Understanding

Ovarian Cancer
A guide for people with cancer,
their families and friends

Cancer
information

For information & support, call

Understanding Ovarian Cancer
A guide for people with cancer, their families and friends

First published September 2003. This edition April 2020.

© Cancer Council Australia 2020. ISBN 978 1 925651 86 7

Understanding Ovarian Cancer is reviewed approximately every two years. Check the publication
date above to ensure this copy is up to date.

Editor: Jenni Bruce. Designer: Emma Johnson. Printer: SOS Print + Media Group.

Acknowledgements
This edition has been developed by Cancer Council NSW on behalf of all other state and territory
Cancer Councils as part of a National Cancer Information Subcommittee initiative.

We thank the reviewers of this booklet: A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology,
Chris O’Brien Lifehouse, NSW; A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists,
and Chair, Australian Society of Gynaecologic Oncologists, TAS; Dr Robyn Cheuk, Senior Radiation Oncologist,
Royal Brisbane and Women’s Hospital, QLD; Kim Hobbs, Clinical Specialist Social Worker, Gynaecological
Cancer, Westmead Hospital, NSW; Sonja Kingston, Consumer; Clinical A/Prof Judy Kirk, Head, Familial Cancer
Service, Crown Princess Mary Cancer Centre, Westmead Hospital, and Sydney Medical School, The University
of Sydney, NSW; Prof Linda Mileshkin, Medical Oncologist and Clinical Researcher, Peter MacCallum Cancer
Centre, VIC; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Support Team, Ovarian Cancer Australia;
Emily Stevens, Gynaecology Oncology Nurse Coordinator, Department of Obstetrics and Gynaecology, Flinders
Medical Centre, SA; Dr Amy Vassallo, Fussell Family Foundation Research Fellow, Cancer Research Division,
Cancer Council NSW; Merran Williams, Consumer. We also thank the health professionals and editorial teams
who have worked on previous editions of this title.

This booklet is funded through the generosity of the people of Australia.

Note to reader
Always consult your doctor about matters that affect your health. This booklet is intended as a general
introduction to the topic and should not be seen as a substitute for medical, legal or financial advice. You 
should obtain independent advice relevant to your specific situation from appropriate professionals, and
you may wish to discuss issues raised in this book with them.

All care is taken to ensure that the information in this booklet is accurate at the time of publication. Please
note that information on cancer, including the diagnosis, treatment and prevention of cancer, is constantly
being updated and revised by medical professionals and the research community. Cancer Council Australia
and its members exclude all liability for any injury, loss or damage incurred by use of or reliance on the
information provided in this booklet.

Cancer Council
Cancer Council is Australia’s peak non-government cancer control organisation. Through the eight state and
territory Cancer Councils, we provide a broad range of programs and services to help improve the quality of
life of people living with cancer, their families and friends. Cancer Councils also invest heavily in research and
prevention. To make a donation and help us beat cancer, visit cancer.org.au or call your local Cancer Council.

Cancer Council Australia

Level 14, 477 Pitt Street, Sydney NSW 2000
Telephone 02 8063 4100 Facsimile 02 8063 4101 Email [email protected] Website cancer.org.au
ABN 91 130 793 725
About this booklet
This booklet has been prepared to help you understand more about
ovarian cancer. It is common to feel shocked and upset when told you
have ovarian cancer. We hope this booklet will help you, your family
and friends understand how ovarian cancer is diagnosed and treated.
We also include information about support services.

We cannot give advice about the best treatment for you. You need to
discuss this with your doctors. However, this information may answer
some of your questions and help you think about what to ask your
treatment team (see page 67 for a question checklist).

This booklet does not need to be read from cover to cover – just read the
parts that are useful to you. Some medical terms that may be unfamiliar
are explained in the glossary (see pages 68–71). You may also like to pass
this booklet to your family and friends for their information.

How this booklet was developed

The information in this booklet was developed with help from a
range of health professionals and people affected by ovarian cancer.
It is based on Australian and international clinical practice guidelines
for ovarian cancer.1–2

If you or your family have any questions, call

Cancer Council 13 11 20. We can send you
more information and connect you with support
services in your area. You can also visit your
local Cancer Council website (see back cover).
Contents
What is cancer?................................................................. 4

The ovaries......................................................................... 6

Key questions.................................................................... 9
What is ovarian cancer?........................................................................... 9
How common is it?.................................................................................. 9
What are the symptoms?....................................................................... 10
What are the risk factors?...................................................................... 12
Should I have genetic testing?............................................................... 13
Which health professionals will I see?.................................................... 14

Diagnosis.......................................................................... 16
Pelvic examination................................................................................. 17
Blood tests............................................................................................. 17
Further tests........................................................................................... 18
Staging ovarian cancer .......................................................................... 22
Grading ovarian cancer.......................................................................... 23
Prognosis............................................................................................... 24

Making treatment decisions........................................... 26

Treatment......................................................................... 28
Surgery................................................................................................... 29
Chemotherapy........................................................................................ 36
Targeted therapy.................................................................................... 42
Radiation therapy................................................................................... 43
Palliative treatment................................................................................. 45
Managing side effects..................................................... 47
Fatigue.................................................................................................... 47
Infertility.................................................................................................. 48
Menopause............................................................................................. 48
Impact on sexuality and intimacy........................................................... 50
Bowel changes....................................................................................... 52
Fluid build-up......................................................................................... 54
Lymphoedema........................................................................................ 55

Looking after yourself..................................................... 57

Life after treatment......................................................... 59

Follow-up appointments........................................................................ 60
What if ovarian cancer returns?............................................................. 61
Living with uncertainty............................................................................ 62

Seeking support.............................................................. 63
Support from Cancer Council ............................................................... 64
Useful websites...................................................................................... 65

Caring for someone with cancer................................... 66

Question checklist........................................................... 67
Glossary........................................................................... 68
How you can help............................................................ 72
 What is cancer?
Cancer is a disease of the cells. Cells are the body’s basic building
blocks – they make up tissues and organs. The body constantly makes
new cells to help us grow, replace worn-out tissue and heal injuries.

Normally, cells multiply and die in an orderly way, so that each new
cell replaces one lost. Sometimes, however, cells become abnormal and
keep growing. In solid cancers, such as ovarian cancer, the abnormal
cells form a mass or lump called a tumour. In some cancers, such as
leukaemia, the abnormal cells build up in the blood.

Not all tumours are cancer. Benign tumours tend to grow slowly
and usually don’t move into other parts of the body or turn into

How cancer starts

Normal cells Abnormal cells Abnormal cells multiply

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 cancer. Cancerous tumours, also known as malignant tumours, have
the potential to spread. They may invade nearby tissue, destroying
normal cells. The cancer cells can break away and travel through the
bloodstream or lymph vessels to other parts of the body.

The cancer that first develops is called the primary cancer. It is

considered localised cancer if it has not spread to other parts of the
body. If the primary cancer cells grow and form another tumour at
a new site, it is called a secondary cancer or metastasis. A metastasis
keeps the name of the original cancer. For example, ovarian cancer
that has spread to the liver is called metastatic ovarian cancer, even
though the main symptoms may be coming from the liver.

How cancer spreads

Malignant cancer

Cancer cells
break away

Cancer cells
travel to lymph
nodes and
other parts
of the body
(metastasis)

Grows own Invades

blood vessels surrounding
(angiogenesis) tissue Lymph vessel
Blood vessel

What is cancer? 5
 The ovaries
The ovaries are part of the female reproductive system, which also
includes the fallopian tubes, uterus (womb), cervix (the neck of the
uterus), vagina (birth canal) and vulva (external genitals).

The ovaries are two small, walnut-shaped organs. They are found in
the lower part of the abdomen (the pelvic cavity). There is one ovary
on each side of the uterus, close to the end of the fallopian tubes.

Each ovary is made up of:

• epithelial cells – found on the outside of the ovary in a layer
known as the epithelium
• germ (germinal) cells – found inside the ovaries, and eventually
mature into eggs (ova)
• stromal cells – form connective (supporting) tissue within the
ovaries, and make the hormones oestrogen and progesterone.

At puberty, the ovaries begin releasing an egg (ovum) each month

in a process known as ovulation. The egg travels down the fallopian
tube into the uterus. If the egg is fertilised by a sperm, it will implant
itself into the lining of the uterus and grow into a baby. If the egg is
not fertilised by a sperm, the lining is shed and flows out of the body
through the vagina. This flow is known as a period or menstruation.

The hormones oestrogen and progesterone cause ovulation and

menstruation. As you get older, the ovaries gradually produce less of
these hormones. When the levels of oestrogen and progesterone fall
low enough, periods become irregular and finally stop. This is known
as menopause. After menopause, you can’t conceive a child naturally.
The ovaries also become smaller.

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 The female reproductive system

Endometrium
(lining of the uterus)
Fallopian tube

Ovary
Ovum
(egg) Uterus
(womb)

Cervix
(neck of
the uterus)

Vagina
(birth canal)

Labia
(inner and outer
Front view lips of the vulva)

The ovaries 7
 Organs near the ovaries
Near the ovaries are many organs and other structures. These include
the diaphragm (the sheet of muscle that separates the chest from the
abdomen), the peritoneum (the lining of the abdomen) and the omentum
(the sheet of fatty tissue that hangs like an apron inside the abdomen).

Diaphragm
Liver

Peritoneum
Omentum

Bowel Spine

Ovary
Uterus (womb)
Bladder
Rectum

Side view

8 Cancer Council
 Key questions
Q: What is ovarian cancer?
A: Ovarian cancer occurs when cells in one or both ovaries become
abnormal, grow out of control and form a lump called a tumour.
There are different types of ovarian cancer – see table, next page.

Sometimes an ovarian tumour is diagnosed as borderline

(also known as a low malignant potential tumour). This is not
considered to be cancer.

If ovarian cancer spreads beyond the ovaries, it often spreads to

the organs in the abdomen (see diagram opposite).

Q: How common is it?

A: Each year, about 1400 Australians are diagnosed with ovarian
cancer. It is more commonly diagnosed over the age of 50, but
can occur at any age. It is the 10th most common cancer in
women in Australia.3–4

Anyone with ovaries can get ovarian cancer, so it mostly affects

women. Transgender men and intersex people can also get
ovarian cancer if they have ovaries. For information specific
to your situation, speak to your doctor.

For an overview of what to expect during all stages of your cancer

care, visit cancerpathways.org.au/optimal-care-pathways/
ovarian-cancer. This is a short guide to what is recommended, from
diagnosis to treatment and beyond.

Key questions 9
 Types of ovarian cancer
There are many forms of ovarian cancer. The three main types start in
different types of cells: epithelial, germ or stromal cells.

• the most common type of ovarian cancer

(about 9 out of 10 cases)
• starts on the surface of the ovary
epithelial (epithelium)*
• subtypes include serous, mucinous,
endometrioid and clear cell cancers
• mostly occurs over the age of 60

• rare type of ovarian cancer (about 4%

of cases)
germ cell
• starts in the egg-producing (germinal) cells
• mostly occurs under the age of 40

• rare cancer that starts in the cells in

the ovaries that produce the hormones
stromal cell oestrogen and progesterone
(or sex cord- • may produce extra hormones, such
stromal tumours) as oestrogen
• mostly occurs between the ages
of 40 and 60

* Epithelial cancer that starts in the fallopian tubes or in the peritoneum

is very similar to epithelial ovarian cancer. Recent research suggests
that many ovarian cancers start in the fallopian tubes.

