• The most common symptoms of advanced ovarian cancer, including abdominal pain, bloating, trouble eating, and frequent urination, can often be managed with ovarian cancer treatments.
• Ovarian cancer treatments, like surgery, chemotherapy, targeted therapy, and radiation, all have side effects that can cause additional pain and discomfort.
• Managing cancer symptoms and treatment side effects can help your treatments work more effectively and give you a better quality of life.

Advanced or recurrent ovarian cancer may cause several symptoms that lead to pain or discomfort. Some of these symptoms can improve after you go through standard ovarian cancer treatments, such as surgery, chemotherapy, and targeted therapy. However, cancer can also cause other more serious problems that require specific treatments.

Advanced ovarian cancer, which also includes advanced fallopian tube or primary peritoneal cancer, includes stage 2, stage 3, or stage 4 tumors. Cancers are classified as higher stage when they have begun to grow and spread to other areas. You may already have advanced ovarian cancer when you receive your first diagnosis. Alternatively, you may have early stage cancer that disappears following treatment, but could become more advanced if it comes back.

Symptoms of Advanced Ovarian Cancer

Ovarian cancer symptoms can occur during early stage disease, when the cancer first starts developing, or later, after the cancer spreads. However, symptoms are much more common in people with advanced stage ovarian cancer. These symptoms often include:

• Pain in your abdomen
• Feeling unusually full after eating
• Having a bloated or swollen stomach
• Needing to urinate often
• Nausea
• Constipation
• Tiredness
• Back pain
• Changes in your period

Symptoms like abdominal pain, bloating, and frequent urination can be caused by cancer spreading in your abdomen. When cancer cells spread and tumors get bigger, they can bring about fluid buildup or a blockage in your digestive system or urinary system. Advanced ovarian cancer frequently leads to these problems.

Fluid in the Abdomen

Advanced ovarian cancer often causes fluid to collect inside the abdomen. This is called ascites. When your abdomen is full of liquid, this can lead to constipation, breathing problems, nausea, or feeling very full after eating.

Abdominal fluid is often treated with a drain. Your doctor will perform a minor procedure to place a tube into your abdomen and remove the extra fluid. This drainage eliminates symptoms for most people. You may also need to take medication to prevent fluid from building up again. Ovarian cancer treatments like chemotherapy may also reduce ascites.

Bowel Blockage

When your intestines become blocked and food is unable to pass through, this is known as a bowel obstruction. If you feel very bloated, have stomach pains, are constipated, and are vomiting a lot, these may be signs that your bowel is blocked.

A bowel obstruction may be treated with medication called Sandostatin (octreotide). It is also sometimes treated with surgery. Surgery may help relieve symptoms, but it also may be hard for you to heal from, especially if you are having other health problems.

Blockage of Urine

A ureter is a small tube that helps transport urine from the kidney to the bladder. Each person has two ureters. If you have a large tumor in your abdomen, it may block one or both of these tubes.

There are a couple of different procedures that can fix a blocked ureter. In one method, a doctor can put in a stent — an artificial tube that fits within the ureter and connects the kidney and the bladder. Alternatively, a ureter blockage can be treated with a nephrostomy tube. In this case, urine drains from a tube placed in the kidney to a hole in the outer surface of the abdomen, and it is collected in a bag worn outside the body.

Pleural Effusion

If you have stage 4 ovarian cancer, this means the cancer has spread to parts of your body far away from your ovaries. In some cases, stage 4 ovarian cancer spreads to the lungs. It can cause fluid to build up between the lungs and chest, called pleural effusion. This condition leads to symptoms like breathing problems, a feeling of heaviness in the chest, coughing, chest pain, difficulty lying flat, or feeling generally sick.

There are a few procedures to treat fluid around the lungs:

• Removing the fluid with a needle
• Inserting a tube or catheter into the chest to help drain the fluid
• Creating a shunt (small passageway) to move fluid from the lungs to the abdomen

Side Effects From Advanced Ovarian Cancer Treatments

Cancer treatments can ease the symptoms of your cancer, but they can also cause unpleasant side effects of their own. Ask your doctor what side effects you should expect from your ovarian cancer treatments. Your care team can often help you find ways to reduce or eliminate these side effects.

Surgery

Treatment of ovarian cancer often begins with surgery to remove the tumor. This can include:

• Salpingo-oophorectomy — Removal of one or both ovaries and fallopian tubes
• Hysterectomy — Removal of the uterus
• Lymphadenectomy — Removal of the lymph nodes, which can help your doctor know whether the cancer has spread

Advanced ovarian cancers usually need to be treated with debulking surgery, which aims to remove as much cancer as possible throughout the abdomen. If cancer is found in other organs, such as the bladder, intestines, or liver, parts of these organs may need to be removed as well.

After this surgery, you may need to stay in the hospital for a few days and may need to avoid activity for several weeks. Pain is common while healing from surgery, and your doctor will likely prescribe painkillers to help you recover.

