Do What You Can to Ease Side Effects of Treatment for Ovarian Cancer

It’s likely that you will have physical concerns since your cancer may cause symptoms and your treatment may cause side effects. The side effects depend on your treatment, and that depends, in part, on how much the cancer has spread from your ovary. In this section, you’ll learn more about how to respond to some of the most common symptoms and side effects of treatment for ovarian cancer.

We’ve listed some common side effects from ovarian cancer treatments and how to ease them. They are listed in alphabetical order so you can find help when you need it.

Allergic Reaction

Some women may be allergic to the medications used during treatment for ovarian cancer. Call your doctor or nurse immediately if you notice any of these common reactions.

• Red face and skin (flushing)

• Warm feeling

• Trouble breathing

If you have a reaction, the nurse or doctor will immediately stop the treatment. In some cases, you may get medication to reverse the reaction.

Anemia (Low Red-Blood-Cell Levels)

Throughout your treatment, your doctor will take small samples of your blood for testing. One thing he or she is checking for is your red-blood-cell count. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired.   Having a low red-blood-cell count is called anemia. Decreased red-blood-cell counts can be caused by small amounts of blood loss, by chemotherapy or radiation, or by the cancer itself.

If your doctor tells you that you have anemia, take these actions to feel better.

• Take short rests when you’re tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine. It may help you sleep better.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of water. Dehydration adds to fatigue.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and Depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back during treatment.

Taking these actions may ease your mental stress.

• Talk with your family or friends.

• Consider joining a cancer support group or finding a cancer “buddy” who can help you cope.

• Ask your doctor about medications for depression and anxiety.

Appetite Loss

People who eat well during cancer treatment maintain their strength better, are more active, and are better able to lower their chance of infection. It’s important to remember that your body needs energy to heal itself. Maintaining your weight is a good way to know if you are giving your body the energy it needs.

When you’re being treated for cancer, a diet high in calories and protein is best. The problem is that side effects of treatment, especially chemotherapy, can make you not want to eat. Some chemotherapy treatments can change the way food tastes to you. If this is the case for you, focus on getting a balanced diet and increasing your activity level. Ask your doctor for a referral to a registered dietitian if you are having trouble maintaining your appetite or your weight.

Also, try these tips to stimulate your desire to eat.

• If you can, eat foods high in protein several times a day. These foods include milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue, and cancer treatments cause you to use more protein than usual.

• To maintain your weight, eat high-calorie foods, such as margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

• Get plenty of fluids to help control your body temperature and improve food elimination. In addition to water, fruit juices, and other liquids, try gelatin, pudding, soups, fruit bars, and ice cream.

• Eat small meals throughout the day instead of three large ones.

• Keep snacks handy to eat when you are hungry.

• Eat with friends or play your favorite music at mealtime to boost your appetite.

• Eat your biggest meal in the morning. Many people getting treatment for cancer find that this is when their appetite is greatest.

• If you can, increase your activity level. Doing so may boost your appetite.

• On days when you don’t feel like eating at all, don’t worry about it. Try again the next day. If you find your appetite doesn’t improve in several days, talk with your doctor or nurse.

Bleeding or Bruising Problems

Certain kinds of chemotherapy may reduce your blood platelet count. Without enough platelets, your blood may have difficulty clotting and lead to a problem called thrombocytopenia. If your doctor tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to bleeding problems.

• Protect your skin from cuts, scrapes, and sharp objects.

• Shave with an electric razor because it is less likely to result in cuts.

• Use a soft toothbrush to prevent bleeding gums.

• Take steps to prevent constipation, which can lead to hemorrhoids and bleeding.

• Call your doctor if you develop a rash, bleeding, or bruising.

Constipation

Constipation, which includes difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. This may be a side effect of chemotherapy. Taking pain medications can also lead to constipation, so it’s wise to take these preventive actions. These same steps will give you relief if you are already constipated.

