Managing Symptoms and Side Effects

Ovarian cancer and its treatment can cause symptoms and side effects. These vary from woman to woman, at different times of the illness and treatment. Coping with these symptoms and side effects can be very difficult. Most women say the side effects of treatment can be the hardest part of having cancer.

We suggest you try to deal with any side effects early. Don’t try to ‘stick it out’ in hope they will stop or let them build up until they are unbearable. The earlier you get help or take prescribed medications for side effects, the better. Always let your doctor know if you develop any new symptoms or side effects, if they are severe, or if they are not improving.

This page includes practical tips to help you deal with the following symptoms and side effects that may affect you.

Fatigue is one of the most common problems women face during and after their cancer treatment. Fatigue means feeling very tired and having no energy. It is a weary and completely ‘worn-out’ feeling. People with cancer often describe their fatigue as overwhelming and debilitating. They say it is not relieved by sleep and can affect your ability to do day-to-day activities, your self-esteem and your relationships.

Fatigue may be caused by chemotherapy, radiotherapy or other medicines. The cancer itself may also cause fatigue or low red blood cells (anaemia). Realising that fatigue is common for people with cancer, and asking for help, are important first steps in coping with it. If ongoing fatigue is a problem, talk to your doctor. They may be able to suggest things to help you.

“I was so tired, very fatigued and I slept a lot and forgot so much. This was the most frustrating part of my treatment.” – Beatrice

Managing fatigue:

  • Plan your day and set goals you can manage.
  • Don’t be afraid to ask for help from those close to you: they will want to help.
  • Rest before you get too tired.
  • Try not to rush: leave plenty of time to get to appointments.
  • Sit down when you can to do things like cutting up vegetables, talking on the phone or playing with children.
  • Eat a well-balanced and healthy diet to keep up your energy levels.
  • Try to do things you enjoy and you know might help you relax: listen to music, have a massage, read, be with those close to you.
  • Say yes when friends and family offer to cook for you.

Nutritional problems can happen to people who have ovarian cancer. These problems may be worse if you have advanced cancer. They can include:

  • loss of appetite
  • weight loss
  • feeling and being sick (nausea and vomiting)
  • difficulty swallowing
  • loss of or changes in taste: metallic taste
  • sore mouth: dry mouth and ulcers.

These problems can be a result of your cancer, treatment, tiredness, pain and depression. Always talk to your doctor if you develop any of these symptoms.

There are anti-sickness medications (anti-emetics) and natural therapies (e.g. acupuncture and/or ginger) that can help prevent and treat these side effects.

Managing nutritional and diet issues:

  • Ask your doctor about medications to help with nausea and vomiting.
  • Acupuncture can help with nausea.
  • Eat small amounts often and try to eat before you get too hungry (an empty stomach can make you feel sicker).
  • Keep your lips moist with lip balm. Suck on ice blocks / sip water regularly to keep your mouth moist.
  • If you have mouth ulcers, keep your mouth clean and moist by using regular mouth washes.
  • Sip ginger in drinks or suck ginger sweets: ginger has anti-nausea properties that may help.
  • Salty foods can help with nausea: try dry salty crackers and Vegemite®, but not if you have mouth ulcers. Avoid fatty or fried foods.

People with cancer have pain for many reasons. It may be caused by the cancer, the treatment or something else such as a bone fracture or blockages in organs. It can be very frightening to be in pain. You may worry about having a lot of pain due to your cancer or its treatment. It may help you to know there is usually something that can be done to help most types of cancer pain.

There are different types of pain, such as nerve pain, bone pain, chronic pain, referred pain and muscle pain. Each one may be relieved using different treatments or pain-relieving drugs.

Talk to your doctor to work out the cause of your pain and how to best manage it. You may also find it helpful to read the Cancer Council booklet Overcoming cancer pain (call 13 11 20 for a free copy).

Managing pain:

  • Let your healthcare team know if you are in pain.
  • Take your pain medicine at the recommended times. Don’t wait until the pain becomes severe, as pain relievers won’t work as well.
  • Resting, using heat packs, having a warm bath and massage can help to ease some pain.
  • See if either resting or gentle movement helps your pain.
  • Distract yourself with music, comedy online or on DVD, or chatting to friends.

Chemotherapy used to treat ovarian cancer may cause hair thinning or loss. This is because it affects the healthy cells involved in hair growth. Many women say losing their hair is one of the hardest parts of having cancer.

Hair loss is usually temporary. If it happens, it will start about two weeks after your first treatment. Hair generally starts to return after your final treatment ends. Many women struggle with hair loss because hair and its appearance are closely related to our self-esteem. Losing your hair makes cancer obvious to others and this can be difficult to cope with.

