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American Cancer Society – A Guide to Chemotherapy
Chemotherapy For Epithelial Ovarian Cancer
by American Cancer Society
“Chemo for ovarian cancer is most often a combination of two or more drugs, given by IV every 3- to 4-weeks. Giving combinations of drugs rather than just one drug alone seems to be more effective in the initial treatment of ovarian cancer. The standard approach is the combination of a platinum compound, such as cisplatin or carboplatin, and a taxane, such as paclitaxel (Taxol®) or docetaxel (Taxotere®). For IV chemotherapy, most doctors favor carboplatin over cisplatin because it has fewer side effects and is just as effective. The typical course of chemo for epithelial ovarian cancer involves 3 to 6 cycles. A cycle is a schedule of regular doses of a drug, followed by a rest period. Different drugs have varying cycles; your doctor will let you know what schedule planned for your chemo. Most of the time, systemic chemo uses drugs that are injected into a vein (IV) or given by mouth. For some cases of ovarian cancer, chemotherapy may also be injected through a catheter (thin tube) 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 chemo.”
It is quite common to undergo minor surgery to have a port placed under the skin in the clavicle area for IV chemotherapy. The port helps to keep veins in the arm viable and makes it easier for chemo nurses to administer drugs and take blood samples. An intraperitoneal or “IP” port may also be placed in the abdominal area when the doctor chooses this additional course of delivery.
Intraperitoneal Chemotherapy (IP)
“In intraperitoneal (IP) chemotherapy for ovarian cancer, in addition to giving the chemo drug paclitaxel IV, the drugs cisplatin and paclitaxel are injected into the abdominal cavity through a catheter (thin tube). The tube can be placed during the staging/debulking surgery, but sometimes it is placed later…. A needle can be placed through the skin and into the port to give chemo and other drugs….Giving chemo this way gives the most concentrated dose of the drugs to the cancer cells in the abdominal cavity. This chemo also gets absorbed into the bloodstream and so can reach cancer cells outside the abdominal cavity… IP chemotherapy currently is only given to some of the women with ovarian cancer that has spread to the inside of the abdomen. It was only [originally] studied in women whose cancer had not spread outside the abdomen (stage III) and who had no tumors larger than 1 cm after surgery (optimally debulked). Also, because it can be so toxic, women must have normal kidney function and be in good overall shape for their doctor to be willing to try IP chemo. They also cannot have a lot of adhesions or scar tissue inside their abdomen because this can prevent the chemo from spreading well.”
Update on IP chemotherapy regarding study GOG 252:
from Ovarian Cancer Research Fund Alliance
“Our scientific advisors don’t believe that the results of this one trial should outweigh the significant prior evidence that suggests that IP chemotherapy is beneficial. The best evidence to date suggests that the ideal treatment for women is optimal debulking followed by IP chemotherapy. At the very least, until results of ongoing trials are known, IP chemotherapy should still be offered to women who are likely to be able to tolerate the significant toxicities associated with the treatment…. OCRA believes that like all good research, the results of GOG 252 raise more important questions for the ovarian cancer research community to tackle.”
Low Blood Cell Counts
It may happen that during chemo your white and red blood cells and platelet counts will drop below normal. This is generally treated with medication, transfusions or delaying chemo.
There is no standardized treatment for “chemo brain.” Check with your doctor if you are experiencing serious symptoms.
“For years people with cancer have worried about, joked about, and been frustrated by the mental cloudiness they sometimes notice before, during, and after cancer treatment. Even though its exact cause isn’t always known, and it can happen at any time during cancer, this mental fog is commonly called chemo brain. Patients have been aware of this problem for some time, but only recently have studies been done that could help to explain it.” Read more about this at the following link, and talk to your doctor about options to relive the symptoms.