Q: What are the symptoms?

A: In its early stages, ovarian cancer usually has no symptoms.
This means it is typically diagnosed when the cancer is
more advanced and has spread to other organs.

10 Cancer Council
 Occasionally, symptoms of ovarian cancer do occur before the
disease is diagnosed. These symptoms may include:
• pressure, pain or discomfort in the abdomen or pelvis
• a swollen or bloated abdomen
• changes in appetite, such as not feeling like eating, or
feeling full quickly
• changes in toilet habits (e.g. constipation, diarrhoea,
passing urine more often, increased wind)
• indigestion and feeling sick (nausea)
• feeling very tired
• unexplained weight loss or weight gain
• changes in the pattern of periods, or vaginal bleeding
after menopause
• pain during sex.

These symptoms do not necessarily mean you have cancer –

they might be caused by another health condition.

If you have these symptoms and they are new for you, are severe
or continue for more than a few weeks, it is best to arrange a
check-up. Keep a record of how often the symptoms occur and
make an appointment to see your general practitioner (GP).

Ovarian Cancer Australia has produced a symptom diary to help

you record any symptoms and talk about your health concerns
with your doctor. Visit ovariancancer.net.au/signs-and-symptoms
to download a PDF that you can print out.

Key questions 11
Q: What are the risk factors?
A: The causes of most cases of ovarian cancer are unknown, but
factors that can increase the risk include:
• age – ovarian cancer is most common in women over 50
and in women who have stopped having periods (have been
through menopause), and the risk increases with age
• genetic factors – up to 20% of serous ovarian cancers (the
most common subtype) are linked to an inherited faulty gene,
and a smaller proportion of other types of ovarian cancer are
also related to genetic faults (see opposite page)
• family history – having one or more close blood relatives
diagnosed with ovarian, breast, bowel or uterine cancers,
or having Ashkenazi Jewish ancestry
• endometriosis – this condition is caused by tissue from the
lining of the uterus growing outside the uterus
• reproductive history – women who have not had children,
who have had assisted reproduction, or who have had children
over the age of 35 may be slightly more at risk
• lifestyle factors – some types of ovarian cancer have been
linked to smoking or being overweight
• hormonal factors – such as early puberty or late menopause.
Some studies suggest that menopause hormone therapy (MHT),
previously called hormone replacement therapy (HRT), may
increase the risk of ovarian cancer, but the evidence is not clear.

Some factors reduce the risk of developing ovarian cancer. These

include having children before the age of 35; breastfeeding;
using the combined oral contraceptive pill for several years; and
having your fallopian tubes tied (tubal ligation) or removed.

12 Cancer Council
Q: Should I have genetic testing?
A: Most women diagnosed with ovarian cancer do not have a family
history of the disease, but some have inherited a faulty gene
that increases the risk of developing ovarian cancer. Having an
inherited faulty gene does not mean you will definitely develop
ovarian cancer, and you can inherit a faulty gene without having
a history of cancer in your family.

About 15–20% of women with ovarian cancer have an inherited

fault in the BRCA1 or BRCA2 genes or other similar genes. The
BRCA gene faults can also increase the risk of breast cancer. Less
commonly, a group of gene faults known as Lynch syndrome
is associated with ovarian cancer and can also increase the risk
of cancer of the bowel or uterus. As other genetic conditions are
discovered, they may be included in genetic tests for cancer risk.

If you are diagnosed with ovarian cancer, your specialist or a

family cancer centre will check if you need a blood test to look
for a fault in the BRCA1, BRCA2 or another similar gene. This
genetic test may be available through the public hospital system
or with a Medicare rebate. The results may help work out the
best treatment for you. If a cancer-related gene fault is found,
Medicare-funded testing may be offered to close adult female
and male relatives to check their risk (men can inherit and pass
on BRCA faults and may have a higher risk of prostate cancer).

For more information, listen to our podcast episode on

genetic tests, and read Ovarian Cancer Australia’s booklet at
ovariancancer.net.au/know-ovarian-cancer/genetic-risks.

Key questions 13
Q: Which health professionals will I see?
A: Your GP will probably arrange the first tests if you have
symptoms. If these tests do not rule out cancer, you will usually
be referred to a specialist called a gynaecological oncologist. The
gynaecological oncologist will arrange further tests, perform

Health professionals you may see

assists you with treatment decisions and works
GP in partnership with your specialists in providing
ongoing care

diagnoses and performs surgery for cancers of

gynaecological
the female reproductive system, such as ovarian,
oncologist*
cervical, uterine, vulvar and vaginal cancers

gynaecological examines tissue removed from the abdomen

pathologist* or ovaries under a microscope
treats cancer with drug therapies including
medical oncologist*
chemotherapy and targeted therapy
treats cancer by prescribing and overseeing
radiation oncologist*
a course of radiation therapy

radiation therapist plans and delivers radiation therapy

reads and interprets diagnostic scans, such as

radiologist*
x-rays and CT and PET scans

coordinates your care, liaises with other members

cancer care
of the MDT and supports you and your family
coordinator
throughout treatment

14 Cancer Council
 any recommended surgery and consider treatment options.
Often the treatment options will be discussed with other health
professionals at what is known as a multidisciplinary team (MDT)
meeting. During and after treatment, you will see a range of health
professionals who specialise in different aspects of your care.

administers drugs and provides care, information

nurse
and support throughout treatment

physiotherapist, assist with physical and practical problems, including

occupational restoring movement and mobility after treatment
therapist and recommending aids and equipment

exercise prescribes exercise to help people with medical

physiologist conditions improve their overall health and fitness
recommends an eating plan to follow while you
dietitian
are in treatment and recovery
links you to support services and helps you with
social worker
emotional, practical and financial issues

counsellor, clinical help you manage your emotional response to

psychologist diagnosis and treatment

palliative care work closely with the GP and oncologist to help

specialists* and control pain and other symptoms and maintain
nurses quality of life

family cancer provide advice about genetic causes of ovarian

specialist*, genetic cancer; arrange genetic test results if required
counsellor and interpret the results for you and your family
* Specialist doctor

Key questions 15
 Diagnosis
If you have been diagnosed with ovarian cancer, you may wonder why
it wasn’t found sooner and why it was never picked up in a screening
test. Screening tests look for some types of cancer in people who do
not have any symptoms. They are sometimes called early detection
tests. At present, there is no effective screening test for ovarian cancer.

The Cervical Screening Test (which has replaced the Pap test)
looks for human papillomavirus (HPV), which causes most cases
of cervical cancer but not ovarian cancer. Neither the Cervical
Screening Test nor the Pap test can help find ovarian cancer.

If you do have symptoms and your doctor suspects you have ovarian
cancer, you may have some of the tests and scans described in this
chapter. These tests can show if there are any abnormalities that need
to be checked by taking a tissue sample (biopsy).

The only way to confirm a cancer diagnosis is to take a biopsy and

look at the cells under a microscope. For ovarian cancer, this is
usually done during surgery (see page 30), which means that the
diagnosis is confirmed and the cancer is treated at the same time.

Sometimes ovarian cancer is diagnosed before it causes symptoms.

This is usually when abnormalities are found during tests or
procedures for another health condition.

I went in to have minor surgery. Afterwards the

doctor said, ‘I’m sorry, but it looks like ovarian cancer’.
It certainly changed my life. Louisa

16 Cancer Council
Pelvic examination
In a pelvic examination, the doctor will check for any masses or
lumps by feeling your abdomen. To check your uterus and ovaries,
the doctor places two fingers inside your vagina while pressing on
your abdomen with their other hand. To examine inside the vagina,
they may insert an instrument called a speculum that separates the
vaginal walls. A pelvic examination is not painful but it may be
uncomfortable. You can ask for a family member, friend or another
staff member to be present during the examination if you prefer.

The doctor may also perform a digital rectal examination, placing a

gloved finger into the anus and rectum. This lets the doctor feel the
tissue behind the uterus where cancer cells may grow.

Blood tests
You may have blood tests to check for proteins produced by cancer
cells. These proteins are called tumour markers. The most common
tumour marker for ovarian cancer is CA125. The level of CA125 may
be higher in some cases of ovarian cancer. It can also rise for reasons
other than cancer, including ovulation, menstruation, irritable bowel
syndrome, liver or kidney disease, endometriosis or fibroids.

The CA125 blood test is not used for screening for ovarian cancer
if you do not have any symptoms. It can be used:

At diagnosis – A CA125 test is more accurate in diagnosing ovarian

cancer if you have been through menopause than if you haven’t. If
you have early-stage ovarian cancer, it is common to have normal

Diagnosis 17
CA125 levels. This is why doctors will often combine CA125 tests
with an ultrasound (see below).

During treatment – For ovarian cancer that produces CA125, the

blood test may be used to check how well the treatment is working.
Falling CA125 levels may mean it is working, and rising CA125 levels
may mean the treatment is not working well, but the CA125 level is
only one of the signs used to check your response to treatment.

After treatment – CA125 blood tests are sometimes included

in follow-up tests. See pages 60–61 for more information.

Further tests
Your doctor may recommend a number of imaging scans and
investigations to work out how far the cancer has spread. You may
also have chest x-rays to check the lungs for cancer or fluid.

Pelvic ultrasound
A pelvic ultrasound uses echoes from soundwaves to create a picture
of your uterus and ovaries on a computer. A technician called a
sonographer does the scan. It can be done in two ways:

Abdominal ultrasound – You will lie on an examination table while

the sonographer moves a small handheld device called a transducer
over your abdominal (belly) area.

Transvaginal ultrasound – The sonographer will insert a small 

transducer wand into your vagina. It will be covered with a disposable

18 Cancer Council
plastic sheath and gel to make it easier to insert. Sometimes this test
may be uncomfortable, but it should not be painful. Talk to your doctor
and the sonographer if you feel distressed or concerned. You can also
ask for someone else to be present.

The transvaginal ultrasound is often the preferred type of ultrasound,

as it provides a clearer picture of both the ovaries and uterus.

CT scan
A CT (computerised tomography) scan uses x-ray beams to take
pictures of the inside of the body. It is used to look for signs that the
cancer has spread, but a CT scan may not be able to detect all ovarian
tumours. CT scans are usually done at a hospital or radiology clinic.

You will be asked not to eat or drink for several hours (fast) before the
scan. A liquid dye (called a contrast) may be injected into a vein to
help make the pictures clearer. The contrast makes your organs appear
white on the scan, so anything unusual can be seen more clearly.

The contrast may make you feel hot all over and leave a bitter taste
in your mouth, and you may also feel a sudden urge to pass urine.
These sensations usually ease quickly, but tell the person carrying
out the scan if they don’t go away.

The CT scanner is a large, doughnut-shaped machine. You will lie

on a table that moves in and out of the scanner. The scan takes about
10–20 minutes, but it may take extra time to prepare and then wait
for the scan. While a CT scan can be noisy, it is painless. You usually
go home as soon as the CT scan is over.

