Other Standard Chemotherapy Treatments
Some other chemotherapies for ovarian cancer are:
- albumin-bound paclitaxel
- mouth sores or bleeding gums
- higher risk of infection
- bleeding or bruising
Many of these side effects are temporary. Your doctor can help minimize them. Other side effects, such as kidney damage, can be more serious and long-lasting. Even if you still have one of your ovaries, chemotherapy can lead to early menopause.
Radiation is a targeted treatment that uses high-energy rays to destroy tumors. It can be delivered externally or internally.
Radiation isnt a primary treatment for ovarian cancer. But it can sometimes be used:
- to help treat a small, localized recurrence
- to ease pain from large tumors that are resistant to chemotherapy
- as an alternative if you cant tolerate chemotherapy
Before your first treatment, youll need a planning session to determine your exact positioning. The goal is to hit the tumor while limiting damage to healthy tissue. Pinpoint tattoos are sometimes used to permanently mark your skin.
Careful attention is paid to positioning each time. Although that can take a while, the actual treatment only lasts a few minutes. Radiation isnt painful, but it does require you to remain perfectly still. Treatments are given five days a week for three to five weeks.
Side effects usually resolve when treatment ends but can include:
- red, irritated skin
rarely treated with hormone therapy. Its more often used for stromal cancer.
- hot flashes
Mechanisms Of Resistance To Paclitaxel
Paclitaxel exerts its effect by binding to the -subunit of tubulin and causing tubulin polymerization in the absence of GTP, a factor that is normally required for microtubule polymerization. Once bound, paclitaxel stabilizes microtubules and prevents tubulin depolymerization. This inhibits the shortening of the microtubules during anaphase when it is necessary to pull apart sister chromatids, which results in cancer cell death. Below, we discuss several mechanisms of resistance to paclitaxel .
Figure 2. Schematic illustration of paclitaxel resistance.
Emerging Studies: Other Resistance Mechanisms To Platinum Agents
More recently, other examples of platinum resistance have been explored. These include upregulating of de-ubiquitination of proteins targeted for proteasomal degradation, increased cisplatin-induced autophagy, and dependence on mitochondrial oxidative phosphorylation for energy supply. Metabolic reprogramming and angiogenesis are hallmarks of cancer that provide tumor supply of nutrients and oxygen, energy efficiency, and drive cell survival thus, they are also speculated to be involved in chemotherapy resistance. For instance, it has been recently shown that upregulation of the serine/threonine kinase Aurora-1 in cisplatin-resistant ovarian cancer increases glycolysis and suppresses cell senescence by stimulating the transcription factor sex determining region Y-box 8 . Another study has shown that fibrillin-1 is significantly upregulated in cisplatin-resistant ovarian cancer organoids and tissues and that FBN1 drives phosphorylation of VEGF2 and nuclear translocation of the transcription factor signal transducer and activator of transcription 2 , which affects the expression of genes associated with STAT2-mediated glycolysis and angiogenesis. A combination of FBN1 knockout and an antiangiogenic drug was demonstrated to improve cell sensitivity to cisplatin. Altogether, there are several emerging studies on mechanisms of platinum resistance in ovarian cancer.
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How Likely Is It For Ovarian Cancer To Come Back
One of the most significant factors in determining a patients risk of recurrence is the stage of the cancer at diagnosis:
- Patients diagnosed in stage 1 have a 10 percent chance of recurrence.
- Patients diagnosed in stage 2 have a 30 percent chance of recurrence.
- Patients diagnosed in stage 3 have a 70 to 90 percent chance of recurrence.
- Patients diagnosed in stage 4 have a 90 to 95 percent chance of recurrence.
You can find more information on managing ovarian cancer recurrence in videos from our 2020 National Conference.
Starting Chemotherapy For Ovarian Cancer
Chemotherapy usually requires a day trip to your hospitals specialist unit, although on some occasions you may be admitted to hospital as an inpatient.
Before you begin treatment, you will be checked to see that you are fit enough to undergo treatment. A nurse will take your blood and ask some questions about your general wellbeing.
Your blood will be sent for tests and there will be a wait for your chemotherapy drugs to be ordered, then prepared.
Once you have been given the all clear to have treatment, you will go to the chemotherapy unit. The nurse will administer some anti-sickness drugs through your line first, along with any other medications you have been advised to take.
The chemotherapy itself is given through your line in the form of a drip. The nurse will set the timing of your drip through a pump which will administer the drugs across a number of hours.
Your nurse will check on you at regular intervals to monitor your temperature, heart rate and blood pressure. This is to ensure you are not having any reactions to the drugs.
Once all of the chemotherapy has been administered you will be given some anti-sickness drugs, along with a supply of any other medication to take in between cycles. You will then be discharged from the unit, returning for your next treatment three to four weeks later.
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Targeted Therapy For Ovarian Cancer
Targeted drugs find and change specific traits of cancer cells that arent found in healthy cells. They do less damage to healthy tissue than chemotherapy or external radiation treatments.
