Familial Ovarian Cancer Clinic (FOCC) and FOCC-Aftercare Clinic

The Familial Ovarian Cancer Clinic (FOCC) and FOCC-Aftercare clinics at Women’s College Hospital provide expert and evidence based clinical care for women at elevated risk for hereditary ovarian and fallopian tube cancers. Clinical care includes the full spectrum of gynecologic care specific to our population: patient centered contraception counselling, liaison with fertility specialists, counselling on ovarian cancer risk reduction, risk reduction surgery, and menopausal aftercare. Patients seen in the FOCC clinic will be followed until the first post-operative appointment. Any additional follow-up will take place in the FOCC-Aftercare clinic.

The FOCC-Aftercare clinic offers services for patients affected by premature menopause or struggling with menopausal symptoms, providing ongoing support for symptom control and health promotion. Patients seen in the FOCC-Aftercare clinic are monitored for diseases of estrogen deficiency and receive counseling on menopausal expectations. Care plans are catered to individualized needs and built to improve quality of life.

In collaboration with the Department of Gynecologic Oncology at Princess Margaret Hospital, the Women’s College Research Institute, and the WCH High Risk Breast Clinic, the clinic utilizes an interdisciplinary model of care to provide counseling, risk reducing surgery, and comprehensive menopause management to women who are at risk for ovarian or fallopian tube cancer. Our clinic staff currently includes a gynecologic oncologist, 2 minimally invasive gynecologic surgeons, and a menopause specialist, as well as a full complement of nursing, allied health and administrative support staff. The program is directed by Drs. Bernardini and Jacobson.

Menopause Specialist

  • Michelle Jacobso

Gynecologic Oncologist

  • Marcus Bernardini

Minimally invasive Gynecologic Surgeons

  • Mara Sobel
  • Lisa Allen

Registered Nurses (RN) and Registered Practical Nurses (RPN)

The nurses work closely with our patients to provide expert health teaching and education around both pre and post-operative care.


Genetic Counsellor

Genetic Counsellors can assess personal and/or family medical history to determine if an individual might have an increased risk for developing certain types of cancers. A Genetic Counsellor will discuss whether the cancer in a family may be hereditary, and if genetic testing is appropriate. Where warranted, genetic testing will be arranged, and results and implications discussed. Genetic Counsellors can provide information and support to an individual and their family, regarding the different options on how to best manage and reduce the risk of developing certain types of cancers.


Social Worker

The Social Worker will assist individuals and families to address and manage their emotional and social wellbeing. The Social Worker works together with other members of the health care team to provide education, counselling, support and therapy to individuals and families throughout the cancer and BRCA diagnosis and care journey. The Social Worker offers brief therapy, group therapy and connects individuals/families with community resources and programs. Speak with your doctor or nurse about getting a referral for social worker or contact 416-323-7330

Available for appointments: Face-to-face interaction/Telephone call/Virtual communication

Onsite Breast Centre/Gynecology 5th floor (Monday-Friday 8:30 am-4:30 pm)


Clinic Secretaries

The Medical Secretary provides clerical support including telecommunications and customer service functions. The Medical Secretary facilitates efficient and timely access to specialty services by receiving and processing referrals and scheduling and confirming of appointments.

Below are the types of surgical options provide to patients of the FOCC.

  • Laparoscopic Bilateral Salpingo-oophorectomy
  • Salpingectomy
  • Hysterectomy

Click on the following link from the Canadian Cancer Society for more information about each procedure.

Familial Ovarian Cancer Clinic (FOCC) and FOCC-Aftercare Clinic

Women’s College Hospital
76 Grenville Street
Floor 5
Toronto, ON M5S 1B2

Phone: 416-323-7744
Fax: 416-323-6237
Referral Fax: 416-323-6330 – Access Centre

Hours of Service

FOCC:

1st and 3rd Friday of the month
9:00 a.m. – 3:00 p.m.

FOCC Aftercare

3rd Friday of the month
9:00 a.m. – 3:00 p.m.:

Clinical Manager: Nancy Groff

Clinical Director: Vicky Noguera

Referrals

Please fax your referral to the FOCC at 416-323-6330

Patient Referral

Social Work Referral Form

Please note that appointment notification will be sent to a referring provider within 2-4 weeks. Confirmation of genetic mutation must be received prior to this appointment.

Your Care

The majority of our patients include those with a deleterious mutation in the BRCA1/2,BRIP1, STK11 and RAD51C/D genes. As our understanding of hereditary ovarian cancer expands, we are beginning to see patients with other genetic mutations.

