Ovarian cancer: what happens after treatment?
Many people are surprised to discover that life after treatment presents its own challenges.
During treatment, you may have been busy with appointments and focused on treatment, but afterwards you may feel anxious rather than secure. You might worry about every ache and pain and wonder if the cancer is coming back. Regular check-ups and talking to your doctor about what to expect if the cancer comes back may reassure you.
Some people feel pressure from their family and friends to get back to their ‘normal life’. Everyone will eventually re-establish a daily routine, but it will be at their own pace and may be different from how things were in the past. Some people call this a ‘new normal’.
Give yourself time to adjust to physical and emotional changes. You may not be fit enough to do your usual activities around the house. If you’re returning to work, ease back into it slowly, rather than rushing back the week after leaving hospital.
Some people say that after cancer, they have changed priorities and see life with a new clarity. For example, you may decide to spend more time with family, start a new hobby, travel or get involved in advocacy or volunteer work.
Talking to someone who has had ovarian cancer may help you deal with the changes in your life. Call 13 11 20 and ask to speak to a Cancer Connect volunteer.
Research into ovarian cancer
Research for ovarian cancer is ongoing. Some recent clinical trials may involve risk reduction, targeted therapy, gene therapy and immunotherapy. These may not be approved or available as standard treatments. Always discuss diagnostic and treatment options with your doctor.
Coping with side effects
It may take some time to recover from treatment. You will find that there are physical and emotional changes. This section discusses ways to cope with these changes.
Many women say that tiredness (or fatigue) is a major problem. This is not surprising, as most women start chemotherapy soon after their operation. Travelling to and from hospitals and clinics for treatment is also very tiring. If you start work again during the treatment and/ or you have a home and family to care for, you will almost certainly find that you are very tired. If you are on your own and have to do everything yourself, tiredness will be a major problem.
Your tiredness may continue for quite a while even after treatment has finished. Recovery is different for everyone. Many women feel ‘normal’ within a couple of months of finishing chemotherapy; for others, it can take longer. It may help to talk with your family and friends about how you feel. Talk about how they can help you. You may need to plan your activities during the day so that you get regular periods of rest.
If you have had both your ovaries and your uterus removed, you will no longer have your periods and it will not be possible to become pregnant. If you have not been through menopause already, you may experience premature menopause. Because your ovaries have been removed, menopausal symptoms such as hot flushes, mood swings and vaginal dryness could be more sudden than they would be with a natural menopause. You will need to talk with your doctor about the need for hormone replacement therapy.
Hormone replacement therapy may be taken to control the symptoms of menopause. Oestrogen, a hormone normally produced by the ovaries, is taken to replace your natural oestrogen. Hormone replacement therapy can also reduce the risk of osteoporosis (thinning of the bones).
Using hormone replacement therapy for more than five years increases the risk of some diseases including some cancers. However it also decreases the risk of some other diseases and cancers.
You will need to discuss the issues with your doctor and weigh up the benefits and possible risks for yourself. There are also many useful books about menopause that may help you with your decisions.
Feeling low or depressed
It isn’t uncommon to feel very low or depressed after a cancer diagnosis. Don’t be too surprised if you do feel fed up and unhappy at certain times. It may help to think about why you feel like you do. Some people feel sad or depressed because of the changes that their cancer has caused. Others become very down because they are frightened about the future. Whatever it is that is causing you to feel down, you need to get support.
There is a difference between feeling down and sad for a while and feeling very depressed for long periods. Depression can go on for a long time if you don’t get the right help. If you have had one or more of these signs for a few weeks or more you should see your GP:
- feeling very sad and low most of the time
- not being able to enjoy life as you usually do
- having negative thoughts about yourself a lot of the time
- changes in eating habits (eating much more or less than usual)
- weight gain or loss
- feeling very tired a lot of the time
- loss of concentration
- loss of interest in sex
- changes in sleeping habits (not being able to get to sleep, waking in the early hours of the morning or sleeping more than usual)
- feeling very anxious and often upset
- feeling like you want to die or end your life.
If you have some of these signs or think you may be depressed, you must get some help. Be honest with your doctor about how bad you feel. This will help your doctor advise you about the type of support and care you need.