If both of your ovaries are removed, you will begin menopause. This can cause symptoms like hot flashes and vaginal dryness. To ease these symptoms, you can try:

• Hormone therapy, including estrogen and/or progestin
• Antidepressants
• Medications to help reduce hot flashes, like Gralise (gabapentin) or Catapres (clonidine)
• Vitamin D to help strengthen your bones

Chemotherapy

Advanced chemotherapy often involves one or more chemotherapy drugs, which can kill cancer cells throughout the body. You may be given these medications before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy). Chemotherapies commonly used to treat advanced ovarian cancer include Paraplatin (carboplatin), Platinol (cisplatin), and Taxol (paclitaxel).

These medications often lead to side effects. While some chemotherapy side effects can be very unpleasant, they can usually be managed with interventions like medication, lifestyle changes, and physical therapy.

Nausea and Vomiting

Antianxiety and anti-nausea drugs may help control these side effects, as can relaxation techniques such as meditation.

Decreased Appetite

You may enjoy food more by having smaller meals, scheduling fun meals with friends or family, and using nonalcoholic mouthwash to prevent mouth dryness. Talk to a nutritionist about ways to make eating easier.

Numbness or Tingling in Hands or Feet

You may be able to counteract the nerve damage that causes numbness by receiving acupuncture, physical therapy, or massage treatments.

Rashes

Wearing sunscreen and keeping rashes clean and dry can help soothe irritated skin.

Tiredness

If you feel unusually tired, try to adjust your sleep schedule to allow for more rest. Find ways to conserve your energy while doing daily tasks, eat healthy foods, and get some light exercise.

Anxiety and Depression

Relaxation exercises, doing activities you enjoy, medication, or talking to a counselor or therapist can help you manage the anxiety and depression that can come with cancer.

Targeted Therapy

Some advanced cancers are treated with targeted therapy drugs. These medications may be given along with initial chemotherapy. Alternatively, if treatments work and your cancer disappears, targeted therapy drugs can be used as maintenance treatment to prevent your cancer from coming back.

Avastin (bevacizumab) is one drug that can slow the growth of a tumor by starving cancer cells. If you take this drug, you may experience side effects like tiredness, bleeding, headaches, or high blood pressure. Rarely, bevacizumab may cause holes to develop in the intestines, which may need to be corrected with surgery.

If you have recurrent ovarian cancer, or if you have a BRCA mutation (genetic change in the BRCA1 or BRCA2 genes), you may receive targeted therapy drugs known as PARP inhibitors. These medications, such as Zejula (niraparib), Lynparza (olaparib), or Rubraca (rucaparib), make it harder for cancer cells to repair DNA damage. PARP inhibitors can lead to diarrhea, nausea, vomiting, abdominal pain, appetite problems, tiredness, and muscle pain.

Radiation Therapy

Some women with ovarian cancer receive radiation therapy to help manage symptoms or treat tumors that have spread to other parts of the body. During this treatment, high-energy X-rays are used to kill cancer cells.

Radiation can cause:

• Red, peeling, or blistered skin
• Nausea
• Vomiting
• Diarrhea
• Tiredness
• Irritation of the vagina

Managing Treatment Side Effects

Many cancer symptoms can be treated, and most treatment side effects will go away once you stop receiving that treatment. If you experience negative health effects, talk to your care team about how to better manage them. Additional treatments may be available to help the side effects go away. You may also be able to try different cancer treatment options if your current plan isn’t working for you.

Relieving cancer symptoms and side effects is an important part of treatment. It allows you to receive the treatments you need for longer periods of time. Treating these symptoms is known as palliative care. Working with health care professionals who specialize in palliative care can help you have a better quality of life, better mental health, and even a better overall outcome.

If you have very advanced ovarian cancer, some treatments may not help. Talk to your doctor to understand what is realistic to expect, in terms of both benefits and risks, from each cancer treatment you are considering.

If you decide to stop using treatment, you can also ask your doctor about hospice or home care. Hospice care helps you live as well as you can in your last days by reducing pain and other symptoms, and improving comfort and quality of life. It allows you to spend time at home, rather than in the hospital. Hospice care provides you with a team to help with your care and offer support to your family around the clock.

When To Talk To Your Doctor

If you have ovarian cancer symptoms that are becoming worse or more frequent, talk to your doctor. You should also tell your care team about any treatment-related side effects you are having. Ask your oncologist how often you should have follow-up appointments to manage your health.

Finding Support

People with advanced cancer of the ovary, fallopian tube, or peritoneum can get support from others who are going through treatments. At MyOvarianCancerTeam, members ask and answer questions related to ovarian cancer symptoms and treatments. Talking to others who have been in your shoes may help you learn new ways to better manage your symptoms.

Have you been diagnosed with advanced ovarian cancer? Do you have any tips for others on managing ovarian cancer symptoms? Comment below, or start a conversation on your Activities page.