Below are some of the services that we provide in the FOCC and FOCC-Aftercare Clinic

  • Contraception counselling
  • Liaison with fertility specialist
  • Counselling on ovarian cancer risk reduction
  • Risk reduction surgery
  • Menopausal aftercare
  • Social Work support

The FOCC and FOCC-Aftercare clinics work as collaborative clinics that include a team of gynecologic physicians and specialists, nurses, allied health professionals and a genetic counsellor to meet unique patient needs. Appointment visits are built around the idea of consultation, with the provision of information and patient-centered options that align with a patient’s presentation.

As part of an academic teaching hospital, patients may also meet with students and trainees in various disciplines from nursing, allied health and medical residents and fellows. These individuals receive specialized and hands-on training with direct supervision and expertise from our team.

There are several surgeons who range in specialization from menopause, oncology and general gynecology. In line with our shared practice model, you may meet one surgeon in consultation and have a different surgeon who performs your surgery or facilitates your follow-up. Together we align our practices to ensure a streamlined transition across all care trajectories for our patients.

We would ask that you plan to arrive at least 10-15 minutes before your scheduled appointment time so that we can complete your registration.

Please remember to bring your Ontario Health Card with you to this appointment. Please Note: f you do not have a valid Ontario Health Card, you will be required to pay directly for the clinical service(s) provided at the time of your visit. Details are available from any of our program secretaries who can be contacted at 416-323-7744

To prepare for all your visits, we recommend that you gather a list of your current medications, review your health history including cancer history and treatment, and write down your concerns or questions. Though not required, we recommend that a family member, friend or advocate accompanies you to your appointment. Should interpreter services be required for your appointment, please advise us as early as possible to ensure accommodations can be made in time for your appointment, test or procedure.

If you are unable to keep your appointment, please notify us at 416-323-7744 to cancel and/or re-schedule your appointment as soon as possible.
We require 48 hours’ notice of a cancellation so we can fill your appointment with another patient

Patient Resources

There are resources available for both patients and health care professionals. The following are websites that will provide the answer to many questions you may have about your gynecological health and general well-being.

Frequently Asked Questions

A referral form must be completed by a primary care practitioner and faxed to 416-323-6330.

Please refer to Our Team for more information on the physicians, surgeons and specialists who work in the FOCC and FOCC-Aftercare clinics.

Please contact the FOCC clinic directly to best assist you with providing an additional copy of the requisition form at 416-323-7744.

Recovery will take approximately 2 weeks. Patients may have some bleeding and experience pain that is controlled with oral medication. After surgery, patients may also experience menopause symptoms (e.g. hot flashes, night sweats, etc.) depending on their preoperative status.

If a cancer diagnosis is confirmed, patients will be seen in the clinic by the specialist and other health care providers to discuss a plan of care. If patients require additional surgery or chemotherapy, they will be referred to the Princess Margaret Hospital (PMH) for care.

Menopause symptoms may include hot flashes, night sweats, vaginal dryness and changes in weight, skin condition, mood and sexual functioning. Silent changes include changes in the cardiovascular system (CVS), bones and cognition function. Many of these symptoms can be alleviated with medication.

We have a trained Social Worker that will be able to assist. The Social Worker can be reached 416-323-7330 or by completing the Social Worker referral form. For more information please refer to Start The Talk.

 

Over 2800 Canadian women are diagnosed with ovarian cancer each year.

Although ovarian cancer is very treatable in the early stages, the symptoms of ovarian cancer are often vague and may not cause concern until the disease is well established. Because ovarian cancer is often diagnosed in the later stages, about 1800 Canadian women die of ovarian cancer each year, making it the fourth most common cause of cancer death.

Some inherited (genetic) factors have been associated with ovarian cancer; however, these factors play a role in only a small percentage of cases. Ninety percent of women diagnosed with ovarian cancer do not have the genetic mutations associated with ovarian cancer or come from families identified as being at high risk for the disease. Factors that increase a woman’s risk of the disease include:

  • being over 50 (although ovarian cancer can occur at any age)
  • family history of breast, endometrial or colorectal cancer
  • having been previously diagnosed with breast, endometrial or colorectal cancer
  • never having children
  • never using hormonal birth control methods such as the birth control pill
  • beginning to menstruate early
  • entering menopause late
  • a history of infertility

There is also some evidence which suggests that exposure to asbestos and talcum powder may increase a woman’s risk of ovarian cancer.

The ovaries are found on either side of the uterus and connected to it by the fallopian tubes. Ovaries are the size and shape of almonds.

The ovaries have two functions:

  • to produce hormones that help regulate the menstrual cycle
  • to produce the egg (ovum) released during each menstrual cycle

This ovum may unite with a male sperm cell to form a fetus, or it may be discarded as part of a woman’s menstrual flow. At menopause, the ovaries shrink in size and stop producing ovum.

