Managing Ovarian Cancer Symptoms and Treatment Side Effects
Fatigue and Chemo Brain
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.
Sometimes during and after treatment, women can also experience problems with short-term memory, concentration and processing, known as 'chemo-brain.'
Fatigue
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.
'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.
Changes in appetite
Appetite changes can happen as a side effect 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.
Bowel changes
Constipation, diarrhoea and bowel obstructions are all possible changes with your bowel during and after ovarian cancer treatment.
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.
Hair loss and skin issues
Some treatments may cause hair thinning or loss as a side effect. Many women say losing their hair is one of the hardest parts of having cancer. Cancer treatments can also cause skin problems.
Chemotherapy used to treat ovarian cancer may cause hair thinning or loss. This is because it affects the healthy cells involved in hair growth.
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.
In order to ensure safety and minimise the impact of COVID-19, these physical workshops have been ceased until further notice. In the interim, you are able to register for an interactive Virtual Workshop, and order a free Confidence Kit to be delivered to your home. More details here: Look Good Feel Better Website
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.
Skin problems
Chemotherapy may cause skin problems including redness, itching, dryness and breakouts, while radiotherapy can cause dry or red skin in the area being treated.
Pain
People with cancer have pain for many reasons, and it can be very frightening to be in pain. It may help you to know there is usually something that can be done to help most types of cancer pain.
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).
Nerve problems and hearing changes
Some types of chemotherapy can cause nerve problems. More common symptoms include tingling, burning or numbness in your hands and feet.
Some chemotherapy can also 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.
Nerve problems
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.
Hearing changes
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.
Lymphoedema
Lymphatic fluid usually drains from your legs via lymph nodes in your pelvis. If you had lymph nodes removed from your pelvis during surgery, lymph fluid may not drain properly. This can cause a build-up of fluid and swelling in one or both legs, called ‘lymphoedema’.
Lymphoedema can also be a side effect of radiotherapy and sometimes may be caused by the cancer itself.
Lymphoedema usually develops gradually – sometimes months or even years after you have finished treatment. Lymphoedema can’t be prevented and there isn’t a known cure. But by being aware of the signs of lymphoedema, you can start treatment early to reduce swelling, improve movement and prevent infections. This treatment is called manual lymphatic drainage is usually done by a physiotherapist or lymphoedema therapist.
See your GP or another member of your healthcare team if you notice any of these changes after the initial side effects of your treatment have settled down:
a feeling of heaviness, tightness or tension in your leg or foot
swelling in your leg – you may see dents in your skin when
you take off tight socks or shoesaching in your leg or foot
swelling or aching in your genital area.
Lymphoedema can affect the way you feel about your body and appearance. You may feel more self-conscious or less attractive even if you cover up the swelling. Be kind to yourself and try to remind yourself it will get easier and there are things that can be done to help.
Risk of infection
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.