Diagnosis 19
 Before having scans, tell the doctor if you have any allergies or have
had a reaction to contrast during previous scans. You should also
let them know if you have diabetes or kidney disease, or if you are
pregnant or breastfeeding.

PET–CT scan
A PET (positron emission tomography) scan combined with a CT scan
is a specialised imaging test. It provides more detailed information
about the cancer than a CT scan on its own. Only some people need
this test. Medicare covers the cost of PET scans only for ovarian cancer
that has returned, so they are not often used for the first diagnosis.

To prepare for a PET–CT scan, you will be asked not to eat or drink
for a period of time (fast). Before the scan, you will be injected with
a glucose solution containing a small amount of radioactive material.
Cancer cells show up brighter on the scan because they take up more
glucose than normal cells do.

You will be asked to sit quietly for 30–90 minutes as the glucose
spreads through your body, then you will have the scan. The scan
itself will take about 30 minutes. Let your doctor know if you are
claustrophobic, as you need to be in a confined space for the scan.
Any radiation will leave your body within a few hours.

MRI scan
An MRI (magnetic resonance imaging) scan uses a powerful magnet
and radio waves to build up detailed, cross-sectional pictures of the

20 Cancer Council
inside of your body. It may be used if it is difficult to tell from the
ultrasound whether a tumour is benign or may be malignant.

Let your medical team know if you have a pacemaker, as the magnet
can interfere with some pacemakers. As with a CT scan, a dye might
be injected into your veins before an MRI scan.

During the scan, you will lie on a bench inside a large metal tube that
is open at both ends. The noisy, narrow machine makes some people
feel anxious or claustrophobic. If you think you may become distressed,
mention it beforehand to your medical team. You may be given a
medicine to help you relax, and you will usually be offered headphones
or earplugs. The MRI scan may take between 30 and 90 minutes.

Colonoscopy
In some cases, you may need to have a bowel examination
(colonoscopy) to check that your symptoms are not caused by a bowel
problem. The doctor will insert a thin, flexible tube with a small
camera and light (colonoscope) through the anus into the bowel.

Before the test, you will have to change your diet and take prescribed
laxatives to clean out your bowel completely (bowel preparation).
The process varies for different people and between hospitals. Your
doctor will give you specific instructions and talk to you about what
to expect. On the day of the test, you will probably be given light
sedation, which means you won’t be fully unconscious but you won’t
feel any discomfort and may fall into a light sleep. A colonoscopy
usually takes about 20–30 minutes. You will need to have someone
take you home afterwards, as you may feel drowsy or weak.

Diagnosis 21
Taking a biopsy
In most cases, a diagnosis of ovarian cancer will be confirmed after
surgery to remove the ovary, which is also the main treatment.
A sample of the tumour, known as a biopsy, will be checked under
a microscope for cancer cells.

If scans show that the cancer has spread too much to be removed
by surgery, a biopsy may be taken in a different way before treatment
begins. This can be done with a very thin needle during a CT scan.
The procedure is known as a fine-needle aspiration when the needle
removes a sample of cells from the tumour, or as paracentesis when
the needle removes a sample of fluid from the abdomen.

The cells in the sample will then be checked under a microscope

to get more information about the cancer.

Staging ovarian cancer

The tests described on pages 17–22 help show whether you have
ovarian cancer and whether it has spread to other parts of the body.
This process is called staging and it helps your health care team plan
the best treatment for you.

In most instances, your doctor will not have enough information

to work out the stage of the ovarian cancer until after surgery (see
page 36 for more information).

The staging system most commonly used for ovarian cancer is the
International Federation of Gynecology and Obstetrics (FIGO) system

22 Cancer Council
(see table below). It divides ovarian cancer into four stages. Stages 1–2
mean it is early ovarian cancer. Stages 3–4 mean the cancer is advanced.
About 7 out of 10 cases of ovarian cancer are diagnosed at stage 3 or 4.

Stages of ovarian cancer (FIGO system)

The four stages of ovarian cancer in the FIGO system may be further
divided into sub-stages, such as A, B, C, which indicate increasing
amounts of tumour.

stage 1 Cancer is in one or both ovaries only.

Cancer is in one or both ovaries and has spread to

stage 2 other organs in the pelvis (uterus, fallopian tubes,
bladder or bowel).

Cancer is in one or both ovaries and has spread

stage 3 beyond the pelvis to the lining of the abdomen
(peritoneum) or to nearby lymph nodes.

The cancer has spread further to distant organs

stage 4
such as the lung or liver.

Grading ovarian cancer

The cancer will also be given a grade based on how the cancer cells
look compared to normal cells under a microscope. This suggests
how quickly the cancer may grow.

Grade 1 (or low grade) ovarian cancer is likely to grow relatively

slowly. Grade 2 (moderate grade) might grow more quickly. Grade 3
(high grade) is likely to grow quickly.

Diagnosis 23
Prognosis
Prognosis means the expected outcome of a disease. You may wish
to discuss your prognosis and treatment options with your doctor,
but it is not possible for anyone to predict the exact course of the
disease in a particular person.

Your doctor will consider many factors in assessing your prognosis.

These include test results; the type of ovarian cancer and its stage and
grade; genetic factors (see page 13); your response to treatment; and
other factors such as your age, fitness and overall health.

Epithelial cancer – If epithelial ovarian cancer is diagnosed and

treated before the cancer has spread outside the ovary (stage 1), it has
a good prognosis. Many cases of more advanced cancer may respond
well to treatment, but the cancer often comes back (recurs) and
further treatment is needed.

Germ cell and stromal cell tumours – These can usually be

treated successfully, although there may be a small risk the cancer
will come back and need further treatment.

Borderline tumour – This can usually be treated successfully with

surgery alone.

Discussing your prognosis and thinking about the future can be

challenging and stressful. It may help to talk with family and friends.
You can also call Cancer Council 13 11 20 if you or your family or
friends need more information or emotional support.
ӹ Listen to our podcast episode “Coping with a cancer diagnosis”.

24 Cancer Council
Key points about diagnosing ovarian cancer

Getting a • There is no effective screening test for

diagnosis ovarian cancer at present.
• Most ovarian cancers are advanced before
they are diagnosed.
• If you have symptoms, you may have a range
of tests and scans to look for signs of cancer.
• In most cases, the only way to confirm a
diagnosis of ovarian cancer is to take a tissue
sample (biopsy) during surgery. This surgery is
usually also the main treatment for the cancer.

Tests and scans • The doctor may feel your abdomen and
do internal examinations of the vagina and
rectum to check for masses or lumps.
• Blood tests will be done to look for tumour
markers such as CA125.
• An ultrasound scan uses soundwaves to
create a picture of the ovaries.
• A CT scan looks for signs that the cancer has
spread. It may not detect all tumours.
• Other tests sometimes used to check for
cancer spread include PET–CT and MRI
scans, and colonoscopy (to check the bowel).

Staging and • Results of the tests and biopsy help your

prognosis doctors work out whether and how far the
cancer has spread. This is called staging.
• The grade describes how similar the cancer
cells look to normal cells.
• A prognosis is a disease’s expected outcome.
Early-stage cancer has a better prognosis.

Diagnosis 25
 Making treatment
decisions
Sometimes it is difficult to decide on the type of treatment to have.
You may feel that everything is happening too fast, or you might be
anxious to get started. Check with your specialist how soon treatment
should begin, as it may not affect the success of the treatment to wait
a short time. Ask them to explain the options, and take what time you
can before making a decision.

Know your options – Understanding the disease, the available

treatments, possible side effects and any extra costs can help you
weigh up the options and make a well-informed decision. Check if
the specialist is part of a multidisciplinary team (see page 15) and
if the treatment centre is the most appropriate one for you – you
may be able to have treatment closer to home, or it might be worth
travelling to a centre that specialises in a particular treatment.

Record the details – When your doctor first tells you that you
have cancer, you may not remember everything you are told. Taking
notes can help or you might like to ask if you can record the discussion.
It is a good idea to have a family member or friend go with you to
appointments to join in the discussion, write notes or simply listen.

Ask questions – If you are confused or want to check anything,

it is important to ask your specialist questions. Try to prepare a list
before appointments (see page 67 for suggestions). If you have a lot
of questions, you could talk to a cancer care coordinator or nurse.

Consider a second opinion – You may want to get a second

opinion from another specialist to confirm or clarify your specialist’s
recommendations or reassure you that you have explored all of

26 Cancer Council
your options. Specialists are used to people doing this. Your GP or
specialist can refer you to another specialist and send your initial
results to that person. You can get a second opinion even if you have
started treatment or still want to be treated by your first doctor. You
might decide you would prefer to be treated by the second specialist.

It’s your decision – Adults have the right to accept or refuse any
treatment that they are offered. For example, some people with
advanced cancer choose treatment that has significant side effects even
if it gives only a small benefit for a short period of time. Others decide
to focus their treatment on quality of life. You may want to discuss
your decision with the treatment team, GP, family and friends.
ӹ See our Cancer Care and Your Rights booklet.

Should I join a clinical trial?

Your doctor or nurse may suggest and led to better outcomes for
you take part in a clinical trial. people diagnosed with cancer.
Doctors run clinical trials to test
new or modified treatments and You may find it helpful to talk
ways of diagnosing disease to to your specialist, clinical
see if they are better than current trials nurse or GP, or to get a
methods. For example, if you second opinion. If you decide
join a randomised trial for a new to take part in a clinical trial,
treatment, you will be chosen at you can withdraw at any time.
random to receive either the best For more information, visit
existing treatment or the modified australiancancertrials.gov.au.
new treatment. Over the years, → See our Understanding Clinical
trials have improved treatments Trials and Research booklet.

Making treatment decisions 27

 Treatment
The treatment for ovarian cancer depends on the type of ovarian
cancer you have, the stage of the cancer, whether you wish to have
children, whether you have a faulty gene (see page 13), your general
health and fitness, and your doctors’ recommendations.

In most cases, surgery is the main treatment. Surgery for ovarian

cancer is complex. It is recommended that you have it performed
by a gynaecological oncologist at a hospital that does a lot of these
operations (high-volume centre).

Treatment options by type of ovarian cancer

epithelial – • usually treated with surgery alone

• may be offered chemotherapy after surgery if
stage 1
there is a high risk of the cancer coming back

• usually treated with a combination of surgery

epithelial – and chemotherapy
stages 2, 3 • new targeted therapy drugs are being offered
and 4 to people with a BRCA gene fault
• in some cases, radiation therapy is offered

germ cell
• usually treated with surgery or chemotherapy
or both

stromal cell
• usually treated with surgery, sometimes
followed by chemotherapy or targeted therapy

borderline
• usually treated with surgery only
tumour

28 Cancer Council
Other treatment options
Some women with ovarian cancer may feel that they are not given
as many options for treatment as there are for other types of cancer.
This is because there are only a few treatment plans for ovarian cancer
that have been proven to be effective. Research is continuing into
ovarian cancer treatments and, in some cases, you may be able to join
a clinical trial (see page 27) to access new treatments.

Surgery
Surgery for ovarian cancer allows your gynaecological oncologist
to confirm the diagnosis of ovarian cancer and work out how far the
cancer has spread. They will also remove as much of the cancer as
possible. This may involve several procedures during the operation.