Tumors need blood vessels to grow and spread. An IV drug called bevacizumab is designed to stop tumors from forming new blood vessels. Its given every two to three weeks.
show that bevacizumab can shrink tumors or slow epithelial ovarian cancer progression. Potential side effects include:
- high blood pressure
- low white blood cell counts
Poly polymerase inhibitors are oral medications. Theyre used when ovarian cancer is associated with BRCA gene mutations.
Two of these, olaparib and rucaparib , can be used for later-stage ovarian cancer after trying chemotherapy. Olaparib is also used to treat recurrent ovarian cancer in women with or without BRCA mutations.
Another PARP inhibitor, niraparib , can be given to women with recurrent ovarian cancer, with or without BRCA mutations, after trying chemotherapy.
Side effects of these medications can include:
Hormone Therapy Medications Learn More > > More > >
Lupron is a GnRH agonist approved for palliative treatment of advanced prostate cancer. It is also used to treat breast and ovarian cancer, though it is not FDA-approved for these indications.
Tamoxifen is a selective estrogen receptor modulator approved for adjuvant treatment to prevent recurrence or spread of early breast cancer and for treatment of women and men with advanced or metastatic breast cancer. It is also used to prevent breast cancer in high-risk women. It is sometimes used to treat ovarian cancer, though it is not FDA-approved for this indication.
Zoladex is a GnRH agonist approved for palliative treatment of advanced prostate cancer and, treatment of localized prostate cancer in combination with Eulexin and palliative treatment of breast cancer in premenopausal women. It is also used to treat ovarian cancer, though it is not FDA-approved for this indication.
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How Often Do You Have It
You usually have chemotherapy once every 3 weeks. You usually have the chemotherapy drugs on day 1 followed by a rest period to allow you to recover from side effects.
Each 3 week period is called a cycle of treatment. You normally have about 6 cycles in all, but you may have more.
It takes 3 to 4 hours to have each treatment in the outpatients department. On rare occasions you might have it over 24 hours, when you would stay in hospital overnight.
Surgery For Ovarian Cancer
Surgical options depend on how far your cancer has spread.
For early-stage ovarian cancer, it may be possible to preserve fertility. Its important to consult with your doctor before you have surgery.
If cancer is found in only one ovary, your doctor can remove it as well as remove the fallopian tube its connected to. Youll still ovulate and menstruate because of your remaining ovary, maintaining your option to get pregnant.
When cancer is found in both ovaries, both of your ovaries and both fallopian tubes might be removed. This will trigger menopause. Symptoms can include hot flashes, night sweats, and vaginal dryness. Your doctor may also advise you to have your uterus removed.
In early-stage ovarian cancer, less-invasive laparoscopic surgery may be an option. This is done with a video camera and long, thin instruments inserted through tiny incisions.
For more advanced ovarian cancer, open abdominal surgery is necessary.
A procedure called debulking cytoreductive surgery is used to treat stage 4 ovarian cancer. It involves removal of your ovaries and fallopian tubes, along with any other affected organs. This can include:
- uterus and cervix
- tissue that covers your intestines and lower abdominal organs
- part of your diaphragm
If you have fluid in your abdominal area or pelvis, it may be removed and examined for cancer cells as well.
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What Happens When You Have Chemotherapy Treatment
Most people have chemotherapy at their local hospital. At the hospital some blood samples will be taken for testing before each session of chemotherapy. These are checks to make sure that it’s safe to go ahead with your treatment.
When you have your treatment, you’ll be shown into the treatment room where you’ll be invited to settle yourself in a comfy chair. The nurse will place a cannula into one of the veins on your hand or arm and attach a drip so the drugs can get into your bloodstream. These drugs are given over a few hours. This might feel a bit uncomfortable as the drip goes in. If you’re having carboplatin and paclitaxel then the nurse will give you the paclitaxel first followed by the carboplatin.
You may also have treatment through a tube in your chest. These are semi-permanent and stay in place for the course of your treatment.
You may feel more anxious about chemotherapy because of the number of blood tests that are needed or because it involves needles. If this is something that worries you, you can ask your nurse to put some anaesthetic cream on your arm about half an hour before the blood test, as this will make it less uncomfortable.
You’ll usually spend most of the day at the hospital so you might want to ask a relative or friend to keep you company, if allowed by your hospital. A couple of magazines or a good book or watching something on your phone or tablet can also help to pass the time.
How Soon After Ovarian Cancer Surgery Does Chemo Start
Chemotherapy for ovarian cancer may be given before or after surgery to remove the tumor. If administered before, the primary goal of the chemotherapy is to shrink the tumor so that it can be more easily removed. If it is administered after the surgery, the goal of the chemotherapy is to destroy any cancer cells that may still be in the patients body. When chemotherapy is needed after surgery, treatment typically begins as soon as the patient is deemed healthy enough to withstand the treatment and its side effects.
In Moffitt Cancer Centers gynecological clinic, our gynecologic oncologists, radiation oncologists, radiologists and other professionals collaborate to review every new case, ensuring each patients treatment plan reflects the unique challenges of her cancer. If you would like to discuss your ovarian cancer treatment options with an expert at Moffitt, call or fill out a new patient registration form online.
