Information & support About ovarian cancer Chemotherapy . Download our booklet on chemotherapy Order printed booklet . Content What is chemotherapy? What chemotherapy will I need? Having treatment Chemotherapy side effects Treatment with Carboplatin Treatment with Taxol Caelyx Caring for yourself when you are having chemotherapy Support for you . Ovacome is a national charity providing support to anyone affected by ovarian cancer. We give information about symptoms, diagnosis, treatments and research. Ovacome also runs a telephone and email support line and works to raise awareness and give voice to all those affected by ovarian cancer. This booklet is part of a series giving clinical information about ovarian cancer. It gives information about the chemotherapy drugs commonly used to treat those who have ovarian cancer. . What is chemotherapy? Chemotherapy is the name given to drug treatment that can kill cancer cells (cytotoxic). There are many different chemotherapy drugs that are used for different cancers. They work in various ways, but often attack the cancer cell structures and DNA to stop or control the disease. Chemotherapy drugs are used to treat ovarian cancer that has, or may have, spread. These drugs are carboplatin and paclitaxel (Taxol) in the first instance (called first line treatment). There are other drugs that are not cytotoxic in the way they work which are increasingly being used to treat cancer. These affect other characteristics of cancer, such as unregulated growth, development of new blood vessels, and cancer’s ability to avoid the immune system. Chemotherapy and these other drugs can be referred to as systemic anti-cancer therapy (SACT). If the cancer comes back it may be treated again with the same drugs, or it may be treated with other drugs such as liposomal doxorubicin (Caelyx). These drugs are given through an intravenous drip in the hand or arm. Sometimes they are given through a permanent central line such as a Hickman line, which is inserted under anaesthetic through the chest into a large vein and can stay in place for months. . What chemotherapy will I need? The chemotherapy you will be offered depends on how far your ovarian cancer has spread, this is the staging, and how active the cancer is, this is the grading. If your cancer is at stage 1a and grade 1 or 2 then you will probably not be recommended to have chemotherapy. If your cancer is at stage 1a and grade 3, or at stage 1c then you will probably be offered carboplatin on its own. Cancers which have spread further to stage 2, 3 or 4 will probably need treatment with carboplatin and Taxol. These are given one after the other (usually Taxol first then carboplatin) in a chemotherapy clinic session. . Having treatment When you are ready to start your chemotherapy treatment you will be given an appointment at the chemotherapy day unit. You will be asked to give a blood sample, or this may have been done a day or two before. This is to check that your kidneys are working well and to check your white and red blood cell levels. You may have a scan to check the size of your tumour. On the day of your appointment you will see a doctor or a nurse before the treatment starts and they will ask you about your recent health. If the blood results are safe for treatment your chemotherapy drugs will be prepared for you. The nurse will put a cannula (a short thin tube) into your vein and inject pre-chemotherapy medications through it. These include anti-sickness drugs and steroids to reduce the risk of allergic reactions. The nurse will then set up your chemotherapy drip, which goes through the cannula into your blood stream. If you are having Taxol this will be given first and takes about three hours to go through. It will be followed by carboplatin which usually takes about an hour. Tell the nurse if your vein or arm becomes painful or swollen. Plan to stay in the chemotherapy day unit for several hours. When the drip has finished you can go home. This process is described as a cycle or session of chemotherapy. You will be given more anti-sickness drugs and steroids to take home with you and instructions on how to take them. Very occasionally chemotherapy may cause an allergic reaction while it is being given. Signs of this happening are: A rash Itching Looking flushed Being short of breath Swelling of the face or lips Feeling dizzy Abdominal, back or chest pain Feeling unwell If you experience any of these symptoms while you are being given chemotherapy, tell the nurse immediately. You will then be given drugs to minimise the risk of a reaction; the flow rate of the chemotherapy may be slowed down, the session may be delayed, or the chemotherapy stopped. . Chemotherapy side effects All drugs have side effects; but that does not mean they will affect you. Side effects can be mild to severe, they may improve during the treatment - or get worse. More side effects may develop as your treatment progresses. Side effects may depend on how often you have had the drug before, your health and the dosage. Tell your team if you experience any side effects and ask for help to manage it. If side effects are sudden or severe, call the chemotherapy emergency contact number you will have been given. . Possible side effects of carboplatin, Taxol and Caelyx A drop in the number of white blood cells, making you prone to infections - call the hospital if