Your gynaecological oncologist will talk to you about the most suitable
type of surgery, as well as the risks and side effects. These may include
infertility. If having children is important to you, talk to your doctor
before surgery and ask for a referral to a fertility specialist (see page 48).

How the surgery is done

You will be given a general anaesthetic and will have either a
laparoscopy (with 3–4 small cuts in your abdomen) or a laparotomy
(with a vertical cut from around your bellybutton to your bikini
line). The type of surgery you have will depend on how certain the
gynaecological oncologist is that cancer is present and how far they
think the cancer has spread. A laparoscopy may be used to see if
a suspicious mass is cancerous; if the cancer is advanced, you will
usually have a laparotomy.

Treatment 29
Taking a biopsy
The gynaecological oncologist will look inside your pelvis and
abdomen for signs of cancer, and take tissue and fluid samples
(biopsy). During the operation, the samples may be sent to a
specialist called a pathologist, who checks them right away for
signs of cancer. This is called a frozen section analysis or biopsy.

Debulking
If cancer is present, the operation will continue and as much cancer
as possible will be removed. This is called debulking. The surgeon
usually has to remove the ovaries, fallopian tubes, uterus and cervix
(see opposite). Depending on how far the cancer has spread, other
organs or tissue may also be removed during the same operation:

Omentectomy – The omentum is a sheet of fatty tissue that hangs

down in front of the intestines like an apron. If the cancer has spread
to the omentum, it will need to be removed.

Lymphadenectomy – Cancer cells can spread from your ovaries

to nearby lymph nodes. Your doctor may suggest removing some
in a lymphadenectomy (also called lymph node dissection).

Colectomy – If cancer has spread to the bowel, some of the bowel

may need to be removed. A new opening called a stoma might be
created (colostomy or ileostomy). See page 53 for more details.

Removal of other organs – Ovarian cancer can spread to many

organs in the abdomen. In some cases, parts of the liver, diaphragm,
bladder and spleen may be removed if it is safe to do so.

30 Cancer Council
 Types of surgery
If ovarian cancer is found, all or some of
the reproductive organs will be removed. Area removed

Total hysterectomy and bilateral salpingo-oophorectomy

In most cases, surgery

for ovarian cancer means
removing the uterus
and cervix, along with both
fallopian tubes and ovaries.

Unilateral salpingo-oophorectomy

If cancer is found early and it is

in one ovary, some young women
who still wish to have children
may have only one ovary and
fallopian tube removed.

Further treatment
It may not be possible to remove all the cancerous tissue during
the operation, but surgery for ovarian cancer is often followed by
other treatments to shrink or destroy any remaining cancer cells
(see pages 36–44).

Treatment 31
What to expect after surgery
When you wake up from surgery, you will be in a recovery room near
the operating theatre. Once you are fully conscious, you will be taken
back to your bed on the hospital ward. The surgeon will visit you as
soon as possible to explain the results of the operation.

Tubes and drips – You are likely to have several tubes in place,
which will be removed as you recover:
• a drip inserted into a vein in your arm (intravenous drip) will give
you fluid, medicines and pain relief
• a small plastic tube (catheter) may be inserted into your bladder
to collect urine in a bag
• a tube may be inserted down your nose into your stomach
(nasogastric tube) to drain stomach fluid and prevent vomiting
• tubes may be inserted in your abdomen to drain fluid from the
site of the operation.

Pain – After an operation, it is common to feel some pain, but this

can be controlled. For the first day or two, you may be given pain
medicine through:
• a drip into a vein (intravenous drip)
• a local anaesthetic injection into the abdomen (a transverse
abdominis plane or TAP block) or into the spine (an epidural)
• a patient-controlled analgesia (PCA) system – you press a button
to give yourself a measured dose of pain relief.

Let your doctor or nurse know if you are in pain so they can adjust
the medicine. Managing your pain will help you to recover and
move around more quickly.

32 Cancer Council
 I felt great relief after the surgery, as once the
tumour had been removed, the pain that I had in my
lower abdomen and hip was gone. Ann

Injections – It is common to have daily injections of a blood thinner

to reduce the risk of blood clots. These injections may continue for
some time after the operation and while you’re having chemotherapy.
A nurse will show you how to give this injection to yourself before
you leave hospital.

Compression devices and stockings – You will need to use

compression devices or wear elastic stockings to keep the blood in
your legs circulating. Once you are able to move around, compression
devices will be removed so you can get out of bed, but you may still
wear the stockings for a couple of weeks.

Wound care – You can expect some light vaginal bleeding after the
surgery, which should stop within two weeks. Your doctor will talk
to you about how to keep the wound clean once you go home to
prevent it becoming infected.

If you had part of the bowel removed and have a stoma (see page 53),
a stomal therapy nurse will explain how to manage it.

Length of stay – You will probably stay in hospital for several days
after a big operation. Your hospital stay will usually be shorter after
a laparoscopy or smaller operation.
ӹ See our Understanding Surgery booklet.

Treatment 33
 Taking care of yourself at home after surgery
Your recovery time will depend on the type of surgery you had, your general
health, and your support at home. If you don’t have support from family, friends
or neighbours, ask a social worker if it’s possible to get help at home. In most
cases, you will be able to fully return to your usual activities after 4–8 weeks.

Rest Work
Take things easy Depending on the
and do only what is nature of your work,
comfortable. You may you will probably
like to try meditation need several weeks
or some relaxation off work.
techniques to reduce
anxiety or tension.

Lifting
Avoid heavy lifting or heavy
work (e.g. gardening) for
at least four weeks. Use a
clothes horse or dryer until
it’s comfortable to hang out
your washing on a line.

Driving
You will most likely need to avoid
driving for a few weeks after the
surgery. Check with your car insurer
for any conditions regarding major
surgery and driving.

34 Cancer Council
Bowel problems Nutrition
You may have constipation To help your body recover
after the surgery and when you from surgery, focus on
are taking strong painkillers. It eating a balanced diet
is important to avoid straining (including proteins such as
when passing a bowel motion, lean meats and poultry, fish,
so your doctor may advise you eggs, milk, yoghurt, nuts,
to take laxatives and drink seeds and legumes/beans).
plenty of fluids.

Sex
Sexual intercourse should be avoided for
about six weeks after the operation to give
your wounds time to heal. Ask your doctor
when you can have sexual intercourse again,
and explore other ways you and your partner
can be intimate, such as massage.

Exercise
Your health care team will probably
encourage you to start walking the
day after the surgery. Exercise may
help manage some side effects and
speed up a return to usual activities.
Start with a short walk and go a little
further each day. Because of the
risk of infection, avoid swimming for
4–6 weeks after surgery.

Treatment 35
 Will I need further treatment after surgery?
All tissue and fluids removed Further treatment will depend
during surgery are checked for on the type of ovarian cancer,
cancer cells by a pathologist. The the stage of the disease and the
results will help confirm the type amount of any remaining cancer.
of ovarian cancer you have, if it If the cancer is advanced, it’s
has spread (metastasised), and more likely to come back, so
its stage. surgery will usually be followed by
chemotherapy, and occasionally
Your doctor should have all the by targeted therapy. Radiation
test results within two weeks therapy is recommended only
of surgery. in particular cases.

Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic)
drugs. The aim is to destroy cancer cells while causing the least
possible damage to normal, healthy cells. Chemotherapy may be used
at different times:

After surgery – Chemotherapy is usually given 2–4 weeks after the

surgery (adjuvant chemotherapy) as there may be some cancer cells
still in the body. For ovarian cancer, the drugs are usually given in
repeating cycles spread over 4–5 months, but this can vary depending
on the stage of the cancer and your general health. Your treatment
team will provide details about your specific schedule.

Before surgery – For stage 3 or 4 ovarian cancer, chemotherapy is

sometimes given before surgery (neoadjuvant chemotherapy). The aim

36 Cancer Council
is to shrink the tumours to make them easier to remove. This usually
involves three cycles of chemotherapy, followed by surgery, and then
another three cycles.

Primary treatment – Chemotherapy may be recommended as the

main treatment if you are not well enough for a major operation or
when the cancer cannot be surgically removed.

Having chemotherapy
Chemotherapy is usually given as a combination of two or more
drugs, or sometimes as a single drug. Let your oncologist know if
you are taking nutritional or herbal supplements as these can interact
with chemotherapy and may lessen the effect.

In most cases, the drugs are delivered into a vein (intravenous

drip). To reduce the need for repeated needles, you may receive
chemotherapy through a small medical appliance or tube inserted
beneath your skin. This may be called a port-a-cath or a peripherally
inserted central catheter (PICC), or it may have another name.

You will usually have chemotherapy as an outpatient (also called

a day patient), but some people need to stay in hospital overnight.
ӹ See our Understanding Chemotherapy booklet.

Each chemotherapy treatment is called a cycle and is followed by a

rest period to give your body time to recover. Ask your doctor about
the treatment plan recommended for you.

Treatment 37
 Intraperitoneal chemotherapy
Occasionally, chemotherapy is Intraperitoneal chemotherapy is
given directly into the abdominal used only in specialised units in
cavity – the space between the Australia. It may be offered for
organs in the abdomen and stage 3 disease with less than
the walls of the abdomen. This 1 cm of tumour remaining after
is known as intraperitoneal surgery. Some studies have
chemotherapy. shown it may be more effective
than giving chemotherapy
In this method, the drugs through an intravenous drip.
are delivered through a tube
(catheter) that is put in Ask your medical oncologist for
place during surgery and more information about this type
removed once the course of chemotherapy and the benefits
of chemotherapy is over. and risks.

Blood tests during chemotherapy

Before each chemotherapy session, you will have blood tests to
ensure your body’s healthy cells have had time to recover. If your
blood count has not recovered, your doctor may delay treatment.

In some cases, you may also have blood tests during treatment to
check your tumour markers, such as CA125 (see pages 17–18). If the
CA125 level was high before chemotherapy, it can be monitored to
see if the treatment is working.

Side effects of chemotherapy

Chemotherapy can affect healthy cells in the body, which may cause
side effects. Not everyone will have side effects, and they will vary

38 Cancer Council
according to the drugs you are given. Your treatment team will talk
to you about what to expect and how to manage any side effects (see
also Managing side effects on pages 47–56).

Fatigue – Your red blood cell level may drop (anaemia), which can
cause you to feel tired and short of breath. Fatigue is very common
during and after cancer treatment, and can also be caused by many
other factors.
ӹ See our Fatigue and Cancer fact sheet.

Nausea and vomiting – Some types of chemotherapy drugs may

make you feel sick (nauseous) or vomit. You will generally be given
anti-nausea medicines with each chemotherapy session to help
prevent or reduce nausea and vomiting. Whether or not you feel
sick is not a sign of how well the treatment is working.

Changed bowel habits – Some chemotherapy drugs, pain

medicines and anti-nausea drugs can cause constipation or diarrhoea.
Tell your doctor or nurse if your bowel habits have changed. If you
are constipated, they may recommend taking laxatives.

Joint and muscle pain – This may occur after your treatment session.
It may feel like you have the flu, but the symptoms should disappear
within a few days. Ask your doctor if taking a mild painkiller such as
paracetamol may help.

