Doctors can use chemotherapy to treat all stages of ovarian cancer. Treatment often involves administering multiple chemotherapy drugs at the same time. There is some evidence that chemotherapy can increase a person’s chances of survival.

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Chemotherapy is the use of pharmaceuticals to treat cancer. Chemotherapy drugs stop cancer cells from reproducing. In theory, this reduces the number of cancer cells within a person’s body.

For females in many developed countries, ovarian cancer is one of the most common causes of cancer-related death.

This condition arises when an individual’s ovarian cells grow abnormally. Without treatment, these cancer cells can spread to other body parts, causing serious problems.

This article takes a detailed look at chemotherapy for ovarian cancer. After discussing its typical uses and efficacy, the article details chemotherapy treatments for ovarian cancer subtypes.

It also describes the chemotherapy treatment process, side effects, and monitoring.

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According to a 2022 review, chemotherapy is a mainstay of ovarian cancer treatment. Doctors often recommend chemotherapy alongside surgery.

Sometimes, the aim of treatment is to cure ovarian cancer. Alternatively, chemotherapy can slow down the progression of ovarian cancer. This could manifest as an improvement in cancer symptoms, and an increase in life expectancy.

At what stage of ovarian cancer is chemo used for?

Doctors use chemotherapy for both early and late stage ovarian cancer.

However, some early ovarian cancer stages, such as 1A and 1B may not require chemotherapy.

According to the same 2022 review as above, there is some evidence that in people with ovarian cancer, those who receive chemotherapy have better chances of survival than those who do not.

However, there also exists evidence to the contrary.

A review in Cancer Medicine explains that around 80% of people who receive chemotherapy develop platinum resistant ovarian cancer (PROC). PROCs are cancer that responds to treatment containing platinum at first but comes back within 6 months after the completion of treatment.

In people with PROC, the chemotherapy response rate drops to 10–15%, and the average survival is between 9–12 months.

Epithelial ovarian cancer develops in the epithelial tissue, which is a lining around the outside of the ovaries.

According to the American Cancer Society (ACS), the first-line treatment for these cancers typically combines two types of chemotherapy drugs:

  • a platinum compound, such as cisplatin or carboplatin
  • a taxane, like paclitaxel (Taxol) or docetaxel (Taxotere)

However, these are not the only drugs for treating epithelial ovarian cancers. Other chemotherapy medications include:

  • etoposide (VP-16)
  • gemcitabine (Gemzar)
  • topotecan
  • ifosfamide (Ifex)
  • liposomal doxorubicin

The above forms of chemotherapy are systemic. This means that the chemotherapy drugs travel around a person’s body until they find some cancer cells.

However, some people with stage 3 ovarian cancer can receive intraperitoneal (IP) chemotherapy, alongside their systemic treatment.

In IP chemotherapy, doctors use a catheter to inject the drugs cisplatin and paclitaxel directly into the abdominal cavity. The idea is to concentrate the greatest possible amount of chemotherapy medication around the ovarian cancer.

Adding IP chemotherapy to systemic chemotherapy may improve survival rates. However, IP chemotherapy can also significantly worsen the side effects of chemotherapy.

A doctor may also administer bevacizumab (Avastin), which is a type of monoclonal antibody. They may continue administering bevacizumab after chemotherapy ends as maintenance treatment. This may be suitable for those with advanced ovarian cancer.

To treat ovarian cancer that is BRCA positive, a doctor may administer medications called PARP inhibitors. These are a type of targeted cancer drug.

Although technically considered a type of chemotherapy, targeted drugs work in a slightly different way. Different from traditional chemotherapy, they can target cancer cells more specifically. This means that they are more likely to leave healthy cells alone.

PARP inhibitors to treat BRCA positive ovarian cancer include:

  • olaparib
  • niraparib
  • rucaparib

Ovarian germ cell tumors are ovarian cancers that develop in ovarian cells that would normally develop into eggs.