It is common to have bowel problems after surgery for ovarian cancer. These can occur for some time after treatment. They may include diarrhoea, cramps or constipation. In particular, it is important not to become constipated. Talk with your doctor, nurse or dietitian about ways you can prevent constipation, and relieve any other symptoms.
Sometimes the bowel becomes blocked because of the surgery you have had. It may also occur because the cancer has come back. This blockage is called a bowel obstruction. If you have symptoms such as nausea (feeling sick), vomiting, abdominal discomfort or pain you should see your doctor or specialist as soon as possible. Quite often a bowel obstruction can be relieved with simple treatment in hospital. Occasionally you may need another operation to relieve your symptoms.
Lymphoedema is swelling of a part of the body, usually the arms or legs. It may occur after treatment for ovarian cancer if you have had some of the lymph nodes in your pelvis removed (lymph node dissection). Removal of the nodes may prevent normal draining of the fluid from the legs. As a result fluid can build up in one or both legs, causing swelling. This usually does not occur until some time after the operation.
It is not possible to predict whether you will have problems with lymphoedema. You should seek advice from your doctor or nurse. You may be given special stockings to wear after your operation. For further information about lymphoedema contact the Cancer Council Helpline on 13 11 20.
Some hospitals have a specialist physiotherapist or nurse who can advise you on how you may be able to reduce your risk of lymphoedema. They can also help you manage if lymphoedema does occur in the future.
Fluid build-up (ascites)
Ascites is a collection of fluid in the abdomen. This can be uncomfortable because of swelling and pressure. If it becomes a problem there is a simple procedure to drain away the fluid and relieve discomfort. This is called a paracentesis. It is usually done on the hospital ward and you may need to stay overnight.
Sometimes fluid collects in the lining of the lungs. You may feel short of breath and have some pain. This fluid can be drained away to give you relief.
When you are first told you have cancer, you may feel a range of emotions, such as fear, sadness, depression, anger or frustration. It may be helpful to talk about your feelings with your partner, family members or friends, or with a hospital counsellor, social worker, psychologist or your religious or spiritual adviser.
Sometimes you may find that your friends and family do not know what to say to you. They may have trouble dealing with their feelings too. Some people may feel so uncomfortable that they avoid you. This can make you feel very lonely. You may feel able to approach your friends directly and tell them what you need. You may prefer to ask a close family member or a friend to talk with other people for you.
You can telephone the Cancer Council Helpline on 13 11 20, for information and support.
Practical and financial help
A serious illness may cause practical and financial problems. You do not need to face these alone. Apart from offering emotional support, a social worker may be able to suggest useful tips to help. Ask at your hospital, your community health centre, or ring the Cancer Council Helpline.
Many services are available, including:
- financial assistance, which may be available for transport costs to medical appointments, prescription medicines, or through benefits or pensions. Contact the social worker at your hospital.
- home nursing care, which is available through district nursing, or through the local palliative care service – your doctor or hospital can arrange this.
- meals on wheels, home care services, and aids and appliances, which can make life easier – contact the hospital social worker, occupational therapist or physiotherapist, or your local council.
If you lose your hair during chemotherapy, you may want to wear a wig, scarf or hat while it’s growing back. You can borrow a wig; some hospitals and cancer care units have wig libraries where wigs are available for a small fee. You can buy a wig, though they can be expensive. Ask your treating hospital or call the Cancer Council Helpline on 13 11 20 to find out more. Some private health funds cover part of the cost of wigs – check with your health fund.
A healthy diet will help you to keep as well as possible and cope with the cancer and any side effects of treatment. Depending on the kind of treatment you have had, you may have special dietary needs. A dietitian can help to plan the best foods for your situation – ones that you find tempting, easy to eat and good for you.
You will probably find it helpful to stay active and exercise regularly if you can. Exercise can help with fatigue. The amount and type of exercise you do will depend upon what you are used to and how well you feel. Talk with your doctor about what will be best for you.
Some people find relaxing or meditating helps them to feel better. The hospital social worker or nurse will know whether the hospital runs any programs, or may be able to advise you on programs in your area. Your local community health centre may also be able to help.
For Cancer Council information on relaxing and coping with anxiety, visit www.cancervic.org.au or telephone 13 11 20.
Last Reviewed: 01/07/2010
Reproduced with kind permission from the Anti-Cancer Council of Victoria.
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