Some treatments for advanced ovarian cancer may come with complications and side effects. “I had to discontinue my medication due to severe fatigue, even at low doses,” one MyOvarianCancerTeam member said. Another member replied, “Surgery put me into early menopause.”

Ovarian cancer is considered advanced when it spreads beyond the ovaries or fallopian tubes. These stages are called stage 2, stage 3, and stage 4. (Cancer stages are sometimes shown in Roman numerals, such as stage III for stage 3.) Treatment plans for ovarian cancer depend on many factors, including the cancer’s type, stage, and grade. A person’s age, overall health, and any other medical conditions also play a role.

Ovarian Cancer Treatments

Some treatment options for advanced ovarian cancer include surgery, chemotherapy, immunotherapy, targeted therapy, hormone therapy, and sometimes radiation therapy. Additionally, new treatments are always being developed and may be available through clinical trials. While these treatments aim to destroy cancer cells, they can also cause long-term side effects or complications.

Surgery

Surgery for ovarian cancer may include:

• Oophorectomy — Removal of the ovaries
• Salpingectomy — Removal of the fallopian tubes
• Hysterectomy — Removal of the uterus
• Lymphadenectomy — Removal of one or more lymph nodes

Other affected tissues and organs may be removed during surgery as well. Your oncologist may also recommend debulking surgery, which removes as much of the tumor as possible before chemotherapy begins.

Chemotherapy

Chemotherapy for ovarian cancer uses drugs to kill cancer cells. It’s typically given:

• Intravenously (through a vein)
• Orally (by mouth)
• Intraperitoneally (into the abdomen)

Chemotherapy may be given before surgery (called neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy).

Targeted Therapy

Targeted therapy uses medications that specifically target and destroy the abnormal parts of cancerous cells. The types of targeted therapy for ovarian cancer include angiogenesis inhibitors, antibody-drug conjugates, PARP inhibitors, and TRK inhibitors. Which one is used will depend on the type of ovarian cancer.

Immunotherapy

Immunotherapy helps your immune system recognize and attack cancer cells.

Hormone Therapy

Hormone therapy for ovarian cancer may include drugs that block the production of estrogen or reduce the effects of estrogen on cells. This approach may slow the growth of some ovarian cancers.

Radiation Therapy

Radiation isn’t commonly used to treat most ovarian cancers. Sometimes, localized radiation (the use of high-energy beams to kill cancer cells) may be used.

Clinical Trials

Clinical trials test new treatments, which may include new chemotherapy drugs, combinations of existing treatments, or targeted therapies. The risks of clinical trials can be similar to current treatments, but there may also be additional or unknown risks.

Complications of Ovarian Cancer Treatments

Treatments for ovarian cancer come with several potential complications.

1. Chemotherapy-Related Side Effects

Chemotherapy involves killing rapidly growing cancer cells. But it also affects healthy cells that undergo constant growth. This may include the hair follicles, cells in the bone marrow that make blood cells, and the lining of the digestive tract.

Many side effects seen with different types of cancer therapy can be due to impaired bone marrow function. This can cause low blood cell counts. Low blood cell counts can lead to:

• More frequent infections
• Slower wound healing
• Increased risk of bleeding
• Fatigue (persistent exhaustion that doesn’t improve with rest)

Other common side effects of chemotherapy include:

• Nausea and vomiting
• Diarrhea or constipation
• Mouth sores
• Hair loss
• Symptoms similar to an allergic reaction (such as rash, itching, or trouble breathing)

Many of these side effects improve after treatment ends, but some — such as fatigue or numbness in hands and feet — may last longer.

2. Infertility and Early Menopause

Infertility (not being able to get pregnant) and early menopause (when periods stop before age 45) are common complications of ovarian cancer treatment, especially in advanced cases.

The ability to become pregnant and have regular periods depends on the ovaries, which produce hormones like estrogen and progesterone.

• Surgical removal of both ovaries or the uterus causes permanent infertility.
• Chemotherapy and hormone treatment may also lead to infertility, even if one ovary and the uterus are still in place. This may occur in people treated for some early-stage ovarian cancers.

Early menopause may happen after surgery, chemotherapy, or hormone therapy. This change can bring symptoms like hot flashes, mood changes, or vaginal dryness.