It is only natural to feel frightened, angry and upset about losing your hair. But it helps to remember it is almost always temporary. Some women who have very long hair may be able to cut their hair before treatment and donate it to make wigs. Women who have done this say it brought something positive out of a traumatic situation. Contact Cancer Council 13 11 20 to find out about donating your hair.

When it comes to hair loss, it’s a great help to be prepared and think about ways to lessen the shock before you start chemo. Read our tips on coping with hair loss in the table below.

Can I prevent losing my hair (cold caps)?

Preventing hair loss from chemotherapy is not always possible. However, you may be able to reduce the amount of hair you lose by using cold caps. Cold caps decrease the scalp temperature, and this reduces the blood flow to the scalp and lowers the amount of chemotherapy that gets to your hair follicles, meaning the risk of hair loss may be reduced. There is no guarantee cold caps will work and you will not know until you try it. Some women still have hair thinning or lose their hair completely.

Cold caps are not suitable for everyone having chemotherapy. You would need to discuss this option with your specialist doctor.  Not all treatment centres offer cold caps.

Look Good … Feel Better

Look Good … Feel Better (1800 650 960) can help with self-confidence during and after cancer treatment. The program offers useful tips on using cosmetics to deal with changes in your skin, hair and general appearance. The two-hour workshops are run in hospitals and cancer centres throughout Australia by beauty professionals who volunteer their time. These workshops are completely free, relaxed and friendly.

“If you are going to lose your hair, make sure you attend a Look Good … Feel Better session beforehand, so you are prepared and have some sassy hats and wigs on standby.” – Jan

Managing hair loss:

  • Cutting your hair very short before treatment helps some women.
  • Find a wig you love. You can borrow a wig for a small fee from some hospitals and cancer care units. Private health insurance may cover part of the cost of buying your own wig.
  • Contact your state/territory Cancer Council: some organisations offer free wigs.
  • Express your personal style by buying or borrowing colourful scarves, turbans or hats.
  • Treat your existing hair and scalp gently and protect bald heads (they are very sensitive to the sun and cold!).
  • Use hair and skin products without added chemicals or perfumes.

Constipation

Constipation may be caused by your cancer treatment, anti-sickness (nausea) or pain-relieving drugs. It can also be a result of the cancer affecting the bowel or being less active when you are unwell. It is important to let your doctor know if you are constipated, as leaving it too long can lead to more serious problems.

Diarrhoea

Some chemotherapy drugs, radiotherapy and antibiotics can cause diarrhoea. Stress, anxiety and infections can also cause diarrhoea. Talk to your doctor if you have diarrhoea, stomach pain or cramps.

Bowel Obstruction

The bowel can sometimes be blocked because of surgery or due to the cancer growing. this blockage is called a ‘bowel obstruction’. Symptoms include nausea, vomiting, and abdominal pain and cramps.

Contact your doctor as soon as possible if you have any new or different symptoms. A bowel obstruction can often be relieved with a simple treatment in hospital, though occasionally a further operation may be necessary.

Managing bowel changes:

Diarrhoea:

  • Drink plenty of fluids to prevent dehydration.
  • Reduce insoluble fibre: avoid grainy breads and cereals, nuts and seeds, and raw fruit or vegies.
  • Increase soluble fibre found in oatmeal, potatoes, bananas and rice.
  • Reduce dairy products or try low or no lactose alternatives.
  • Avoid caffeine.
  • Ask your doctor about anti-diarrhoea medicine that may be suitable for you.

Constipation:

  • Drink plenty of liquids – aim for around two litres of clear liquids a day.
  • Do something active every day, even if it’s just a gentle walk around the block.
  • Increase the fibre in your diet by eating wholegrain breads, cereals, vegetables and fruit.
  • Talk to your doctor as they may suggest laxatives if simple ideas are not working.

Some chemotherapy drugs, especially platinum-based chemotherapy, can damage your inner ear – this is called ‘ototoxicity’ and can result in loss of hearing high-pitched sounds, ringing in your ears (tinnitus) or dizziness. This can be very distressing.

Let your doctor know if you notice any change in your hearing or if you have ringing in your ears or dizziness.

Managing hearing changes:

  • Avoid exposure to loud noises to help prevent further damage.
  • Drink plenty of fluids as dehydration can worsen dizziness.
  • Have quiet background music playing when you are trying to rest/sleep. This can help you to pay less attention to ringing in your ears, making it easier to rest or sleep.

Chemotherapy may cause skin problems including redness, itching, dryness and breakouts, while radiotherapy can cause dry or red skin in the area being treated.

Managing skin issues:

  • Use gentle skin care: soap-free cleansers and low-irritant moisturisers.
  • Protect your skin from the sun using hats, sunglasses and SPF30+ sunscreen for sensitive skin.

Recurrent ovarian cancer can cause a build up of fluid in the abdomen known as ‘ascites’. This causes bloating, swelling and discomfort. Fluid can also build up in the lungs, which is called ‘pleural effusion’. This can be painful and make you short of breath.