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative only as prescribed by your doctor.

Diarrhea

Diarrhea, which includes loose or frequent bowel movements, or both, may lead to dehydration if you don’t take these precautions. Many drugs can cause bowel changes. Diarrhea may be a side effect of surgery, chemotherapy, or radiation therapy.

Take these actions to help.

• Avoid milk and milk products.

• Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

• Eat low-residue, low-fiber foods such as those included in the BRAT diet (bananas, rice, applesauce, and toast).

• Drink more fluids such as water and broth, or electrolyte solutions such as sports drinks, to prevent dehydration.

• Ask your doctor about medications that may help.

Fluid Build-Up

Chemotherapy sometimes causes fluid build-up. This may also be a symptom of the cancer itself. Ascites occurs when large amounts of fluid pool in your abdomen. The fluid can cause a sense of fullness and make your clothes fit tightly.

Try these tips to manage the effects of the fluid build-up.

• Try to eat foods high in protein and calories. Small, frequent meals (up to 6 meals a day) may be easier for you to eat.

• Rate your pain daily using a scale of 0 to 10 in which 0 equals no pain and 10 equals the worst pain that you can imagine. Select the number that best describes your level of pain and write it down in a journal. Bring the journal with you to doctor appointments.

• You should do what you feel like doing. Rest periods may be helpful. Elevate your feet and legs when sitting.

Call your nurse or doctor if any of these things occurs.     

• A weight gain so that your clothes do not fit

• Trouble breathing or shortness of breath

• Nausea or vomiting

• Increase in pain rating to above 4 for 2 days in a row

Hair Loss (called Alopecia)

Some chemotherapy drugs cause hair to come out. Losing your hair can be upsetting because thinning or baldness is a visible reminder that you are being treated for cancer. Keep in mind that your hair will grow back after treatment. Try these coping tips.

• Consider cutting your hair short before treatment starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair, and you’ll be ready with head coverings, if you choose to use them.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Hot Flashes

A hot flash is also called a hot flush. It is a sudden rush of warmth to the face, neck, upper chest, and back—with or without sweating. It can last for a few seconds to an hour or more. Hot flashes will likely occur if you’ve had your ovaries removed. Hot flashes can also occur with chemotherapy. Some women have mild symptoms, while others have more severe ones. In many cases, hot flashes stop when treatment stops. Some women report that hot flashes last for years after hormone treatment is done.

To ease them, try these tips.

• Limit your intake of hot drinks, caffeine, alcohol, and spicy foods.

• Avoid strenuous exercise.

• Layer your clothing so that you can add or remove as needed.

• Stay out of environments with very warm temperatures.

• Use sprays or moist wipes to help lower skin temperature.

• Ask your doctor about relaxation training or acupuncture.

• Ask your doctor about medications you can take to ease symptoms. One your doctor may suggest is Megace (megestrol acetate). It’s a form of progesterone called progestin. It seems to be effective in lowering hot-flash severity but has some side effects. These include breast tenderness, irregular vaginal bleeding, mood changes, and bloating. Your doctor may also prescribe antidepressants, such as Effexor (venlafaxine). For hot flashes, these are given in doses smaller than those given for depression.

• Ask your doctor about taking phytoestrogens. These are estrogens that come from plants. Soy products and some herbs contain phytoestrogens. Although raising the amount of phytoestrogens in the diet is commonly recommended to lessen the severity of hot flashes, studies have shown conflicting results about their effectiveness. Their potential side effects are unknown.

Increased Infection

Throughout your treatment, your doctor will take small samples of your blood for blood tests. One thing he or she is checking for is your white-blood-cell count. Many types of chemotherapy can cause low white-blood-cell counts. This is called neutropenia. Without enough white blood cells, your body may not be able to fight infection. If your doctor tells you that your white-blood-cell count is low, take these actions to stay healthy.

• Avoid crowds or people with colds.

• Wash your hands often or use hand sanitizer throughout the day to kill germs.