Types of Ovarian Cancer

Ovarian tumours that are malignant, or cancerous, can potentially spread (or metastasize) to other parts of the body. There are three main types of ovarian cancer: epithelial tumours, germ cell tumours and stromal tumours.

Epithelial tumours

Ovarian cancer most often develops from the abnormal growth of cells on the surface of the ovaries. These cells are called epithelial cells. Epithelial cells line the surface of most of the body’s organs. When cancers develop from the abnormal growth of epithelial cells, they are called adenocarcinomas. Most ovarian cancers (85 to 90 percent) are adenocarcinomas, and tend to occur in women between the ages of 40 and 80.

Germ cell tumours

Cancers can also develop from the tissues in the centre of the ovary that produce ovum or eggs; however, these are relatively rare. About five percent of ovarian cancers are germ cell tumours. These cancers tend to occur in young girls and teenagers. With the exception of occasionally widespread metastatic disease, these cancers are highly curable.

Stromal tumours

Tumours that develop from the connective tissue that holds the ovary together and produces the female hormones estrogen and progesterone are called stromal tumours. Approximately five to seven percent of ovarian cancers are stromal tumours.

Familial Ovarian Cancer

Some ovarian cancers are associated with specific genetic mutations, which can be inherited. These inherited ovarian cancers are also usually adenocarcinomas. Familial ovarian cancers occur in individuals who have inherited specific changes (or mutations) in their BRCA1 and BRCA2 genes, as well as women with hereditary nonpolyposis colon cancer. Research suggests that mutations in these genes make cells less able to repair damage to their DNA, making uncontrolled cell growth, and cancer, more likely.

Women with mutations in their BRCA1 and BRCA2 genes are at increased risk for developing ovarian and breast cancer. A woman who is a carrier has a 15 to 45 percent chance of developing ovarian cancer. It is important to remember though that not every woman who has family members with BRCA1 or BRCA2 will have this genetic mutation, and not every case of cancer in these families results from the genetic mutation.

Non-Cancerous Ovarian Growths

Most tumours that start growing in the ovaries are benign, meaning that they are non-cancerous or non-malignant. Non-malignant growths do not spread beyond the ovaries and do not grow rapidly. The most common type of ovarian growth is called an ovarian cyst. Generally, ovarian cysts are filled with fluid, while malignant (cancerous) growths are solid. Conditions such as endometriosis and polycystic ovary syndrome can also cause cysts to grow on the ovaries. Ovarian cysts may cause abdominal discomfort and swelling, and may need to be surgically removed; however, they are not cancer.

Ovarian Cysts

An ovarian cyst is a fluid-filled sac in the ovary. The most common type of ovarian cyst – a functional cyst – often disappears without treatment. It is believed that most women of reproductive age have functional cysts from time to time. These cysts usually disappear within one or two menstrual cycles and women are rarely even aware of them. Occasionally, this sort of cyst will persist or grow very large, causing symptoms.

The most common symptom of an ovarian cyst is pain in the lower abdomen. Ovarian cysts are almost never cancerous when they occur in women of reproductive age. However, your doctor should investigate any pelvic pain.

In addition to functional cysts, there are several less common types of ovarian cysts. For example, endometriosis can cause cysts on the ovary; and polycystic ovary syndrome is sometimes, though not always, characterized by multiple cysts in the ovarie

There are no clear recommendations for preventing ovarian cancer; however, knowing about some of the risk factors may be useful, particularly for women with a family history of the disease.
Limiting the Number of Menstrual Cycles

Several studies have shown that anything that reduces the number of periods a woman has throughout her life may also reduce her risk of ovarian cancer. This can include

  • pregnancy
  • breastfeeding
  • the use of birth control pills
  • getting your period at a late age
  • starting menopause at a young age

Breastfeeding may reduce a woman’s risk of ovarian cancer.Of course, we have no control over some of these factors, such as when we begin to menstruate. However, these findings are one reason to encourage women to breastfeed after childbirth. Studies have shown that women who breastfeed are less likely to develop ovarian cancer.

A study published by the Centre for Research in Women’s Health, in 1998, showed that women who had a genetic risk for ovarian cancer but who had taken birth control pills were less likely to develop the disease. Although physicians do not prescribe birth control pills simply to reduce the risk of ovarian cancer in women without risk factors, women at genetic risk for ovarian cancer may be counselled to consider using birth control pills.

Avoiding Talcum Powder

The use of talcum powder on the genitals may be associated with ovarian cancer. Findings in this area are unclear. Some studies have found a link between the powder and ovarian cancer but this may be due, in part, to the fact that up until the 1970s, talcum powder contained asbestos. Since a connection between the talcum powder marketed today and cancer has not been ruled out, most health-care providers recommend avoiding talcum powders in the genital area. Cornstarch is a good alternative.

