Chemotherapy for ovarian cancer: cycles, surgery timing and side effects

Most women having chemotherapy for ovarian cancer receive around six cycles, usually given every three weeks, so the main course lasts roughly four to five months. Some schedules give part of the treatment weekly instead. The medicines are given through a drip in day care, and each session can take several hours. For very early, low-risk ovarian cancer, chemotherapy may not be needed after surgery, while some other early cancers need a shorter course. After the main course, some women are offered ongoing maintenance treatment, as tablets or a targeted drip, depending on gene test results. The exact plan depends on the type of ovarian cancer, how far it has spread, how much remained after surgery and your general health.

Surgery and chemotherapy are both central in ovarian cancer, and the order depends on how widespread the cancer is and how fit you are. When the surgeon expects to remove all visible cancer safely, surgery usually comes first, followed by chemotherapy. When the cancer is widespread, or you are too unwell for a major operation straight away, a few cycles are often given first to shrink the disease, then surgery is performed, followed by the remaining cycles. This is sometimes called interval surgery. A specialist gynaecological cancer team, including a surgeon experienced in ovarian cancer, should review your scans and decide the order. It is reasonable to ask why a particular sequence has been chosen for you.

Two side effects dominate ovarian cancer chemotherapy. Hair loss is expected with the most common schedules and usually starts a few weeks after the first cycle, often including eyebrows and body hair. Hair generally begins to regrow within a few months of finishing. The second is nerve damage, felt as tingling, numbness or burning in the fingers and toes, which can build up with each cycle and sometimes lasts after treatment. Joint and muscle aches for a few days after each cycle, tiredness, feeling sick, lowered infection resistance and allergic reactions during the drip are also common. Report tingling early, because your team may adjust the plan to limit lasting damage.

Usually around six cycles

Every three weeks, over roughly four to five months.

Before or after surgery

A few cycles may come first when the cancer is widespread.

Hair loss and tingling dominate

Both are expected, and tingling should be reported early.

It cannot tell you how many cycles or which order suits you. Your scans and surgical team decide that.

It also cannot predict how your cancer will respond. Blood tests and scans help your team judge that.

The blood marker test

A tumour marker blood test is often checked before each cycle. The trend over several tests matters more than any single result, and the marker can rise for reasons other than cancer. Your oncologist interprets it alongside scans and symptoms, so try not to read too much into one number.

Inherited gene testing

Many women with ovarian cancer are offered a blood test for inherited gene faults. A positive result can guide maintenance tablets and also matters for relatives, including daughters, sisters and brothers, who may be offered testing and screening. A genetic counsellor can help your family understand what the result means.

Gene tests on the tumour

The tumour tissue itself may be tested for faults in how cells repair damaged DNA, even when the blood test is normal. These results help decide whether maintenance tablets are likely to be useful after the main course, so ask whether this test has been arranged and when results are expected.

Maintenance treatment

After the main chemotherapy course, some women take tablets or receive a targeted drip for a period to keep the cancer under control. These treatments have their own side effects, such as tiredness, feeling sick and low blood counts, and need regular blood tests. Your oncologist will explain whether maintenance suits you.

Fertility

Treatment for most ovarian cancers removes both ovaries and the womb. Some younger women with very early cancer confined to one ovary may be able to keep the other ovary and womb. If having children matters, raise this before surgery, as options must be planned in advance with your team.

Surgical menopause

Removing the ovaries brings an immediate menopause, with hot flushes, sleep problems, vaginal dryness and a risk of bone thinning over time. Whether hormone replacement is suitable depends on the type of ovarian cancer. Your team can advise on safe ways to manage these symptoms.

Coping with hair loss

Scalp cooling is less effective with some ovarian cancer schedules and may not be offered. Many women choose to cut their hair short before it falls, and use scarves, caps or a wig. Losing eyebrows and eyelashes can feel especially hard, and support from nurses and other women helps.

Protecting hands and feet

Numb feet increase the risk of falls and unnoticed injuries. Wear well-fitting footwear at home, check your feet daily, test bath water with your elbow and keep floors clear. Tell your team if buttoning clothes, writing or walking becomes difficult, so they can review the plan.

Allergic reactions

Some ovarian cancer medicines can cause allergic reactions, and with certain medicines the risk rises after several cycles. Medicines to reduce this are given beforehand, and nurses monitor you during the drip. Tell the nurse at once if you feel flushed, itchy, breathless or unwell.

Fluid in the tummy

Ovarian cancer can cause fluid to build up in the tummy, causing swelling, discomfort, breathlessness and early fullness when eating. This can be drained with a thin tube if it becomes uncomfortable. Chemotherapy often reduces the fluid over time, but report any rapid swelling or breathlessness to your team.

If the cancer comes back

Ovarian cancer can come back after treatment. Further chemotherapy is often possible, and the choice of medicines depends partly on how long it has been since the last course. Your oncologist will explain the options, which may also include targeted medicines, clinical trials or care focused on comfort.

Costs and planning

Cost depends on the schedule, number of cycles, surgery, gene tests, maintenance tablets and scans. Maintenance treatment and gene tests can add significantly. Ask for a written estimate covering the whole plan, and ask about insurance, government schemes and patient assistance programmes that may help your family through treatment.

What to do next

Ask whether surgery comes first or after some cycles, ask about inherited and tumour gene tests, raise fertility before surgery, and report tingling, tummy swelling or fever promptly.