological Oncologist, Mater Hospital Brisbane, QLD; Sue Hayes, Consumer; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Health, QLD; Dr Andrew Lee, Radiation Oncologist, Canberra Region Cancer Centre and Canberra Hospital, ACT; A/Prof Tarek Meniawy, Medical Oncologist, Sir Charles Gairdner Hospital, WA; Caitriona Nienaber, Cancer Council WA; Jane Power, Consumer; A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW.
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The information on this webpage was adapted from Understanding Ovarian Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in April 2022.