Treating the symptoms of advanced ovarian cancer

Palliative treatment aims to shrink and control cancer, and help you feel better. Palliative treatments for ovarian cancer include surgery, chemotherapy and radiotherapy.

You might also have other palliative treatments to help with symptoms. Such as fluid in your tummy or a blockage to your bowel.

Aims of treatment

Advanced ovarian cancer means that the cancer has spread outside the ovary. It may have spread within the pelvis or abdomen, or further away to other parts of the body such as the lungs.

Some women have advanced ovarian cancer when they are first diagnosed, and treatment can cure their cancer. This depends on several factors, including the exact stage of the cancer.

But for more advanced cancers, or those that come back after treatment, the aim of treatment is usually to:

• shrink the cancer
• control it for as long as possible - this might be for many months and sometimes years
• control the symptoms and help you feel as well as possible

Decisions about treatment

When you have a more advanced cancer, it can be difficult to decide which treatment to try. Or in some cases whether to have treatment at all.

Your doctor may decide to wait until you develop symptoms before offering these treatments. Treatment can control symptoms and help you to feel better. It may also help you to live longer. 

You will need to balance the benefits of treatment with the effects on your quality of life. Side effects may make you feel ill and treatment may cause stresses. Such as travelling back and forth to the hospital. It is very important for you to understand what can be achieved with the treatment your doctor is offering you.

Your doctor will discuss the options for treatment with you. It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends. For example your cancer specialist nurse or a counsellor.

The treatments

Chemotherapy, surgery and targeted cancer drugs are all treatments for advanced ovarian cancer. Some women may have radiotherapy.

The treatment you have depends on:

• where in the body the cancer is
• the size and number of secondary cancers
• the treatment you have already had (if any) and its side effects
• your general health
• your wishes

Your doctor or specialist nurse can talk to you about the benefits and possible side effects.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

For newly diagnosed ovarian cancer, doctors commonly use the drug carboplatin. You might have it on its own or with another chemotherapy drug called paclitaxel (Taxol).

For ovarian cancer that has come back you will probably be able to have chemotherapy. Even if you already had some at an earlier stage in your illness. You might have carboplatin again, or try a different chemotherapy drug. 

Surgery

You might have surgery to remove as much cancer as possible from inside your abdomen before you have chemotherapy. Or you have chemotherapy first and then surgery. 

You might have further surgery if your cancer comes back after chemotherapy. Or if your cancer causes a blockage in your bowel. 

Targeted cancer drugs

Targeted cancer drugs can help the body to control the growth of cancer cells.

One type of targeted drug is called bevacizumab (Avastin). It works by stopping tumours from developing their own blood vessels, so the cancer can't grow. Doctors might use it alongside chemotherapy for some women with advanced ovarian cancer. 

Other types are niraparib (Zejula) and olaparib (Lynparza). They are treatments for some types of ovarian cancer that have come back after treatment.

Radiotherapy

Occasionally doctors suggest radiotherapy for advanced ovarian cancer. Radiotherapy can shrink tumours and reduce symptoms.

There is a maximum total dose of radiotherapy you can have to any part of the body. So if you had radiotherapy to your abdomen after your initial surgery, you may not be able to have radiotherapy to that area of the body again.

Your doctor might still use radiotherapy to treat cancer that has spread outside the abdomen.

Treating your symptoms

Symptoms of advanced cancer can be difficult to cope with. But doctors and nurses can offer support and treatment to help you.

Treatments such as chemotherapy, radiotherapy or biological therapy can help to shrink the cancer, reduce symptoms and help you feel better. Medicines such as painkillers can also help you to manage your symptoms.

Fluid in the abdomen

Ascites is the medical name for a build up of fluid in the abdomen. Many women with advanced ovarian cancer have ascites.

There are a number of reasons why ascites can develop. For example, when cancer cells spread to the lining of the abdomen (peritoneum), they can irritate it and cause fluid to build up. Also, cancer can block part of the lymphatic system so fluid can't drain out of the abdomen as usual. 

The swelling caused by the build up of fluid can be uncomfortable. You may have other symptoms such as:

• loss of appetite
• indigestion
• feeling sick
• constipation
• shortness of breath

The treatment you have for ovarian cancer, such as chemotherapy, can help to reduce the build up of fluid. Or your doctor may drain off some of the fluid to help relieve symptoms. 

Treating a blockage in the bowel

Sometimes ovarian cancer grows and completely blocks the bowel - this is called bowel obstruction. The waste from food you have digested, and the fluids normally produced inside the gut, cannot get past the blockage.

This causes symptoms such as:

• feeling bloated and full
• pain
• feeling sick
• vomiting large amounts
• constipation

To relieve the symptoms, an operation can sometimes unblock the bowel. It may be possible to close up the bowel again, or you may have to have a stoma - an opening onto the abdomen. Your poo (faeces) comes out of the opening into a waterproof bag that sticks onto your skin over the stoma.

You might want to talk over having this operation with your close family and friends as well as your doctor and nurse.

No one can say how much you will benefit from it beforehand. The operation may help you feel better for a time, but the cancer may come back to block the bowel again. It is likely to be quite a big operation when you may already be feeling very low.

If surgery is not an option, doctors can use a drug called octreotide to treat a blocked bowel. It can control the symptoms for a time. Octreotide works by reducing the amount of fluid produced in your stomach and digestive system.

A blockage in the tubes to the bladder

Sometimes ovarian cancer can cause pressure so that it blocks part of the urinary system. It may block one or both of your ureters - the tubes that connect the kidneys with the bladder. This means your urine cannot drain away, and the kidney may swell and become damaged.

Your doctor may suggest putting in a tube (stent) to bypass the blockage and drain urine from the kidney. There are 2 ways of doing this.

An internal tube called a ureteric stent

A ureteric stent can be put in using a local anaesthetic. The doctor (radiologist) uses ultrasound or x-ray to put the stent into the blocked ureter. This lets urine drain from the blocked kidney into your bladder.

Or you may have a ureteric stent put in under general anaesthetic during a cystoscopy operation.

First, the doctor puts a flexible telescope tube called a cystoscope into the bladder. This allows them to see the opening of the ureter to the blocked kidney. They then push the stent up into the ureter from the bladder.

An external tube called a nephrostomy tube

A nephrostomy tube goes through your skin into your kidney. The doctor uses x-ray or ultrasound to help guide the tube into the right place.

The tube connects to a bag to drain the urine.

You usually have this procedure done with local anaesthetic to numb the area. You might have some sedation to make you drowsy.

Research

There is always research going on into improving treatment for different types of cancer. Your doctor may talk about clinical trials and ask whether you would like to take part.

These may be trials for new combinations of chemotherapy drugs or looking at adding other cancer drugs such as targeted cancer drugs.