Chemotherapy for Ovarian Cancer
What is ovarian cancer?
Cancer begins when the cells in the body begin to grow out of control. Any cells in the body can start to become cancerous and can spread to other parts of the body. The beginning of ovarian cancer happens in the ovaries. Ovaries are basically the reproductive glands found in women. These ovaries produce eggs for reproduction purposes and are also known to be the main sources of hormones called estrogen and progesterone. The ovaries are made of three kinds of cells and each kind of cell can then develop into a different type of tumor cell.
- Epithelial tumor - This type of tumor begins from the cells that cover the outer surface of the ovary. It is the most common type among ovarian tumors.
- Germ cell tumor (GCT) - Starts from the cells that produce eggs or ova.
- Stromal tumor - Begins from the structural tissues that hold the ovary together. It also produces the female hormones called estrogen and progesterone.
Most of these tumor cells are noncancerous or benign, and do not usually spread beyond the ovary. They can be treated by completely removing the ovary or a part of it, which contains the tumor. However, malignant or low malignant potential (LMP) cancerous cells easily spread across the other parts of the body, and hence, can turn out to be fatal.
Symptoms of Ovarian Cancer
In certain cases, ovarian cancer can cause early signs or symptoms. The following are the most common symptoms of ovarian cancer:
- Experiencing pain in the abdomen or pelvic region
- Feeling bloated or feeling full all the time
- Having trouble eating
- An urgent need to urinate or urinating more than usual
Treatment of Ovarian Cancer
Ovarian cancer is known to affect at least more than 20,000 women a year. There are no real methods that could help on the early screening of the disease. By the time the person learns about the condition, it almost reaches the advanced level. The treatment usually begins with surgery, wherein its main aim is to remove cancer from the body to avoid it from spreading to other parts of the body.
In many cases, a total hysterectomy has to be performed since ovarian cancer cells are not easy to remove. These cancer cells tend to easily spread in the abdomen and hide. In most of the cases, just a few of the cancer cells are removed, while there is still much hiding and having access to the entire abdominal cavity. Thus, to eliminate these remaining cells, chemotherapy has to be performed. Chemotherapy is basically a process that uses certain drugs, which help kill the cancer cells. Chemo is an essential step towards treatment and recovery. In some cases, chemotherapy can be performed prior to the surgery, and is called as neoadjuvant chemotherapy. The use of this therapy is done to shrink the tumor, so that it can be easily removed at the time of surgery.
Chemotherapy for Ovarian Cancer
There is a fairly standard type of drug used in the process of chemotherapy. In most of the cases, the doctors combine a platinum-based drug such as a combination of carboplatin or cisplatin with a taxane such as docetaxel or paclitaxel. There are two different methods used to administer the drug in the body. The first method is to give these medications intravenously or through a vein. The chemotherapy is administered to the patient in cycles of treatment days and then rest. This means that one will have the period of drug treatment followed by a few rest periods. The number of treatment days would vary based on the drug given. However, women who suffer from ovarian cancer usually get six cycles of chemotherapy.
The second option is to give chemotherapy directly in the abdominal cavity with the help of a thin tube or catheter. This process of chemo is known as intraperitoneal (IP) chemotherapy. The advantage of this second therapy is that it directly cleanses the cancer cells present in the abdomen with the drugs which kills those cancer causing cells. The doctors would usually place the tube for IP in the initial surgery to remove cancer. This tube is attached to a port, which would make it easier for the doctors to administer the drugs into the abdomen every time a treatment is given. Many women who undergo the IP chemo also receive the IV chemo treatment as well. This is done since there have been studies that show that such combination has a great effect on the improvement of the disease and also increase the chances of survival. However, one of the major drawbacks of IP chemotherapy is that it also leads to an increased risk of side effects associated with the therapy. In some cases, the side effects become so severe that the patient often has to switch from the IP chemo to the IV chemo.
There are very limited options available for the treatment of ovarian cancer. Thus, new types of drugs are being researched in combination with the chemotherapy. One of the new promising drugs is Avastin (bevacizumab). This medicine works by stopping the growth of new blood vessels, and would cut off the essential nutrient supply to the tumor cells.
Drugs that have been approved for ovarian cancer chemotherapy are listed below:
- Alkeran (melphalan)
- Platinol, Platinol-AQ (cisplatin)
- Avastin (Bevacizumab)
- Neosar, Cytoxan, Clafen (cyclophosphamide)
- Niraparib tosylate monohydrate
- Taxol (paclitaxel)
- Dox-SL, DOXIL, Evacet, LipoDox (doxorubicin hydrochloride liposome)
- Gemzar (gemcitabine hydrochloride)
- Hycamtin (topotecan hydrochloride)
- Lynparza (olaparib)
- Paraplat, Paraplatin (carboplatin)
- Rubraca (rucaparib camsylate)
Below are some of the commonly used drugs for chemotherapy:
- Cisplatin
- Carboplatin
- Paclitaxel
- Docetaxel
Carboplatin
Carboplatin is used for the treatment of ovarian cancer and is under the brand name of Paraplatin. It is an anti-cancer medication, which is specially used for chemotherapy sessions. Carboplatin is also used for treating other types of cancer, which would include cancer of the head and neck, lung, breast, cervix, and the central nervous system.