• Call your doctor right away if you have any of these signs of infection: a temperature of 100.5 degrees or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Insomnia (Trouble Sleeping)

Insomnia can be caused by anxiety, depression, or your cancer treatment. Use these tips to improve your rest.

• Keep a regular bedtime schedule.

• Use your bed only for sleeping, not watching TV.

• If you don’t fall asleep within 15 minutes, get up, do something else, and try again later.

• Avoid stimulants such as caffeine and tobacco, especially close to bedtime.

• Don’t eat, drink fluids, or exercise close to your bedtime.

• Avoid long naps during the day.

Menopausal Symptoms

Removal of the ovaries and some types of chemotherapy will cause menopausal symptoms in women who’ve not yet reached menopause. They include symptoms such as hot flashes, vaginal dryness, mood swings, and weight changes. Periods may become irregular or may stop, and you may not be able to get pregnant.

• If needed, talk with your doctor about birth control before treatment begins.

• Talk with your doctor about ways to manage menopausal symptoms, such as using lubricants for vaginal dryness, doing mild exercise, and talking with a therapist about mood swings or signs of depression.

• Report any unusual bleeding to your doctor.

• Continue with regular pelvic exams.

Also see vaginal dryness, hot flashes, mood swings, and weight changes.

Mood Swings

It’s normal to experience emotional changes, both during and after cancer treatment. Even if cancer treatment is successful, many people experience fears about what the future holds. Women who have had their ovaries removed may also have mood swings as part of surgically induced menopause. Talk with your doctor or nurse about ways to manage these changes and try these tips.

• Be as open as you can with loved ones about your fears.

• Remember that exercise, sleeping, and eating well can greatly influence moods.

• Get a referral to a psychiatrist, psychologist, or other counselor.

• Look into cancer support groups.

Mouth Sores (Mucositis)

Some types of chemotherapy may cause mouth sores, but they aren’t common from treatment for ovarian cancer. Mouth sores may hurt and make eating an unpleasant experience.

To prevent sores in your mouth, take these actions.

• Brush your teeth after meals and before bedtime; floss every day.

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

To ease the pain if you get sores in your mouth, take these actions.

• Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Avoid tobacco because it may irritate the sores. Smoking can also make you more susceptible to sores.

• Ask your doctor about topical mouth medications.

• Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

• Call your doctor or nurse if your temperature reaches 100 degrees or higher.

Nausea or Vomiting

Nausea or vomiting as a result of chemotherapy or radiation treatment for cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea.

• Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment, and the symptoms end within the first 24 hours.

• Delayed-onset vomiting develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting is learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

• Breakthrough vomiting occurs despite treatment to prevent it. It requires additional treatment.

• Refractory vomiting occurs after one or more chemotherapy treatments--essentially, you’re no longer responding to anti-nausea treatments.

To prevent nausea, take these actions. Most nausea can be prevented.

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed.

To help ease nausea or vomiting if you have it, try these tips.

• Try eating foods and drinking beverages that were easy to take or made you feel better when you’ve had the flu or were nauseated from stress. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

• Eat room-temperature or cold foods. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists, which may help to decrease your nausea.

Numbness, Tingling, or Muscle Weakness in Your Hands or Feet (called Peripheral Neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some types of chemotherapy are known to cause this. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, take these precautions to protect yourself.

• Take extra care walking and moving so that you don’t fall.

• Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

Pain

Chemotherapy for ovarian cancer may cause muscle or joint pain. When it occurs, it usually happens 48 to 72 hours after treatment. Pain can range from mild to severe and is usually felt in the shoulders, hips, and knees. Always tell your doctor or nurse about any muscle or joint pain. There is medication available that can help.

Here are some tips to reduce pain.

• Rest

• Massage the sore area

• Take a warm bath

• Put heat on the sore area

You may also have pain from the cancer itself or from surgical incisions. Try these tips to ease the pain.