If fertility is important to you, talk to your healthcare team before starting treatment. They can help you understand your options for preserving fertility or managing early menopause.

3. Bladder and Bowel Changes

When ovarian cancer spreads to other abdominal organs, surgery may involve removing parts of those organs. If the surgeon removes tissue from the bladder, they may place a urinary catheter. This allows the bladder to heal while also giving you a way to pass urine.

If a portion of the intestines is removed, a colostomy may be needed. A colostomy creates an opening (called a stoma) in the abdomen, allowing solid waste to leave your body through a colostomy bag.

These changes can affect your daily routine, but support and resources are available to help you adjust. Talk to your care team about what to expect.

4. Abdominal Adhesions

Abdominal surgery can sometimes lead to abdominal adhesions — bands of internal scar tissue that form between organs or tissues in the belly.

These adhesions may cause:

• Bloating
• Abdominal pain
• Bowel obstruction (a blockage in the intestines)

In some cases, severe adhesions may need another surgery to relieve symptoms or remove the blockage.

5. Fluid Buildup and Swelling

Edema (collection of fluid in the body) is a common complication of surgical removal of lymph nodes in the pelvis and abdomen. Fluid that’s normally drained by the lymphatic system can build up in areas such as the feet and legs, leading to swelling and pain.

6. Bladder Irritation and Bleeding

Bleeding and irritation of the lining of the bladder can occur with the chemotherapy drug ifosfamide (Mitoxana).

7. Bone Marrow Damage and Secondary Cancer

In rare instances, long-lasting damage to bone marrow from chemotherapy can result in types of blood cancer called myelodysplastic syndrome and acute myeloid leukemia.

8. Cognitive Impairment

Sometimes called “chemo brain,” cognitive impairment can happen during or after chemotherapy. It may involve:

• Memory problems
• Difficulty concentrating
• Trouble finding the right words when speaking

These changes are often temporary but can last for months or longer in some people. There are strategies and treatments that may help improve focus and thinking.

9. Eye Issues

Some medications, such as antibody-drug conjugates, may lead to eye issues. These can include:

• Blurry vision
• Conjunctivitis (inflammation of the eye’s outer lining)
• Keratopathy (a condition affecting the cornea, the clear front part of the eye)

10. Hearing Loss

The chemotherapy drug cisplatin may cause nerve damage, leading to loss of hearing and dizziness. “I had hearing loss prior to ovarian cancer and wore hearing aids as a result,” one MyOvarianCancerTeam member said. “Post-chemo, this loss was significantly greater. Very disappointing.”

11. Kidney Damage

Chemotherapy with cisplatin may also result in long-term kidney damage. However, kidney damage is usually prevented with proper hydration using intravenous (IV) fluids.

12. Lung Inflammation

Antibody-drug conjugates may cause inflammation in the lungs. Doctors may use corticosteroids to treat it.

13. Osteoporosis

Osteoporosis is the loss of bone mass that can result from factors like aging, cancer, or hormone therapy. It can increase your risk for broken bones, but treatments are available to help.

14. Peripheral Neuropathy

Peripheral neuropathy is nerve damage that causes numbness, tingling, or a burning sensation — usually in the hands and feet.

Some types of chemotherapy and certain types of targeted therapy can lead to nerve damage.

15. Sexual Dysfunction

Surgery, chemotherapy, and hormone treatment can result in sexual dysfunction. This may include:

• Loss of sex drive
• Pain during sex
• Difficulty achieving arousal and orgasm

Changes in hormones, body image, or emotional well-being can also contribute to sexual dysfunction.

Knowledge Is Power

Understanding the possible side effects of treatment can help you feel more prepared and in control. Talk with your oncologist before and during treatment about what to expect and what symptoms to report right away. Many side effects can be managed — and some may even be prevented — especially when caught early.

Palliative care can play an important role in improving quality of life, even while you’re still receiving cancer treatment. It focuses on relieving symptoms, supporting emotional well-being, and helping you live as comfortably as possible.

No one should have to navigate advanced ovarian cancer alone. Staying informed and speaking up about how you’re feeling can help your care team support you every step of the way.

Talk With Others Who Understand

MyOvarianCancerTeam is the social network for people with ovarian cancer and their loved ones. Members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Are you or someone you care for living with ovarian cancer? Share your experience in the comments below, or start a conversation by posting on MyOvarianCancerTeam.