Carboplatin is given intravenously or through vein infusion. It can also be given directly into the peritoneal cavity, which is in the abdomen, and is called as intraperitoneal. The dosage of carboplatin for chemotherapy usually depends on many factors. Some of these factors would include:
- The weight and height of the patient
- The general health of the patient
- Other underlying medical condition/s
- How the body responds to the treatment
The doctor would determine the correct dosage of the drug and its administration schedule. Like any other drug, carboplatin also comes with its own side effects, which include:
- A low count of RBCs, WBCs, and platelets
- Nausea and vomiting
- Hair loss
- Changes in one's taste
- Abnormal blood test results
The less common side effects of carboplatin are:
- Diarrhea
- Abdominal pain
- Mouth ulcers or sores
- Constipation
- Swelling at the site of injection
- Redness or burning sensation
- Signs and symptoms of infection
- Loss of hearing
- Cardiovascular problems
- Allergies
Seek medical attention immediately with the following symptoms:
- High fever with chills
- Chest pain
- Difficulty in breathing
- Severe pain in the abdomen
- Vomiting more than 4-5 times within 24 hours
- Muscle cramps
- Extreme fatigue
Before starting with carboplatin treatment, inform your doctor about other medications you have taken including over-the-counter and prescription drugs. Moreover, during the treatment period, avoid receiving vaccinations or any kind of immunization.
Carboplatin would not be advisable to individuals who have a history of severe allergies to drugs similar to carboplatin such as cisplatin and other platinum-containing drugs. With repeated treatment of carboplatin, one may encounter numbness, a decrease in sensations, and tingling sensations in the toes or fingers. These symptoms can get progressively worse as the treatment goes on.
Carboplatin may cause harm to an unborn baby. For this reason, inform your doctor right away if you are pregnant or planning to get pregnant. Moreover, avoid nursing a baby while under carboplatin treatment. During the duration of the treatment, make sure to drink at least eight to ten glasses of water per day unless otherwise instructed.
Since the drug can weaken the immune system, avoid going or staying in crowded places to prevent contracting any kind of infection. To minimize the risk of bleeding, use electric razors or a soft toothbrush. One should also avoid doing any kind of sports or physical activity, which can increase the chances of injury. Avoid sun exposure and wear protective clothing. Try and maintain a good nutrition and ensure to get plenty of rest to regain your strength and fight back against the disease.
Bevacizumab
Bevacizumab is known by the trade name Avastin. Bevacizumab is used for treating various types of cancer including rectal cancer, non-small-cell lung cancer, metastatic breast cancer, and ovarian cancer. Bevacizumab is also given intravenously or infused into the vein. The first dose of bevacizumab is given over 90 minutes. This infusion time is gradually shortened to 30 minutes if the person can tolerate the medicine well.
Bevacizumab also has certain side effects such as constipation, sores in the mouth, infection in the upper respiratory tract, a dip in the white blood cell count, nausea, vomiting, hair loss, bleeding from the nose, diarrhea, headache, loss of appetite and general weakness.
The lesser known side effects would include aches or pain in the muscles and joints, high blood pressure, irregular breathing, dizziness, and weight loss. A bevacizumab therapy can also lead to some serious kind of complications which cannot be ignored. Such complications include:
- A severe rise in the blood pressure
- Severe internal bleeding
- Congestive heart failure
Contact the doctor immediately if the following conditions are experienced:
- A body temperature of more than 38 degrees Celsius or 100.4 degrees Fahrenheit
- Fever with chills
- Pain in the chest
- Difficulty in breathing
- Severe pain in the abdomen
- Vomiting more than four to five times within 24 hours
- Muscle cramping
- Extreme body weakness or fatigue
- Severe case of bleeding
- Sudden gain in weight
- Coughing up blood
- Bloody or tarry stools
- Severe signs of dehydration
- Swelling of the tongue
- Blood traces in the urine
Before starting the treatment, don't forget to inform your doctor about other medications you have recently taken. Other precautions include:
- Do not take bevacizumab if you are allergic to similar kinds of drugs.
- Do not receive any vaccinations while the treatment is going on.
- Avoid breastfeeding.
- Inform your doctor if you are pregnant or planning to have a baby as bevacizumab is considered as Pregnancy Category C.
Take good care of yourself during the course of treatment. Take plenty of rest, make dietary changes by only consuming nutritious food to keep the bowels moving, drink plenty of water unless instructed otherwise, avoid exposure to the sun or wear protective clothing when going out, avoid drinking alcohol or smoking, and report any signs of infection to the doctor since your immune system is weak while you are on treatment.
Side Effects of Chemotherapy
While chemotherapy treatment works by killing the cancer-causing cells, it also creates havoc to the overall health of the individual at the same time. The reason why this type of therapy is so damaging is that it targets all kinds of fast-growing cells in the body like the hair follicles, which is also the reason why chemo patients experience hair loss during treatment.
Some of the side effects of chemotherapy are nausea, vomiting, fatigue, and tingling sensations in the toes and fingers. Women tend to lose hair two to three weeks after the starting the treatment. They also tend to lose their eyebrows and pubic hair. Some may come out well throughout the therapy, while some may take it extremely challenging. Preventive medications can be taken before the start of the therapy to relieve some of the symptoms.