your temperature goes up to 37.5 degrees centigrade twice in an hour or immediately if it rises to 38 degrees centigrade or above. A drop in red blood cells causing tiredness and breathlessness - you may need a transfusion. Bruising caused by a drop in the number of platelets in your blood. Nausea and sickness - these can be controlled by anti-sickness medicines. Kidney or liver changes - this is detected by the blood tests before your treatment. Your kidneys and liver usually recover after treatment. Your periods may stop. Your fertility may be affected. Diarrhoea and/or constipation – if you experience these contact your medical team for advice. Numbness and/or tingling in fingers and toes. This affects about four per cent (four in 100) of people using carboplatin and 30 to 80 per cent (three to eight in 10) of people using Taxol. For three to 15 per cent (three to 15 per 100) of these people it can be severe. It may get worse immediately after treatment but usually resolves during the following year. Contact your medical team for advice. Loss of appetite. Loss of taste and smell. A sore mouth - this can be helped by using mouthwash and a soft toothbrush, you can use mouthwash with a local anaesthetic (Difflam). . Treatment with Carboplatin Carboplatin is a platinum-based drug that attacks cancer cells by damaging the DNA. It has been used for many years as an effective treatment for ovarian cancer and some other cancers too. It is often given in a 21 day cycle. That means you will have a carboplatin chemotherapy session every 21 days, usually for a total of six cycles. Like all drugs, carboplatin has benefits and risks, which include side effects. Most patients feel well on the day they receive their carboplatin and on the next day too. They are more likely to experience side effects on the second and third days after treatment. Your medical team can give you medication to help. Side effects that are experienced by between 10 per cent (one in 10) and one percent (one in 100) of people using carboplatin are: Hair thinning (not usually complete hair loss). Loss of hearing high pitch sound (this is usually temporary). Ringing in the ears. . Treatment with Taxol Taxol is the brand name for paclitaxel. It is made from the needles of the yew tree. It was first discovered in the 1960s and is an effective chemotherapy drug that has been used to treat ovarian cancer and other cancers. It works by stopping cancer cells from dividing into new cells and spreading. Taxol is given with carboplatin to those with ovarian cancer at stage 2, 3 or 4 meaning that the cancer has spread or is at a later stage. Cancers at these later stages are more likely to recur and Taxol is used to control the cancer and maximise the time between any recurrences. It is usually given in cycles of 21 days. It is given through a drip into the bloodstream and is usually given before carboplatin. In the chemotherapy unit, before you receive Taxol, you will be given a steroid injection or steroid tablets plus an antihistamine injection to minimise any allergic reaction you may have to the drug. You will also be given medicine to stop heartburn. . Taxol side effects Like all drugs, Taxol has side effects. These are side effects that more than 10 per cent (one in 10) of people will experience: Aching joints, which affects 60 per cent of people (six in 10) starts a couple of days after treatment and lasts about five days. Mild allergic reactions such as a rash or redness on the face affecting 34 per cent of people (more than three in 10). Hair loss, usually temporary and can affect all body hair, regrowth starts when treatment ends. You may be offered scalp cooling. You may qualify for support towards the cost of a wig. Some other less common Taxol side effects are experienced by one per cent to 10 per cent of people (between 1 in 10 and 1 in 100). These are: Redness, swelling or leaking around the site of the drip (tell the nurse immediately). Skin rashes and nail changes. There are other much less common side effects that fewer than one per cent (one in 100) of people will get: Abdominal pain including feeling bloated or having wind or indigestion. Low blood pressure. Blood clots, tell the nurse if you have redness, pain or swelling in your legs, chest pain or breathlessness. Changes to your heartbeat, it may feel irregular or slow. Tell your medical team, it is usually temporary but can be permanent in a very few people. Muscle weakness in the arms hands and legs. A high temperature - over 38 degrees centigrade. Lung changes that can cause coughing and breathlessness. Swelling in the arms and legs caused by fluid build - up. Hearing or sight disturbances. Dizziness or fitting. Severe skin reaction, wear sun protection on your hands and feet during treatment. Changes in your finger or toenails. . Caelyx Caelyx can be given in combination with carboplatin instead of Taxol. If your ovarian cancer becomes resistant to platinum-based drugs such as carboplatin, you may be offered Caelyx on its own or in combination with other drugs as an alternative to carboplatin. Platinum resistance is generally defined as when ovarian cancer comes back less than six months after carboplatin treatment ended. This indicates that the cancer is resistant to platinum drugs, so they will not work effectively. Caelyx was originally developed from anti-cancer compounds found