Treating the symptoms of advanced ovarian cancer

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.

Unfortunately advanced cancer can’t always be cured. But treatment might:

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

This is sometimes called palliative treatment.

Making 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 help to control symptoms and make you 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. Palliative treatments can help to reduce symptoms and might make you feel better. But they also have side effects that can make you feel unwell for a while.

Talk to your doctor or specialist nurse to understand:

• what your diagnosis means
• what is likely to happen
• what treatment is available
• how treatment can help you
• what the side effects of the treatment are

You might feel that you don’t want to know much information straight away. Tell your doctor or nurse. You will always be able to ask for more information when you are ready.

Everyone is different and there is no right way to feel.

Types of treatment

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 and level of fitness
• your wishes

To shrink your cancer, slow its growth and relieve your symptoms your doctor might recommend:

Chemotherapy

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

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

For ovarian cancer that has come back you will probably be able to have chemotherapy. Even if you already had some previously. You might have carboplatin again, or try a different chemotherapy drug. 

Surgery

You might have surgery for advanced cancer. Your specialist surgeon (gynaecological oncologist) will check where the cancer is in your tummy (abdomen) and remove as much of it as possible.

You might have more 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.

You might have a targeted cancer drug either: 

• with chemotherapy
• on its own after chemotherapy 

Types of targeted cancer drugs for ovarian cancer include:

• PARP inhibitors (including olaparib, niraparib and rucaparib)
• bevacizumab
• trametinib

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells. Occasionally doctors suggest radiotherapy for advanced ovarian cancer. Radiotherapy can shrink cancers and reduce symptoms.

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

Treating your symptoms

The symptoms of advanced cancer can be difficult to cope with. But your healthcare team can offer support and treatment to help you.

Tell your doctor or nurse about any symptoms that you have.

Fluid in the abdomen (ascites)

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, cancer cells can irritate the lining of the abdomen (peritoneum) and cause fluid to build up. Cancer can also block part of the lymphatic system so fluid can't drain out of the abdomen as usual. 

Ascites 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 put a small tube called a drain into your abdomen to remove some of the fluid and help relieve symptoms. This is called an abdominal tap or abdominal paracentesis.

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 can cause 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. The surgeon removes enough of the cancer to unblock the bowel. They might remove part of the bowel as well.

Your surgeon may be able to repair the bowel by stitching the ends back together. But sometimes it isn’t possible to do this and you may need to have a colostomy (stoma). A stoma is an opening from the bowel onto the abdomen. Your poo comes out of this opening into a plastic bag that sticks over it.

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

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 weak.

If surgery is not an option, doctors might use: 

• a tube called a stent that is put into your bowel to hold it open
• drug treatment to reduce the amount of fluid in your digestive system, or to reduce inflammation in the bowel

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. This means your pee cannot drain away, and the kidney may swell and become damaged.

Your doctor may suggest putting in a tube to bypass the blockage and drain urine from the kidney. You might have an:

• internal tube (ureteric stent) – this drain your pee from your kidney into your bladder
• external tube (nephrostomy) – this is put through the skin into your kidney. The tube connects to a bag to drain your pee

A ureteric stent or nephrostomy is usually put in using a local anaesthetic. 

Controlling other symptoms

Your doctor or specialist nurse can help you to control other symptoms. They can:

• give you medicines
• get equipment that you need
• suggest other ways of controlling your symptoms
• refer you to a symptom control team (a palliative care team)

Symptom control team

There are symptom control teams in most cancer units. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.

Most symptom control teams have home care services so they can visit you at home.