Systemic chemotherapy uses drugs that are injected into a vein (IV) or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancers that have metastasized (spread). For some cases of ovarian cancer, chemotherapy may be injected through a catheter directly into the abdominal cavity. This is called intraperitoneal (IP) chemotherapy. Drugs given this way are also absorbed into the bloodstream, so IP chemotherapy is also a type of systemic chemotherapy. See below for more information.

Chemotherapy drugs kill cancer cells but also damage some normal cells. Therefore, your doctor will be careful to avoid or minimize side effects, which depend on the type of drugs, the amount taken, and the length of treatment.

Temporary side effects might include nausea and vomiting, loss of appetite, loss of hair, hand and foot rashes, and mouth sores. Some of the drugs used in treating ovarian cancer can cause kidney and nerve damage.

Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in:

• an increased chance of infection (caused by a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (caused by a shortage of blood platelets)
• fatigue (caused by low red blood cell counts)

Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends, although it may look different. There are remedies for many of the temporary side effects of chemotherapy. For example, there are very good drugs that can be given to prevent and treat nausea and vomiting. For more information about chemotherapy and its side effects, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.

Side effects that may be permanent include premature menopause and infertility (inability to become pregnant).

Rarely, some cancer treatment drugs may later cause a life-threatening cancer of white blood cells called acute myeloid leukemia. This is called a secondary malignancy. Your health care team knows which drugs can cause this problem and will discuss this possibility with you. Their positive effects against ovarian cancer offset the small chance that any of these drugs will cause leukemia.

The typical course of chemotherapy for epithelial ovarian cancer involves 6 cycles. A cycle is a schedule that allows regular doses of a drug, followed by a rest period. Different drugs have varying cycles; your oncologist (cancer doctor) will prescribe the particular cycle or schedule for your chemotherapy.

These drugs are usually given intravenously in a 3- to 4-week cycle. If chemotherapy treatment is chosen, you will probably receive a combination of drugs. Most oncologists in the United States believe that combination chemotherapy is more effective in treating ovarian cancer than one drug alone.

Combination therapy using a platinum compound, such as cisplatin or carboplatin, and a taxane, such as paclitaxel (Taxol^®) or docetaxel (Taxotere^®), is the standard approach. For IV chemotherapy, most doctors favor carboplatin over cisplatin because it has fewer side effects and is just as effective.

In intraperitoneal (IP) chemotherapy the chemotherapy drugs are injected into the abdominal cavity through a thin tube or catheter. The tube can be placed during the staging/debulking surgery, but sometimes it is placed later, after surgery. If it is done after surgery, many doctors place it using laparoscopy. The catheter is usually connected to a "port," which is placed under the skin against a bony structure of the abdominal wall, such as a rib or pelvic bone. A port is a half dollar-sized disk topped with a pliable diaphragm. A needle can be placed through the skin and the diaphragm to give medicines like chemotherapy. Over time, there can be problems with the catheter. -- it may become plugged or infected or even damage the bowel.

Giving chemotherapy this way has the advantage of giving the most concentrated dose of the drugs to the cancer cells in the abdominal lining. The chemotherapy drugs given this way also get absorbed into the bloodstream and reach cancer cells outside of the abdominal cavity. IP chemotherapy works well, but the side effects can be more severe than with regular chemotherapy. In a study of women with advanced ovarian cancer, women getting the IP chemotherapy had more abdominal pain, nausea, vomiting, and other side effects than the women getting chemotherapy through the vein. These side effects actually made some women stop their treatment early. Still, the women getting intraperitoneal chemotherapy lived longer than the women getting regular chemotherapy. IP chemotherapy is currently only given to some of the women with advanced cancer.

Although epithelial ovarian cancer tends to respond to chemotherapy, the cancer cells may eventually begin to grow again. Tumor recurrence can be treated with additional cycles of the same chemotherapy used the first time. In some cases, different drugs are used. Some of these are topotecan, anthracyclines such as doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil), gemcitabine, cyclophosphamide, vinorelbine (Navelbine), hexamethylmelamine, ifosfamide, and etoposide.

Different drug combinations are often used to treat germ cell tumors and are described in the section on treatment of germ cell tumors.

Last Medical Review: 08/27/2009
Last Revised: 08/27/2009