I kept a notebook to record my chemotherapy

symptoms and any questions I had. Ann

Treatment 39
Risk of infections – Chemotherapy reduces your white blood cell
level, making it harder for your body to fight infections. Colds and
flu may be easier to catch and harder to shake off, and scratches
or cuts may get infected more easily. You may also be more likely to
catch a serious infection and need to be admitted to hospital. Contact
your doctor or go to the nearest hospital immediately if you have one
or more symptoms of an infection, such as:
• a temperature of 38°C or above
• chills or shivering
• burning or stinging feeling when urinating
• a severe cough or sore throat
• severe abdominal pain, constipation or diarrhoea
• any sudden decline in your health.

Hair loss – Depending on the chemotherapy drug you receive,

you will probably lose your head and body hair. The hair will grow
back after treatment is completed, but the colour and texture may
change for a while. If you choose to wear a wig until your hair grows
back, you can call Cancer Council 13 11 20 to ask about wig services
in your area. If you have private health insurance, check whether
your provider offers a rebate if you buy a wig because of hair loss
related to chemotherapy.
ӹ See our Hair Loss fact sheet.

Numbness or tingling in your hands and feet – This is known

as peripheral neuropathy, and it can be a side effect of certain
chemotherapy drugs. Let your doctor know if this happens, as your
dose of chemotherapy may need to be adjusted.
ӹ See our Understanding Peripheral Neuropathy fact sheet.

40 Cancer Council
Emma’s story
Although I had a long history of I also had a bad reaction to the
gynaecological problems, my first drug, which meant I had
diagnosis of ovarian cancer at to take medicines before each
age 36 was a complete surprise. infusion to try to prevent this.

During an emergency operation Although some people bounce

to fix a twisted ovary, the doctors right back, once treatment was
took a biopsy from an ovarian over I questioned my values and
cyst. Five days later, I got a call reasons for being here. Attending
to say I had ovarian cancer. support groups and seeing an
oncology psychologist really
I had surgery to remove my helped me come to grips with the
remaining ovary, along with the experience of having had ovarian
uterus and some lymph nodes. cancer, and my emotions are
Luckily the cancer was found now in a much better place.
early and it hadn’t spread outside
the ovary. My body also needed time
to recover after treatment.
As they found a clustering of Although I’m still dealing with
cells in my abdomen during the lymphoedema and fatigue, I’m
surgery, the medical oncologist happy to be getting back to work
recommended I have a course and my usual activities.
of chemotherapy to help prevent
the cancer coming back. I now realise how important it is
to build a relationship with my
Even though I was young and health care professionals and to
fit, I found the chemotherapy actively look after my health.
very difficult. I had treatment
weekly for 16 weeks and had
a lot of side effects, including
fatigue, nausea, diarrhoea and
constipation, numbness in the
hands and feet, and hair loss.

Treatment 41
Targeted therapy
Targeted therapy drugs can get inside cancer cells and block specific
particles (molecules) that tell the cancer cells to grow. These drugs
are used to treat some types of ovarian cancer. They may also be used
in certain situations (e.g. if chemotherapy has not been successful).
Genetic testing (see page 13) will help show if you have a particular
faulty gene that may respond to targeted therapy drugs.

Bevacizumab is a targeted therapy drug sometimes used to treat

advanced epithelial tumours. It is given with chemotherapy every
three weeks as a drip into a vein (intravenous infusion).

Olaparib is a targeted therapy drug occasionally used for ovarian

cancer. You may be offered this if you have a high-grade epithelial
ovarian cancer that has come back after initial treatment and has a
BRCA1 or BRCA2 gene mutation. This drug is usually given after
chemotherapy to help stop the cancer growing. It is taken as a tablet
twice a day for as long as it appears to be helping control the cancer.
This is known as maintenance treatment.

Other targeted therapy drugs may be available on clinical trials

(see page 27). Talk with your doctor about the latest developments
and whether you are a suitable candidate.

Side effects of targeted therapy

Although targeted therapy minimises harm to healthy cells, it can still
have side effects. It is important to discuss any side effects with your
doctor right away. If left untreated, some can become life-threatening.
Your doctor will monitor you throughout treatment.

42 Cancer Council
The most common side effects of bevacizumab include bleeding,
wound-healing problems, high blood pressure and kidney problems.
In very rare cases, small tears (perforations) may develop in the
bowel wall.

The most common side effects of olaparib include nausea, fatigue,

vomiting and low blood cell counts. More serious side effects include
bone marrow or lung problems.
ӹ See our Understanding Targeted Therapy fact sheet.

Immunotherapy for ovarian cancer

Immunotherapy is a type of proven to be an effective
drug treatment that uses the treatment for ovarian cancer.
body’s own immune system
to fight cancer. In Australia, International clinical trials are
immunotherapy drugs are continuing to test immunotherapy
currently available as treatment drugs for ovarian cancer. You can
options for some types of ask your treatment team for the
cancer, such as melanoma latest updates.
and lung cancer. At present, →S ee our Understanding
immunotherapy has not been Immunotherapy fact sheet.

Radiation therapy
Also known as radiotherapy, radiation therapy uses a controlled
dose of radiation to kill cancer cells or damage them so they
cannot grow, multiply or spread. The radiation is usually in the
form of x-ray beams.

Treatment 43
Radiation therapy is occasionally used to treat ovarian cancer that has
spread to the pelvis or to other parts of the body. It may be used after
chemotherapy or surgery, or on its own as a palliative treatment.

Before treatment starts, the radiation oncology team will explain the
treatment schedule and the possible side effects.

For each radiation therapy session, you will lie on a treatment table
under a machine that delivers radiation to the affected parts of the
body. You will not feel anything during the treatment, which will take
only a few minutes each time. You may be in the room for a total of
10–20 minutes for each appointment.

The number of radiation therapy sessions you have will depend

on the type and size of the cancer. You may have a few treatments
or daily treatment for a number of weeks.

Side effects of radiation therapy

The side effects of radiation therapy vary. Most are temporary and
disappear a few weeks or months after treatment. Radiation therapy
for ovarian cancer is usually given over the abdominal area, which can
irritate the bowel and bladder. It can also cause infertility (see page 48).

Common side effects include feeling tired, diarrhoea, needing to pass

urine more often and a burning feeling when passing urine (cystitis),
and a slight reddening of the skin around the treatment site. More
rarely, you may have some nausea or vomiting. If this occurs, you will
be prescribed medicine to control it.
ӹ See our Understanding Radiation Therapy booklet.

44 Cancer Council
Palliative treatment
Palliative treatment helps to improve people’s quality of life by
managing the symptoms of cancer without trying to cure the disease.
It is best thought of as supportive care.

Many people think that palliative treatment is only for people at

the end of their life, but it can help people at any stage of advanced
ovarian cancer, even if they are still having active treatment of the
cancer. It is about living for as long as possible in the most satisfying
way you can.

As well as slowing the spread of cancer, palliative treatment can

relieve pain and help manage other symptoms. Treatment may
include chemotherapy and radiation therapy. If you have swelling and
are uncomfortable, you may have a procedure called paracentesis or
ascitic tap to drain the extra fluid from your abdomen (see page 54).

Palliative treatment is one aspect of palliative care, in which a team

of health professionals aims to meet your physical, emotional,
cultural, social and spiritual needs. The team also provides support
to families and carers.
ӹ See our Understanding Palliative Care and Living with Advanced
Cancer booklets.

Treatment 45
 Key points about treating ovarian cancer

Treatment • Your treatment will depend on many factors,

options including the type of ovarian cancer,
its stage, whether you wish to have children,
whether you have a faulty gene, and your
overall health and fitness.

Surgery • Ovarian cancer is usually treated with

surgery. In most cases, this involves a total
hysterectomy (removal of the uterus and
cervix), as well as the removal of both fallopian
tubes and both ovaries. Other nearby tissue
may also be removed. All removed tissue will
be checked for cancer cells.
• It will take several weeks to recover from
the operation. You may need other treatments
after surgery.

Other • Chemotherapy is usually given soon after the

treatments surgery for 4–5 months (adjuvant therapy).
In some cases of advanced ovarian cancer,
it may be given before surgery (neoadjuvant
therapy). Side effects may include tiredness,
nausea and vomiting, and hair loss.
• Sometimes targeted therapy drugs are used
to help stop the cancer growing. You may
need a genetic test to see if you are likely to
respond to these drugs.
• Radiation therapy is offered in some cases.
This uses radiation to damage cancer cells.
• Palliative treatment aims to improve your
quality of life by relieving the symptoms
of cancer.

46 Cancer Council
 Managing side effects
Treatment can cause physical and emotional changes. Some people
experience many side effects, while others have few. Most side effects
are temporary, but some may be permanent. It is important to tell
your treatment team about any new or ongoing side effects you have,
as they will often be able to help you manage them. This chapter also
offers tips for coping with some common side effects.

Fatigue
It is common to feel very tired and lack energy during or after
treatment. Fatigue for people with cancer is different from tiredness
as it doesn’t always go away with rest or sleep. Most people who have
chemotherapy start treatment before they have had time to fully
recover from their operation. Fatigue may continue for a while after
chemotherapy has finished, but it is likely to gradually improve over
time. In some cases, it may take a year or two to feel well again.
ӹ See our fact sheet and listen to our podcast episode on fatigue.

Tips for managing fatigue

• Plan your day. Set small, • Regular light exercise has been
manageable goals and rest shown to reduce fatigue. Even a
before you get too tired. walk around the block can help.

• Ask for and accept offers • Talk to your doctor about

of help with tasks such as what type of exercise would
cleaning and shopping. be suitable for you or ask for
a referral to a physiotherapist
• Eat nutritious food to keep or exercise physiologist.
your energy levels up.

Managing side effects 47

Infertility
In most cases, surgery or radiation therapy for ovarian cancer will
mean you are unable to conceive children. Before cancer treatment
starts, ask your doctor or fertility specialist to explain the options
available to you. If you have stage 1 ovarian cancer and have not yet
reached menopause, you may be able to have surgery that leaves the
uterus and one ovary in place (unilateral salpingo-oophorectomy, see
page 31). You will need to avoid pregnancy while on chemotherapy.

Many women experience a sense of loss when told that their

reproductive organs will be removed or will no longer function. You
may feel extremely upset if you cannot have children, and may worry
about the impact of this on your relationship or future relationships.
Even if your family is complete or you were not planning to have
children, you may feel a sense of loss and grief.

If you have a partner, you may find it helpful to talk to them about
your feelings. Speaking to a counsellor or gynaecological oncology
nurse may also help.
ӹ See our Fertility and Cancer booklet.

Menopause
If you were still having periods (menstruating) before surgery, having
your ovaries removed will mean you no longer produce the hormones
oestrogen and progesterone, and you will stop menstruating. This is
called menopause. When menopause occurs naturally, it is a gradual
process that starts between the ages of 45 and 55, but menopause after
surgery is sudden.

48 Cancer Council
Symptoms of menopause can include hot flushes, dry or itchy skin,
mood swings, trouble sleeping (insomnia), tiredness and vaginal
dryness. These symptoms are usually more intense after surgery than
during a natural menopause, because the body hasn’t had time to get
used to the gradual decrease in hormone levels.