• Take your pain medications regularly; don’t wait for your pain to become severe.

  (Take steps to avoid constipation, a common side effect of pain medications.)

• Change your activity level. See if resting or moving around more help you feel better.

• Distract yourself with music, funny videos, or computer games.

• Use relaxation techniques, such as yoga or meditation, or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Sexual Changes

Removing the ovaries can result in sexual changes. The psychological stress of coping with cancer can also affect your ability to enjoy sex. Before treatment, ask your doctor what you can expect. Knowing what to expect may help you cope.

Taking these actions may help you cope with these changes.

• Talk with your partner about changes in your desire to have sex.

• See a counselor who specializes in sexual problems.

• Discuss it with your doctor and other members of your healthcare team. They may be able to refer you to a sexual rehabilitation program.

Skin Changes

Radiation treatment can cause dry or red skin in the area being treated. With some types of chemotherapy, you may also have nail changes, such as splitting, or slower growth. Try these tips.

• Protect your skin from sun exposure, especially between 10:00AM and 3:00PM , by wearing sunscreen with an SPF (sun protection factor) of at least 15.

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don’t use any lotion, soap, deodorant, sun block, cologne, cosmetics, or powder on your skin within 2 hours after treatment because they may cause irritation.

• Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

• Don’t scratch, rub, or scrub treated skin. After washing, gently blot-dry.

• Don’t bandage skin with tape. If you must bandage it, use paper tape and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don’t apply heat or cold to the treated area. Bathe only with lukewarm water because it’s less dehydrating.

• If you must shave the treated area, use only an electric shaver because it’s less irritating. Don’t use lotion before shaving. And don’t use hair-removal products. Both can irritate the skin.

• Keep your nails well trimmed and clean so you don’t accidentally scratch yourself.

Trouble Thinking and Remembering

You may have mild problems with concentration and memory during and after chemotherapy. Being tired can make this worse.

Taking these actions may help.

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

Tiredness

Tiredness is a very common symptom of ovarian cancer and side effect from chemotherapy and radiation treatments. You may feel only slightly tired, or you may suffer from extreme fatigue.

Taking these actions may help increase your energy level. Fatigue can last 4 to 6 weeks after treatment ends.

• Take action to treat a poor appetite, because eating improperly can make you tired.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

• Follow the tips under “anemia.”

Urinary Problems

After ovarian cancer surgery, you may have frequent urination or problems emptying your bladder. Symptoms such as pain or burning while using the bathroom could mean a urinary tract infection. Do these things for relief.

• Report any symptoms to your doctor. Medication can help.

• Try emptying your bladder regularly.

• Ask your doctor or nurse about special incontinence hygiene products.

Vaginal Dryness and Other Problems

Vaginal dryness can be a bothersome side effect of sudden menopause from having your ovaries removed. In addition to vaginal dryness, lowered estrogen levels may cause women to have vaginal thinning and difficult or painful intercourse. Lubricants can help with some of these problems. Vaginal infections may also occur more often. When you talk with your doctor about these problems, make sure he or she knows you’ve had cancer. Try these methods to ease symptoms.

• Use over-the-counter vaginal moisturizers and lubricants, such as Replens, Gyne-Moistrin, or Lubrin.

• Before sexual activity, use water-soluble lubricants, such as KY Jelly, Astroglide, or any vaginal moisturizers.

• Apply vitamin E oil to the area to ease irritation and burning.

• Ask your doctor about products that may help replace estrogen vaginally.

• As relief for infections, try over-the-counter antifungal creams, but see your gynecologist for symptoms that do not go away.

Weight Gain

Chemotherapy can sometimes cause weight gain. Take these actions to help manage your weight.

• Increase the amount of your daily exercise. Strive to be active every day.

• Eat a balanced, low-calorie diet.

• Increase the amount of fruits and vegetables you eat. And drink more water. These can help fill you up—and are good for you—without adding a lot of calories.