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Sexuality And Intimacy Issues
Interest in sexual intimacy often decreases for chemotherapy patients for many reasons, including additional stress and the side effects of treatment. Patients need to maintain a positive self-image during this time and sustain open communication with their partners. When a patient is ready to engage in sexual activity, she should consider taking the following actions:
- Make time for rest before and after sexual activity to preserve energy.
- Use water-soluble lubricants as her vagina may be drier than usual due to hormonal changes.
- Experiment to find comfortable positions and avoid those that will tire her quickly.
Targeted Therapies For Ovarian Cancer
While each type of targeted therapy works differently, all attack the inner workings of cancer cells the so-called programming that makes them different from normal, healthy cells. Our doctors analyze the molecular profile of each persons tumor to recommend a personalized treatment plan involving targeted therapy and/or chemotherapy.
Targeted therapies used in the initial treatment of ovarian cancer include:
- Poly polymerase inhibitorsPARP inhibitors are oral drugs that help fight cancers caused by inherited mutations in the BRCA1 and BRCA2 genes, as well as other genetic alterations that can impair a cells ability to repair DNA. They exploit the weakness of tumor cells to repair DNA by blocking PARP-1, an enzyme that is important for cancer cells to survive and grow.
- Bevacizumab Bevacizumab is a targeted therapy that is given as an infusion into the vein and blocks the growth of blood vessels that supply and nourish the tumor.
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Clinical Trials For Ovarian Cancer
Clinical trials compare standard treatment with innovative new therapies not yet approved for general use. Clinical trials can involve people with any stage of cancer.
Ask your oncologist whether a clinical trial is a good option for you. You can also visit the searchable database at ClinicalTrials.gov for more information.
You might find it helpful to supplement your cancer care with complementary therapies. Some people find they enhance quality of life. Some you might consider are:
- Aromatherapy. Essential oils may improve your mood and reduce stress.
- Meditation.Relaxation methods can help ease pain and improve sleep.
- Massage therapy. This therapeutic treatment for your body might help lower stress and ease anxiety and pain.
- Tai chi and yoga. Nonaerobic mind-body practices that use movement, meditation, and breathing can promote your overall sense of well-being.
- Art therapy and music therapy.Creative outlets may help you deal with the emotional aspects of cancer and treatment.
- Acupuncture. This form of Chinese medicine in which needles are strategically placed can relieve pain and other symptoms.
Check with your doctor before trying new therapies, especially dietary or herbal supplements. These can interact with your medications or cause other problems.
You might also want to consult with a palliative care doctor. These specialists work with your oncology team to provide symptom relief and improve quality of life.
What Is Chemotherapy For Ovarian Cancer And When Is It Given
Chemotherapy works by using cytotoxic drugs to attack and kill cancer cells. It is one of the most commonly used treatments for ovarian cancer, along with surgery.
Most women with ovarian cancer are offered chemotherapy at some point during their treatment. When its used will depend on the individual patient and the stage of their cancer. In fact you may not require this treatment at all if your cancer has been discovered at a very early stage.
Your consultant and specialist nurse will explain if and how chemotherapy fits into your treatment pathway. Here are some examples about when and why chemotherapy might be appropriate.
After surgery for ovarian cancer
If you are diagnosed with a borderline or early stage one ovarian cancer you may have chemotherapy after your surgery to ensure all the cancer has been removed and to help prevent the cancer from returning in the future.
If your ovarian cancer is found to have spread to a more advanced stage you may have de-bulking surgery . Chemotherapy can be used to eradicate any remaining signs of cancer after surgery.
Chemotherapy which is administered after surgery is known as adjuvant chemotherapy.
Before surgery for ovarian cancer
If your ovarian cancer has been diagnosed at a later stage then it might not be possible to perform surgery initially. Chemotherapy will be given first to shrink as much of the ovarian cancer as possible and make any subsequent surgery safer and more effective.
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Considering Complementary And Alternative Methods
You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.
New Drug Class Gives Hope To Some Ovarian Cancer Patients
The study provides insights into how the cancers resist treatments, and which patients may benefit from treatment.
Barbara Clements, , 253.740.5043
A study published today in Nature Communications shows that the drug rucaparib has been effective in treating certain types of ovarian cancers if used early in treatment, after a diagnosis, and before the cancer cells build up a resistance to chemotherapy.
Rucaparib is in a relatively new class of drugs – Poly polymerase or PARP inhibitors – which have been approved for therapy in ovarian cancers. This study provides insights into both how the cancers resist treatments, and which patients may respond favorably to the drug, said lead author Dr. Elizabeth Swisher, a UW Medicine gynecologic oncologist and a professor of obstetrics and gynecology at the University of Washington School of Medicine. She also co-directs the Breast and Ovarian Cancer Research Program at the Seattle Cancer Care Alliance.
The paper represents collaborative work of researchers in 75 universities and focuses on treatments of 493 patients between April 2013 and October 2016.
PARP inhibitors are a drug class that has become an important therapeutic for ovarian and some other cancers. This study looked at pretreatment biopsies to define predictors of response to treatment and mechanisms of resistance , which is critical to understanding best use of these therapies, Swisher said.
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