in soil-based microbes. Caelyx is the brand name of liposomal doxorubicin. It works by attacking ovarian cancer cells’ DNA and stopping it from creating new cells and spreading. Caelyx comes in the form of a bright red liquid that is given through a drip into the bloodstream using a cannula. It is usually given every four weeks for between four and eight cycles. Each treatment takes from 60 to 90 minutes to go through. The red colour means your urine may be red or pink for around 48 hours after treatment. Before you are given Caelyx you will have blood tests to check your levels of red and white blood cells and platelets, plus your liver and kidney function. Your blood pressure will be taken, and your heart may be checked using an ECG (electrocardiogram) or an echocardiogram which uses ultrasound. This is to make sure you are well enough to have the treatment. . Caelyx side effects More than 10 per cent (one in 10) of people using Caelyx will experience one or more of these more common side effects: PPE (palmar-plantar erythrodysesthesia) is a redness, soreness and peeling on the palms of the hands and soles of the feet. It affects about 45 per cent (45 in 100) of people. You can minimise and help to treat this by keeping cool and avoiding heat and hot water. You can try holding ice packs during treatment; not wearing gloves socks or tight shoes; not rubbing your skin and avoiding vigorous exercise. Your nurse can advise you on suitable creams to take care of your skin. Tell your nurse if you see signs of PPE. Sores in the throat that make it painful to swallow (tell your doctor or nurse). Weight loss. Hair thinning, sometimes hair loss. Between one per cent and 10 per cent (1 in 100 to 10 in 100) will experience these less common Caelyx side effects: Watery or sore eyes or blurred vision. Heart muscle damage, this usually recovers when treatment ends. Your heart will be checked before each session. Sensitivity to the sun, stay in the shade and use protection until several months after treatment ends. Itchy inflamed skin. Abdominal pain. Thrush (fungal infection) in the mouth, easily treated with solution and pastilles. Cold sores. Bone muscle or joint pain. Swollen legs, hands and arms caused by a build-up of fluid. Nail changes. Sore tongue. Less than one per cent (one in 100) experience the following rare Caelyx side effects: Confusion Lung changes; tell your doctor if you develop a cough, wheezing, breathlessness or if existing breathing problems get worse. . Caring for yourself when you are having chemotherapy There are steps you can take to help yourself while you are having chemotherapy by watching for any signs of infection, reporting any symptoms promptly to your medical team and protecting yourself from risks of infection. Chemotherapy suppresses the immune system and so carries a risk of infection. Contact your hospital by calling the chemotherapy emergency number immediately if you develop signs of infection such as headaches, sore throat, cough, pain on urination, rashes, aches, shakes and shivers. Also call the emergency telephone number or local A+E if your temperature rises to 38 degrees centigrade. Do not contact your GP. Protect yourself by avoiding people with obvious infections, avoid crowded places and live vaccines. Ask your chemotherapy nursing team about your diet and any foods to avoid. If you are having treatment from a doctor or a dentist that is not to do with your cancer always tell them that you are having, or have had, chemotherapy. Only your oncologist (cancer doctor) can make decisions about your chemotherapy. Any other clinicians must contact your chemotherapy unit to discuss any treatment that may affect your chemotherapy. Tell your oncologist if you are thinking of using complementary or alternative treatments as some may affect your chemotherapy. Support for you . If you would like more information on the sources and references for this fact sheet, or you would like to discuss anything about ovarian cancer, please phone our support line on 0800 008 7054 Monday to Friday between 10am and 5pm. Booklet text reviewed by Dr Cathy Hughes,Consultant Nurse Gynaecology/Oncology & Deputy Divisional Director of Nursing (Gynaecology and Reproductive Medicine), Women’s, Children’s and Clinical Support, Imperial College Healthcare NHS Trust and Baleseng Nkolobe, Macmillan Chemotherapy Nurse Practitioner, Imperial College Healthcare NHS Trust Disclaimer Ovacome booklets are designed to provide information, advice and support about ovarian cancer to health care professionals, patients and the public. Whilst Ovacome makes every attempt to ensure the accuracy and reliability of the information contained in the booklet, it is not a formal legal document. The information provided is accurate at the time of printing; please take into account the fact that medical research is constantly changing. The information provided here is not a substitute for professional medical care. If you suspect you have cancer you should consult your doctor as quickly as possible. Ovacome cannot accept liability for any inaccuracy via third party information from sources to which we link. Rights reserved. Last updated October 2020 Due for review October 2022 Did you find this fact sheet helpful? We welcome your feedback. If you have any comments or suggestions, please email [email protected] or call 0207 299 6653.