Tips for managing the symptoms

of menopause
• Vaginal moisturisers available your bones becoming weak.
over the counter from Regular exercise will help keep
chemists can help with vaginal your bones strong. For more
discomfort and dryness. information, call Osteoporosis
Australia on 1800 242 141 or
• Talk to your doctor about visit osteoporosis.org.au.
the benefits and risks of
menopause hormone therapy • Cholesterol levels can change
(MHT), previously called after menopause, and this
hormone replacement therapy can increase your risk of heart
(HRT). If taken after natural disease. Regular exercise
menopause, MHT containing and a balanced diet may help
oestrogen may increase the improve cholesterol levels. If
risk of some diseases. If you not, talk to your doctor about
were on MHT when cancer cholesterol-lowering drugs.
was diagnosed, you’ll need to
consider whether to continue. • Meditation and relaxation
techniques may help reduce
• Menopause can increase your stress and lessen symptoms.
risk of developing thinning
of the bones (osteoporosis). • Talk to your doctor or call
Cancer Council 13 11 20
Talk to your doctor about
for more ways to relieve the
having a bone density test or
symptoms of menopause.
taking medicines to prevent

Managing side effects 49

Impact on sexuality and intimacy
Ovarian cancer can affect your sexuality in physical and emotional ways.
The impact of these changes depends on many factors, such as treatment
and side effects, your self-confidence, and whether you have a partner.

It is important to feel that your sexuality is respected when discussing

how cancer treatment will affect you. Whatever your sexual orientation,
your medical team should be able to openly discuss your needs and
support you through treatment. Try to find a doctor who helps you
feel at ease talking about sexual issues and relationships.

Treatment can cause physical side effects such as vaginal dryness,

scarring and internal scar tissue (pelvic adhesions, see page 54). These
side effects can make sexual penetration painful, and you may have to
explore different ways to climax (orgasm). The experience of having
cancer can also reduce your desire for sex (libido).

For most people, sex is more than arousal, intercourse and orgasms.
It involves feelings of intimacy and acceptance, as well as being able to
give and receive love. Although sexual intercourse may not always be
possible, closeness and sharing can still be part of your relationship.

Changes to your body can affect the way you feel about yourself
(your self-esteem) and make you feel self-conscious. You may feel less
confident about who you are and what you can do. Give yourself time to
adapt to any changes. Try to see yourself as a whole person (body, mind
and personality) instead of focusing on the parts that have changed.
ӹ See our Sexuality, Intimacy and Cancer booklet and listen to our
“Sex and Cancer” podcast episode.

50 Cancer Council
Tips for managing sexual changes
• Give yourself time to get used • Try different positions during
to any physical changes after sex to work out which position
cancer treatment. is the most comfortable for you.

• Show affection by touching, • If you can’t enjoy penetrative

hugging, massaging, talking sex, explore other ways to
and holding hands. climax, such as oral and
manual stimulation.
• Let your partner know if you
don’t feel like having sex, • Talk about your feelings with
or if you find penetration your sexual partner or doctor,
uncomfortable. or ask your treatment team for
a referral to a sexual therapist
• Talk to your doctor about or psychologist.
ways to manage side effects
that change your sex life. • Do some regular physical
These may include using activity to boost your energy
vaginal dilators, lubricants and mood. Talk to your
and moisturisers. GP about managing any
depression as it may be
• If you find that vaginal dryness affecting your libido.
is a problem, take more time
before and during sex to help • For ideas about how to
the vagina relax and become discuss sexuality questions
more lubricated. with your treatment team,
visit Cancer Australia at
• Extra lubrication may make canceraustralia.gov.au
intercourse more comfortable.
and search for their online
Choose a water-based or
resource Intimacy and
silicone-based gel without
sexuality for women with
perfumes or colouring.
gynaecological cancer –
• Spend more time on foreplay starting a conversation.
and try different ways to
become aroused.

Managing side effects 51

Bowel changes
After surgery or during chemotherapy or radiation therapy, some
people notice problems with how their bowel works. You may
experience diarrhoea, constipation or stomach cramps. Pain relief
medicines may also make you feel constipated. Diarrhoea and
constipation can occur for some time, but are usually temporary.
Sometimes tissues in the pelvis stick together after surgery (pelvic
adhesions). This can lead to ongoing bowel problems and pain
and in rare cases may need further surgery. To help manage bowel
changes, ask your doctor, nurse or dietitian for advice about eating
and drinking, and see the tips below.
ӹ See our Nutrition and Cancer booklet.

Tips for managing bowel changes

• Drink plenty of liquids to • Eat small, frequent meals
replace fluids lost through instead of three big ones.
diarrhoea or to help soften
faeces (poo) if you are • Drink peppermint or
chamomile tea to reduce
constipated. Avoid alcohol,
stomach or wind pain.
caffeinated drinks and very
hot or very cold liquids. • If you have diarrhoea, rest as
much as possible – diarrhoea
• Avoid fried, spicy or greasy can make you very tired.
foods, which can cause pain
and make diarrhoea and • If you are constipated,
constipation worse. do some gentle exercise,
such as walking.
• Ask your pharmacist or doctor
about suitable medicines to
relieve symptoms of diarrhoea
or constipation.

52 Cancer Council
Treating a blockage in the bowel
Surgery for ovarian cancer sometimes causes the bowel to become
blocked. This is called a bowel obstruction. A bowel obstruction can
also occur if the cancer comes back. Because faeces (poo) cannot
pass through the bowel easily, symptoms may include feeling sick,
vomiting, or a swollen and painful stomach.

A bowel obstruction can sometimes be treated by resting the bowel,

which means you have nothing to eat or drink until the blockage
clears. Your doctor may also try giving you an anti-inflammatory
medicine to reduce the swelling around the obstruction.

Some bowel obstructions require a surgical procedure. If only one

area is blocked, you may have a small tube (stent) put in to help
keep the bowel open and relieve symptoms. The stent is inserted
through the rectum using a flexible tube called an endoscope.

If the bowel is blocked in more than one spot, you may have surgery
to create a stoma, an opening in the abdomen that allows faeces to
leave the body. A stoma may be a colostomy (made from the colon,
part of the large bowel) or an ileostomy (made from the ileum, part
of the small bowel). A small bag called a stoma bag or appliance is
worn on the outside of the body to collect the waste. A stomal therapy
nurse will show you how to look after the stoma. The stoma may be
reversed when the blockage is cleared, or it may be permanent.

To find out more, call Cancer Council 13 11 20 or visit the Australian

Association of Stomal Therapy Nurses at stomaltherapy.com or the
Australian Council of Stoma Associations at australianstoma.com.au.

Managing side effects 53

 Tissues in the pelvis may stick together after a hysterectomy. This
is called a pelvic adhesion, and it can be painful or cause other
problems such as constipation. Rarely, adhesions to the bowel or
bladder may need to be treated with further surgery.

Fluid build-up
Sometimes ovarian cancer can cause fluid to build up in different
parts of the body.

Ascites – This is when fluid collects in the abdomen. It causes

swelling and pressure, which can be uncomfortable and make
you feel breathless. If you have ascites, your doctor may inject a
local anaesthetic into the abdomen and then insert a needle to take
a sample of the fluid. This is called a paracentesis or ascitic tap.
The fluid sample is sent to a laboratory to be examined under a
microscope for cancer cells.

Sometimes, to make you feel more comfortable, the doctor will

remove the remaining fluid from your abdomen. It will take a few
hours for all the fluid to drain into a drainage bag.

Pleural effusion – This is when fluid builds up in the area between

the lung and the chest wall (pleural space). It can cause pain and
breathlessness. The fluid can be drained using a procedure called a
thoracentesis or pleural tap. Your doctor will inject a local anaesthetic
into the chest area, and then insert a needle into the pleural space to
drain the fluid.

54 Cancer Council
Lymphoedema
Some people who have lymph nodes removed from the pelvis
(a lymphadenectomy, see page 30) may find that one or both legs
become swollen. This is known as lymphoedema. It can happen
if lymph fluid doesn’t circulate properly and builds up in the legs.
Radiation therapy in the pelvic area may also cause lymphoedema.

Lymphoedema can make movement and some types of activities

difficult. The swelling may appear at the time of treatment or months
or years later. It is important to seek help with lymphoedema
symptoms as soon as possible because early diagnosis and treatment
lead to better outcomes.

Though lymphoedema may be permanent, it can usually be managed.

Gentle exercise, compression stockings and a type of massage called
manual lymphatic drainage can all help to reduce the swelling.

To find a practitioner who specialises in managing lymphoedema,

you can visit the Australasian Lymphology Association website
at lymphoedema.org.au. If your GP refers you to a lymphoedema
practitioner, you may be eligible for a Medicare rebate. Talk to your
GP about developing a Chronic Disease Management Plan or Team
Care Arrangement to help you manage the condition.
ӹ See our Understanding Lymphoedema fact sheet.

Managing side effects 55

 Key points about managing side effects

What to expect • Cancer treatment can cause a range of side

after treatment effects, but there are often ways to reduce
or manage them.
• The most common side effect is fatigue. This
may continue for a while after treatment has
finished. It may help to plan your activities so
you can take regular rest breaks.

Infertility, • If you are unable to have children (infertility)

menopause as a result of treatment for ovarian cancer,
and sexuality you may feel very upset. Talking with your
family, friends or a counsellor may be helpful.
• If your ovaries have been removed, you will
go through menopause. This means that
your periods will stop and it will no longer be
possible to become pregnant. You may also
have other symptoms of menopause.
• Treatment for ovarian cancer can have an
impact on sexuality and self-esteem. There are
things you can do to manage these changes.

Other side • Bowel changes such as diarrhoea, cramps

effects or constipation are common. Less often, the
bowel might become blocked.
• If fluid builds up in your abdomen (ascites) or
in your lungs or chest wall (pleural effusion),
your medical team may need to drain it.
• If fluid builds up in the legs (lymphoedema),
a lymphoedema practitioner can help you
manage it with gentle exercise, compression
stockings and massage.

56 Cancer Council
 Looking after yourself
Cancer can cause physical and emotional strain, so it’s important
to look after your wellbeing. Cancer Council has free booklets and
programs to help you during and after treatment. Call 13 11 20 to find
out more, or visit your local Cancer Council website (see back cover).

Eating well – Healthy food can help you cope with treatment and side
effects. A dietitian can explain how to manage any special dietary needs
or eating problems and choose the best foods for your situation.
ӹ See our Nutrition and Cancer booklet.

Staying active – Physical activity can reduce tiredness, improve

circulation and lift mood. The right exercise for you depends on what
you are used to, how you feel, and your doctor’s advice.
ӹ See our Exercise for People Living with Cancer booklet.

Complementary therapies – Complementary therapies are designed

to be used alongside conventional medical treatments. Therapies
such as massage, relaxation and acupuncture can increase your sense
of control, decrease stress and anxiety, and improve your mood. Let
your doctor know about any therapies you are using or thinking about
trying, as some may not be safe or evidence-based.
ӹ See our Understanding Complementary Therapies booklet.

Alternative therapies are therapies used instead of conventional

medical treatments. These are unlikely to be scientifically tested and
may prevent successful treatment of the cancer. Cancer Council does
not recommend the use of alternative therapies as a cancer treatment.