According to the ACS, doctors will normally treat these cancers with BEP, a combination chemotherapy treatment. BEP uses the following chemotherapy drugs:

  • bleomycin
  • etoposide
  • cisplatin (Platinol)

Sometimes, ovarian germ cell tumors do not respond well to BEP. If this occurs, the doctor can recommend some alternative combination chemotherapy treatments. These include:

  • TIP: paclitaxel, ifosfamide, and cisplatin
  • VeIP: vinblastine, ifosfamide, and cisplatin
  • VIP: etoposide, ifosfamide, and cisplatin
  • VAC: vincristine, dactinomycin, and cyclophosphamide

Some ovarian germ cell tumors respond very well to chemotherapy, sometimes allowing doctors to use less toxic doses. Others are more resistant.

Ovarian stromal cell tumors are ovarian cancers that develop in the stromal cells, which hold the ovaries together.

As the ACS explains, it is rare for doctors to treat these ovarian cancers with chemotherapy. When they do, the typical treatment involves either carboplatin plus paclitaxel or PEB. PEB uses:

  • cisplatin
  • etoposide
  • bleomycin

Doctors can administer systemic chemotherapy for ovarian cancer intravenously.

This involves nurses attaching a drip to their patient’s vein. The drip contains the chemotherapy drugs, which slowly enter the bloodstream. After a chemotherapy session is over, medical staff can disconnect the drip.

Sometimes, doctors will recommend a central line instead. This technique uses a long tube, which passes through the chest or arm, to deliver chemotherapy drugs into a large vein. This tube remains there for the duration of treatment.

How many rounds of chemotherapy are needed?

Although every treatment plan is different, first-line chemotherapy plans will involve at least 3–6 cycles.

A cycle is around 3–4 weeks, during which the individual has one treatment session.

For those with recurrent or stage 4 ovarian cancer, treatment with chemotherapy is indefinite, or ongoing.

Before undergoing chemotherapy, a person will need to have a blood test. This is to make sure that chemotherapy is safe for them to receive.

An individual will have a blood test before every chemotherapy session. This could be the day before the session, or on the day itself.

Individuals may also find it helpful to prepare themselves for the possible side effects of chemotherapy. A person can speak with their doctor about how chemotherapy might affect them and how to prepare for the side effects.

As chemotherapy drugs travel around the bloodstream, they can potentially harm noncancerous cells. This can cause a wide range of side effects.

The following are common side effects of chemotherapy for ovarian cancer:

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Learn more about the side effects of chemotherapy:

How to manage side effects

Chemotherapy side effects can be hard to manage. However, the National Health Service (NHS) in the U.K. provides some advice that might help. This includes:

  • resting
  • asking loved ones for help with daily tasks
  • taking antiemetic medication for nausea or vomiting

During appetite loss, people should aim to eat small, frequent high calorie snacks instead of large meals.

People should also stay well hydrated before, during, and after treatment. This can help to reduce side effects and complications.

The ACS also provides resources for dealing with cancer-related side effects.

Doctors have ways to check whether an individual’s chemotherapy treatment is working. These methods include:

  • CA125 blood tests
  • imaging techniques

CA125 is a protein that exists at elevated levels, in some people with ovarian cancer. If blood tests show CA125 levels dropping, it could indicate that treatment is working.

Imaging techniques, such as CT scans, can show whether tumors have stopped forming, or growing.

Alongside surgery, chemotherapy remains a common treatment option for many kinds of ovarian cancer. These include epithelial ovarian cancer and ovarian germ cell tumors. Doctors are less likely to recommend this treatment for ovarian stromal cell tumors.

Doctors can use chemotherapy to treat any stage of ovarian cancer. However, this is a relatively uncommon treatment in the earliest stages. Treatment usually involves several types of chemotherapy medications in a systematic therapy.

Some people with ovarian cancer will have an improved life expectancy. However, many people with ovarian cancer will eventually stop responding to chemotherapy treatment. The research into new drugs continues.