Talk to your doctor if you have any symptoms that suggest fluid is building up in your abdomen or lungs. There is a simple procedure your doctor can use to drain away the fluid and relieve your discomfort.

After having chemotherapy, many women have problems with their short-term memory, concentration and processing information. This is often called ‘chemo brain’.

This problem can be incredibly frustrating and debilitating, especially if you have previously had a good memory or if you need to concentrate carefully for work or study. Don’t be hard on yourself when you forget things or feel a bit confused. Just take a break and acknowledge it is a side effect from your treatment.

Talk to your doctor or another member of your healthcare team if you have ongoing concerns about your memory or concentration.

 “I had to keep reading things over and over with the studies I was doing because my chemo brain made concentrating very hard. I had to do it bit by bit but it was still possible.” – Vicki

Managing memory and concentration changes - a.k.a 'chemo brain'

  • Use a calendar, planner or mobile phone to keep track of appointments, birthdays and important tasks.
  • Write lists of things you need to remember: phone calls to make, emails to return, items to buy.
  • Schedule tasks that require a lot of concentration for times of the day when you feel most alert.
  • Keep your brain active with crosswords, puzzles, reading, interesting conversation and hobbies. Don’t push yourself though.

Chemotherapy can reduce the number of white blood cells (neutropaenia) in your body, and this can increase your risk of developing infections. Your white blood cell count will be checked regularly during treatment and if a blood test shows your count is low, your medical oncologist may delay the next round of chemotherapy.

If you feel like you have a fever, it is important you seek help immediately. It is important to have a thermometer at home in case you feel you have a fever. Febrile neutropaenia is a serious situation and needs urgent medical intervention.

If your temperature reaches 38 degrees or over, you should attend the emergency department immediately.

Seek urgent help if you have any unusual symptoms that may indicate you have an infection such as a fever, sore throat, shaking (chills), diarrhoea, vomiting, burning when you pass urine, redness or swelling around a wound or your chemotherapy device (e.g. PICC line, Hickman line). If you are unable to get to the emergency department, call 000.

Treatments can also affect your level of red blood cells and platelets. If your red blood cells become too low (anaemia), you may need to have a blood transfusion. Decreased platelets can lead to serious problems such as bleeding that won’t stop. Seek immediate help if you have a nose bleed or notice you are bruising easily. 

Bleeding or bruising is a rare side effect of chemotherapy caused by a drop in blood platelets. Your doctor will keep a close eye on your platelet count during treatment, but always let them know if you are bruising more easily than usual, are bleeding from your gums or nose, or have blood in your bowel motions.

Managing risk of infection

  • Seek medical advice immediately if you notice you are feeling unwell, have a fever or think you may be getting an infection.
  • Avoid people with colds, coughs and other infections. Always wash your hands well. Avoid public transport and crowded places where you are more likely to catch an infection.

Some types of chemotherapy can cause nerve problems.  More common symptoms include tingling, burning or numbness in your hands and feet. This is called ‘peripheral neuropathy’ and occurs gradually over time. If it occurs, it may get worse with each treatment. In severe cases, peripheral neuropathy can lead to difficulty walking and unbuttoning clothes. Symptoms usually improve after treatment ends.

Let your doctor know if you experience any symptoms of peripheral neuropathy.

“The peripheral neuropathy was so debilitating. I could not even dry myself with a towel as it was too painful to hold the towel. I ended up buying the small camping towels which were light in weight and softer on my skin.” – Tricia

Managing nerve problems

  • Talk to your doctor about adjusting your treatment to avoid further nerve damage.
  • Take extra care with sharp objects and around hot water if you are having any numbness or tingling in your hands and feet.
  • Use roll-on deodorants instead of spray as pushing the spray button can be difficult.

Lymphatic fluid usually drains from your legs via lymph nodes in your pelvis. If you have had lymph nodes removed from your pelvis during surgery, then lymph fluid may not drain properly. This can cause a build-up of fluid and swelling in one or both legs, called ‘lymphoedema’. You may have a feeling of heaviness, tightness, aching or tension in your leg or foot. See your GP or another member of your healthcare team if you notice any of these changes. Treatment may include gentle exercise, elevation, compression, lymphatic drainage and paying special attention to skincare.

Cancer Australia has a booklet on lymphoedema.

More Information

  • Cancer symptoms and side effects of treatment can dramatically affect the emotional, intimate and spiritual parts of your life. You may experience sadness, depression or anxiety and your sexual desire may be affected. Read the Staying well chapter in our Resilience Kit for more information.
  • OCA Connect gives you access to a community of compassionate and supportive women who have been affected by ovarian cancer. The forum includes many discussions about the side effects of ovarian cancer treatments.