Looking after yourself 57

Work and money – Cancer can change your financial situation,
especially if you have extra medical expenses or need to stop
working. Getting professional financial advice and talking to your
employer can give you peace of mind. You can also check with a
social worker or Cancer Council whether any financial assistance
is available to you.
ӹ See our Cancer and Your Finances and Cancer, Work & You booklets.

Relationships – Having cancer can affect your relationships with

family, friends and colleagues in different ways. Cancer is stressful,
tiring and upsetting, and this may strain relationships. It may
also result in positive changes to your values, priorities or outlook
on life. Give yourself time to adjust to what’s happening, and do
the same for those around you. It may help to discuss your feelings
with each other.
ӹ See our Emotions and Cancer booklet.

I am glad my doctor helped me work through

the emotions of what was my top priority. I finally
felt that overcoming cancer and getting on with my
life were most important and everything else came
after that. Thuy

58 Cancer Council
 Life after treatment
For most people, the cancer experience doesn’t end on the last day of
treatment. Life after cancer treatment can present its own challenges.
You may have mixed feelings when treatment ends, and worry that
every ache and pain means the cancer is coming back.

Some people say that they feel pressure to return to “normal life”.
It is important to allow yourself time to adjust to the physical and
emotional changes, and establish a new daily routine at your own
pace. Your family and friends may also need time to adjust.

Cancer Council 13 11 20 can help you connect with other people

who have had cancer, and provide you with information about the
emotional and practical aspects of living well after cancer.
ӹ See our Living Well After Cancer booklet.

Dealing with feelings of sadness

If you have continued feelings can get a Medicare rebate for
of sadness, have trouble getting sessions with a psychologist. Ask
up in the morning or have lost your doctor if you are eligible.
motivation to do things that Cancer Council may also run a
previously gave you pleasure, you counselling program in your area.
may be experiencing depression.
This is quite common among For information about coping
people who have had cancer. with depression and anxiety, call
Beyond Blue on 1300 22 4636 or
Talk to your GP, as counselling visit beyondblue.org.au. For
or medication – even for a short 24-hour crisis support, call Lifeline
time – may help. Some people 13 11 14 or visit lifeline.org.au.

Life after treatment 59

Follow-up appointments
After treatment ends, you will have regular appointments to monitor
your health, manage any long-term side effects and look for any
signs that the cancer has come back or spread. These are known as
follow-up appointments.

In most cases, your follow-up appointments will be with your

gynaecological oncologist or medical oncologist, who may do
a physical examination and arrange blood tests or scans such as
ultrasounds and CT scans. You will also be able to discuss how
you are feeling and mention any concerns you may have.

There is no set follow-up schedule for ovarian cancer, but people

commonly see their specialist every three months for the first two
years, and every four to six months for the next two years. Some
people prefer not to follow a schedule but to see their specialist
if they experience symptoms. Check with your doctor if you are
unsure of your follow-up plan.

Your check-ups will become less frequent if you have no further

problems. Between follow-up appointments, let your doctor know
immediately of any symptoms or health problems.

When a follow-up appointment or test is approaching, you may find

that you think more about the cancer and feel anxious. Talk to your
treatment team or call Cancer Council 13 11 20 if you are finding it
hard to manage this anxiety.

60 Cancer Council
Having CA125 blood tests
Your specialist will also talk to you about the advantages and
disadvantages of having regular CA125 blood tests. This test is
optional; research has found that waiting until new symptoms
develop before starting treatment is just as effective as starting
treatment earlier. This means that your quality of life is better for
longer because side effects of further treatment are delayed.

What if ovarian cancer returns?

If ovarian cancer is advanced at diagnosis, it often does come back
after treatment and a period of improvement (remission). This is
known as a recurrence and it is why regular follow-up appointments
are important. In many cases, there may be a number of recurrences,
with long intervals in between recurrences when cancer treatment
is not needed. Early-stage ovarian cancer is less likely to come back
than advanced ovarian cancer.

The most common treatment for epithelial ovarian cancer that has
come back is more chemotherapy or targeted therapy. The drugs used
will depend on what drugs you had initially, the length of remission
and the aim of the treatment. The drugs used the first time may be
given again if you had a good response to them and the cancer stayed
away for six months or more.

New drugs are constantly being developed. Genetic tests and targeted
therapy are offering new treatment options for people with ovarian
cancer. Talk with your doctor about the latest developments and
whether a clinical trial (see page 27) may be right for you.

Life after treatment 61

Living with uncertainty
One of the challenges of an ovarian cancer diagnosis is dealing with
uncertainty. When first diagnosed, many people want to know what’s
going to happen and when it will be over. But living with uncertainty
is part of having cancer, especially if the cancer is advanced.

There are some questions you will not be able to answer. Learning as
much as you can about the cancer may make you feel more in control.

Tips for dealing with uncertainty

• Talk with other people who • Try to exercise regularly.
have had ovarian cancer. Exercise has been shown
You may find it reassuring to to help people cope with the
hear about their experiences. side effects of treatment.
See page 64 for information
about support groups. • Focus on making healthy
choices in areas of your life
• Keep a diary to track how that you can control, such
you’re feeling. as eating well and getting
regular exercise.
• Explore different ways to relax,
such as meditation or yoga. • Set yourself some goals –
as you achieve each one,
• Talk to a psychologist or set some new goals.
counsellor about how you are
feeling – they may be able to • Listen to our “Managing
teach you some strategies to Fear” and “Living Well
help you manage your fears. with Advanced Cancer”
podcast episodes.
• Practise letting your thoughts
come and go without getting
caught up in them.

62 Cancer Council
 Seeking support
A cancer diagnosis can affect every aspect of your life. You will
probably experience a range of emotions – fear, sadness, anxiety,
anger and frustration are all common reactions. Cancer also often
creates practical and financial issues.

There are many sources of support and information to help you, your
family and carers navigate all stages of the cancer experience, including:
• information about cancer and its treatment
• access to benefits and programs to ease the financial impact
of cancer treatment
• home care services, such as Meals on Wheels, visiting nurses
and home help
• aids and appliances
• support groups and programs
• counselling services.

The availability of services may vary depending on where you live,

and some services will be free but others might have a cost.

To find good sources of support and information, you can talk to the
social worker or nurse at your hospital or treatment centre, or get in
touch with Cancer Council 13 11 20.

Ovarian Cancer Australia provides an online forum and a free resilience

kit on their website – visit ovariancancer.net.au. The Ovarian Cancer
Research Alliance (OCRA) has an online support group for women from
all over the world at inspire.com/groups/ovarian-cancer.

Seeking support 63
 Support from Cancer Council
Cancer Council offers a range of services to support people
affected by cancer, their families and friends. Services may vary
depending on where you live.

Cancer Council 13 11 20
Trained professionals will answer any questions you
have about your situation and link you to services in
your area (see inside back cover).

Information resources
Cancer Council produces booklets and fact sheets on
over 25 types of cancer, as well as treatments, emotional
and practical issues, and recovery. Call 13 11 20 or visit
your local Cancer Council website (see back cover).

Practical help
Your local Cancer Council can help you find
services or offer guidance to manage the practical
impact of a cancer diagnosis. This may include
access to transport and accommodation services.

Legal and financial support

If you need advice on legal or financial issues, we can
refer you to qualified professionals. These services
are free for people who can’t afford to pay. Financial
assistance may also be available. Call Cancer Council
13 11 20 to ask if you are eligible.

Peer support services

You might find it helpful to share your thoughts and
experiences with other people affected by cancer.
Cancer Council can link you with individuals or
support groups by phone, in person, or online.
Call 13 11 20 or visit cancercouncil.com.au/OC.

64 Cancer Council
Useful websites
You can find many useful resources online, but not all websites are
reliable. These websites are good sources of support and information.

Australian
Cancer Council Australia cancer.org.au
Cancer Council Online Community cancercouncil.com.au/OC
Cancer Council podcasts cancercouncil.com.au/podcasts
Australasian Lymphology
lymphoedema.org.au
Association
Australia New Zealand
anzgog.org.au
Gynaecological Oncology Group
Australian Gynaecological
agcf.org.au
Cancer Foundation
Beyond Blue beyondblue.org.au
Cancer Australia canceraustralia.gov.au
Carer Gateway carergateway.gov.au
Carers Australia carersaustralia.com.au
Centre for Genetics Education www.genetics.edu.au
Healthdirect Australia healthdirect.gov.au
Optimal Care Pathways cancerpathways.org.au
Ovarian Cancer Australia ovariancancer.net.au

International
American Cancer Society cancer.org
Cancer Research UK cancerresearchuk.org
Macmillan Cancer Support (UK) macmillan.org.uk
Ovarian Cancer Research
ocrahope.org
Alliance (US)

Seeking support 65
 Caring for someone
with cancer
You may be reading this booklet because you are caring for someone
with cancer. What this means for you will vary depending on the
situation. Being a carer can bring a sense of satisfaction, but it can
also be challenging and stressful.

It is important to look after your own physical and emotional

wellbeing. Give yourself some time out and share your concerns
with somebody neutral such as a counsellor or your doctor, or try
calling Cancer Council 13 11 20. There is a wide range of support
available to help you with both the practical and emotional aspects
of your caring role.

Support services – Support services such as Meals on Wheels,

home help or visiting nurses can help you in your caring role. You can
find local services, as well as information and resources, through the
Carer Gateway. Call 1800 422 737 or visit carergateway.gov.au.

Support groups and programs – Many cancer support groups and

cancer education programs are open to carers as well as to people
with cancer. Support groups and programs offer the chance to share
experiences and ways of coping.

Carers Associations – Carers Australia works with the Carers

Associations in each state and territory to provide information and
services to carers. Call 1800 242 636 or visit carersaustralia.com.au.

Cancer Council – You can call Cancer Council 13 11 20 or visit your

local Cancer Council website to find out more about carers’ services.
ӹ See our Caring for Someone with Cancer booklet.

66 Cancer Council
 Question checklist
Asking your doctor questions will help you make an informed choice.
You may want to include some of the questions below in your own list.

Diagnosis
• What type of ovarian cancer do I have?
• Has the cancer spread? If so, where has it spread? How fast is it growing?
• Are the latest tests and treatments for this cancer available in this hospital?
• What sort of genetic testing can I have? Can I see a genetic counsellor?
• Will a multidisciplinary team be involved in my care?
• Are there clinical guidelines for this type of cancer?

Treatment
• What treatment do you recommend? What is the aim of the treatment?
• Are there other treatment choices for me? If not, why not?
• If I don’t have the treatment, what should I expect?
• How long do I have to make a decision?
• I’m thinking of getting a second opinion. Can you recommend anyone?
• How long will treatment take? Will I have to stay in hospital?
• Are there any out-of-pocket expenses not covered by Medicare or my
private health cover? Can the cost be reduced if I can’t afford it?
• How will we know if the treatment is working?
• Are there any clinical trials or research studies I could join?

Side effects and after treatment

• What are the risks and possible side effects of each treatment?
• Will I have a lot of pain? What will be done about this?
• Can I work, drive and do my normal activities while having treatment?
• Will the treatment affect my sex life and fertility? What are my
fertility options?
• Should I change my diet or physical activity during or after treatment?
• Are there any complementary therapies that might help me?
• How often will I need check-ups after treatment?
• If the cancer returns, how will I know? What treatments could I have?

Question checklist 67
 Glossary
abdomen BRCA1 and BRCA2 mutations
The part of the body between the chest Gene changes that increase the risk
and hips, which contains the stomach, of getting breast or ovarian cancer.
spleen, pancreas, bowel, bladder and
kidneys. Also known as the belly. The CA125
lower part of the abdomen (pelvic cavity) A protein found in the blood that is
contains the ovaries and other female often higher than normal in people with
reproductive organs. ovarian cancer.
advanced cancer cervix
Cancer that is unlikely to be cured. In most The lower part of the uterus that
cases, the cancer has spread to other connects the uterus to the vagina. Also
parts of the body (secondary or metastatic called the neck of the uterus.
cancer). Treatment can often still control chemotherapy
the cancer and manage symptoms. A cancer treatment that uses drugs to
ascites kill cancer cells or slow their growth.
Fluid build-up in the abdomen, making colectomy
it swollen and bloated. An operation in which diseased areas
of the colon are cut out and the healthy
bilateral salpingo-oophorectomy parts are sewn back together.
Surgery that removes both ovaries and colonoscopy
fallopian tubes. An examination of the large bowel with
biopsy a camera on a flexible tube (endoscope),
The removal of a sample of tissue which is passed through the anus.
from the body for examination under a colostomy
microscope to help diagnose a disease. A surgically created opening (stoma) in
borderline tumour the abdomen to the outside of the body.
A type of ovarian tumour that is not It is made from the colon (part of the
considered cancerous. large bowel).
bowel CT scan
The long, tube-shaped organ in the Computerised tomography scan. This
abdomen that is part of the digestive scan uses x-rays to create a detailed
tract. The bowel has two main parts: cross-sectional picture of the body.
the small bowel and the large bowel.
bowel obstruction debulking
When the bowel is blocked and faeces Surgery to remove as much of a
(poo) cannot pass through easily. tumour as possible. This makes it
bowel preparation easier to treat the cancer that is left
The process of cleaning out the bowel and increases the effectiveness of
before a test or scan. other treatments.

68 Cancer Council
endoscope grade
A flexible tube with a light and camera A number that describes how similar
on the end. It is used during diagnostic cancer cells look to normal cells and
tests to look inside the body. how quickly the cancer is likely to grow.
epithelial ovarian cancer gynaecological oncologist
Cancer that starts in the surface of the A gynaecologist who specialises
ovary (epithelium). in treating cancer of the female
epithelium reproductive organs.
Layers of cells covering internal and
external surfaces of the body. hysterectomy
The surgical removal of the uterus. See
fallopian tubes also total hysterectomy.
The two thin tubes that extend from the
uterus to the ovaries. The tubes carry ileostomy
sperm to the egg, and a fertilised egg A surgically created opening (stoma) in
from the ovaries to the uterus. the abdomen to the outside of the body.
family cancer centre It is made from the ileum (part of the
A medical clinic that offers genetic small bowel).
counselling and other services for people immunotherapy
with a family history of cancer. Also Treatment that uses the body’s own
called a familial cancer centre. immune system to fight cancer.
infertility
genes The inability to conceive a child.
The microscopic units that determine intraperitoneal chemotherapy
how the body’s cells grow and behave. A technique of putting chemotherapy
Genes are found in every cell of the body into the abdominal cavity.
and are inherited from both parents.
genetic testing laparoscopy
Genetic testing aims to detect faulty Surgery done through small cuts in the
genes that may increase the risk of abdomen using a viewing instrument
developing certain cancers. There are a called a laparoscope.
number of genetic conditions included laparotomy
in genetic tests for ovarian cancer. A type of open surgery in which a long
germ cell ovarian cancer cut is made in the abdomen to examine
Ovarian cancer that begins in the cells and remove internal organs.
that eventually develop into eggs. lymphadenectomy
germ cells Surgical removal of the lymph nodes
Cells that produce eggs in females and from a part of the body. Also called a
sperm in males. Also called germinal cells. lymph node dissection.

Glossary 69
lymph nodes omentectomy
Small, bean-shaped structures that Surgical removal of the omentum.
collect and destroy bacteria and viruses. omentum
Also called lymph glands. A sheet of fatty tissue that hangs over
lymphoedema the abdominal organs.
Swelling caused by a build-up of lymph ovary
fluid. This happens when lymph vessels A female reproductive organ that
or nodes can’t drain properly because contains eggs (ova). It produces the
they have been removed or damaged. hormones oestrogen and progesterone.
Lynch syndrome ovulation
A genetic condition that increases the The release of an egg during the
risk of developing ovarian cancer. menstrual cycle.

maintenance treatment palliative treatment

Treatment given for months or years Medical treatment for people with
as part of the treatment plan after the advanced cancer to help them manage
initial treatment to prevent the cancer pain and other symptoms.
coming back. paracentesis
malignant The draining of excess fluid from the
Cancerous. Malignant cells can spread abdomen. Also called an ascitic tap.
(metastasise) and eventually cause death patient-controlled analgesia (PCA)
if they cannot be treated. An intravenous system that allows a
menopause person to administer a measured dose
When a woman stops having periods of pain relief by pressing a button.
(menstruating). This can happen pelvis
naturally, from treatment, or because The lower part of the trunk of the body;
the ovaries have been removed. roughly, the area that extends from hip
menopause hormone therapy (MHT) to hip and waist to groin.
Drug therapy that supplies the body with peritoneum
hormones that it is no longer able to The lining of the abdomen.
produce naturally. Previously known as pleural effusion
hormone replacement therapy (HRT). A collection of fluid between the two
metastasis (plural: metastases) sheets of tissue that cover the lungs.
Cancer that has spread from a progesterone
primary cancer in another part of the A sex hormone made mostly by the
body. Also called secondary cancer. ovaries that prepares the uterus lining
(endometrium) for pregnancy.
oestrogen puberty
A sex hormone produced mainly The process of reaching sexual maturity
by the ovaries. and becoming capable of reproduction.

70 Cancer Council
radiation therapy tumour markers
The use of targeted radiation (usually Chemicals produced by cancer cells
x-ray beams) to kill or damage cancer and released into the blood. These
cells so they cannot grow, multiply or may suggest the presence of a tumour.
spread. Also called radiotherapy. Markers can be found by blood tests or
recurrence by testing tumour samples.
The return of a disease after a period
of improvement (remission). ultrasound
remission A scan that uses soundwaves from a
When the symptoms and signs of the device called a transducer to create
cancer reduce or disappear. a picture of part of the body. The
transducer may be a handheld device
stage moved over your belly area (abdominal
The extent of a cancer and whether the ultrasound) or a wand inserted in your
disease has spread from its original site vagina (transvaginal ultrasound).
to other parts of the body. uterus
stromal cell cancer A hollow muscular organ in a woman’s
Cancer that begins in the cells in the lower abdomen in which a fertilised egg
ovaries that release the hormones (ovum) grows and a fetus is nourished
progesterone and oestrogen. until birth. Also called the womb.

targeted therapy
Treatment that attacks specific particles Can’t find a word here?
(molecules) within cells that allow cancer
For more cancer-related words, visit:
to grow and spread.
• cancercouncil.com.au/words
total hysterectomy
• cancervic.org.au/glossary
The surgical removal of the uterus and
• cancersa.org.au/glossary.
cervix. See also hysterectomy.

References
1. Gynaecological Oncology Network, Gynaecological cancer: A guide to clinical
practice in NSW, Agency for Clinical Innovation, Chatswood, NSW, 2019.
2. National Comprehensive Cancer Network (US), NCCN Clinical Practice Guidelines in
Oncology (NCCN Guidelines): Ovarian Cancer including Fallopian Tube Cancer and
Primary Peritoneal Cancer, Version 3.2019.
3. Australian Institute of Health and Welfare (AIHW), Cancer Data in Australia, Australian
Cancer Incidence and Mortality (ACIM) books: ovarian cancer, AIHW, Canberra, 2018.
4. Australian Institute of Health and Welfare (AIHW), Cancer in Australia 2019, AIHW,
Canberra, 2019.

Glossary 71
 How you can help
At Cancer Council, we’re dedicated to improving cancer control. As
well as funding millions of dollars in cancer research every year, we
advocate for the highest quality care for cancer patients and their
families. We create cancer-smart communities by educating people
about cancer, its prevention and early detection. We offer a range
of practical and support services for people and families affected
by cancer. All these programs would not be possible without
community support, great and small.

Join a Cancer Council event: Join one of our community

fundraising events such as Daffodil Day, Australia’s Biggest Morning
Tea, Relay For Life, Girls’ Night In and other Pink events, or hold
your own fundraiser or become a volunteer.

Make a donation: Any gift, large or small, makes a meaningful

contribution to our work in supporting people with cancer and their
families now and in the future.

Buy Cancer Council sun protection products: Every purchase

helps you prevent cancer and contribute financially to our goals.

Help us speak out for a cancer-smart community: We are a

leading advocate for cancer prevention and improved patient
services. You can help us speak out on important cancer issues
and help us improve cancer awareness by living and promoting
a cancer-smart lifestyle.

Join a research study: Cancer Council funds and carries out

research investigating the causes, management, outcomes and
impacts of different cancers. You may be able to join a study.

To find out more about how you, your family and friends can help,
please call your local Cancer Council.

72 Cancer Council
 Cancer Council
13 11 20
Being diagnosed with cancer can be overwhelming. At
Cancer Council, we understand it isn’t just about the treatment
or prognosis. Having cancer affects the way you live, work and
think. It can also affect our most important relationships.

When disruption and change happen in our lives, talking

to someone who understands can make a big difference.
Cancer Council has been providing information and support
to people affected by cancer for over 50 years.

Calling 13 11 20 gives you access to trustworthy information

that is relevant to you. Our cancer nurses are available to answer
your questions and link you to services in your area, such as
transport, accommodation and home help. We can also help
with other matters, such as legal and financial advice.

If you are finding it hard to navigate through the health care

system, or just need someone to listen to your immediate
concerns, call 13 11 20 and find out how we can support you,
your family and friends.

Cancer Council services and programs vary in each area.

13 11 20 is charged at a local call rate throughout Australia (except from mobiles).

If you need information If you are deaf, or have a

in a language other hearing or speech impairment,
than English, an you can contact us through
interpreting service is the National Relay Service.
available. Call 13 14 50. www.relayservice.gov.au
 UNDERSTANDING OVARIAN CANCER
For information and support
on cancer-related issues,
call Cancer Council 13 11 20.
This is a confidential service.

Visit your local Cancer Council website

Cancer Council ACT Cancer Council Queensland Cancer Council Victoria
actcancer.org cancerqld.org.au cancervic.org.au

Cancer Council NSW Cancer Council SA Cancer Council WA

cancercouncil.com.au cancersa.org.au cancerwa.asn.au
APR 2020 CAN958

Cancer Council NT Cancer Council Tasmania Cancer Council Australia

nt.cancer.org.au cancertas.org.au cancer.org.au

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To support Cancer Council, call your local Cancer Council or visit your local website.