Eating a Low-Fat Diet Rich in Fibre and Vitamins

Research suggests there may be some connection between dietary factors and ovarian cancer. For the Iowa Women’s Health Study, researchers collected information about the eating habits of 29,000 women over a 10-year period. Of these women, 139 developed ovarian cancer. This study suggested that the regular consumption of green leafy vegetables decreased a woman’s risk of developing ovarian cancer, while diets high in cholesterol and lactose increased the risk.

Other studies have associated a high-fat diet with ovarian cancer, although this was not apparent in the Iowa study. Recent research also suggests that a diet rich in fibre, fruits and vegetables lowers a woman’s risk of developing ovarian cancer.

Preventive Removal of the Ovaries

A woman at genetic risk for ovarian cancer may be counselled to consider having both ovaries removed as a preventive measure. This is called prophylactic oophorectomy. Studies have confirmed that for a woman who has the BRCA1 or BRCA2 genetic mutation or the hereditary nonpolyposis colon cancer gene, prophylactic surgery greatly reduces (though it does not entirely eliminate) her chance of developing ovarian cancer. Women of childbearing age who have both ovaries removed will experience early menopause.

Avoiding Hormone Therapy

Hormone therapy is associated with a small increased risk of ovarian cancer. This may be something to consider before starting either estrogen-only therapy or estrogen-progestin hormone therapy.

Tubal Ligation

Women who have a tubal ligation (have their ‘tubes tied’), or surgery to block the fallopian tubes to prevent pregnancy, are substantially less likely to develop ovarian cancer. This procedure also reduces the risk of ovarian cancer for women with the BRCA1 or BRCA2 gene mutations.

Ovarian cancer often has no symptoms (or only very mild ones) until it begins to spread beyond the ovaries. Unfortunately, there is no effective way of screening for ovarian cancer at this time. The effective treatment of ovarian cancer will be significantly increased if researchers can develop a screening test that helps doctors identify ovarian cancer at its early stages. Several large studies are currently underway, but the results will not be available for several years.

Physical symptoms of ovarian cancer include:

  • abdominal discomfort or pelvic pain
  • bloating
  • difficulty eating or feeling full quickly
  • frequent urination
  • fatigue
  • backache
  • nausea, indigestion, loss of appetite
  • weight loss
  • change in bowel habits
  • gas
  • pain during intercourse
  • abnormal vaginal bleeding (rare)

These symptoms are associated with a variety of health concerns, many of which are not serious. However, any woman who experiences any combination of these symptoms for more than three weeks should contact her family doctor and consider having the following tests:

  • a bimanual rectovaginal examination
  • a transvaginal ultrasound
  • a CA-125 blood test (postmenopausal women only)

A bimanual rectovaginal exam

A bimanual rectovaginal exam involves a doctor inserting one finger into the vagina and another into the rectum, to feel for any lumps around the ovaries.

Transvaginal ultrasound

An ultrasound uses sound waves to create a picture of the inside of the body. During a transvaginal ultrasound, a probe is placed inside the vagina to take ‘pictures.’ The images can be seen on a video monitor and may also be printed out.

A transvaginal ultrasound can help spot abnormal growths on the ovary, and if abnormalities are present, it may help to distinguish between a tumour and a cyst. The test is painless and can be completed very quickly. You do not need to drink water for this test.

CA-125 test

CA-125 is a protein which is normally found in the body, but which is often produced at higher levels by tumour cells. Most women with Stage-3 or Stage-4 ovarian cancer have elevated levels of CA-125. A blood test can measure your level of CA-125.

A CA-125 test has several limitations. It is not effective for detecting ovarian cancer in its early stages, as only 40 to 50 percent of women with Stage-1 ovarian cancer have elevated levels of CA-125. Another limitation is that many women who have elevated levels of CA-125 do not have ovarian cancer at all. Elevated CA-125 levels can also be caused by a number of other conditions, many of which are benign. These include endometriosis, pelvic inflammatory disease, fibroids, benign tumours, pregnancy and other conditions.

If abnormalities are found during any of these tests, further tests should be done, as none of these initial tests can prove you have cancer. To distinguish between a malignant growth and a benign tumour or cyst, followup diagnostic tests are needed.

If your doctor suspects that you may have ovarian cancer, ask for a referral to a gynecological oncologist.

Diagnostic Tests for Ovarian Cancer

Imaging technologies, such as CT scans or radiographic scans, may be used to define the size, location of and changes to any abnormal growths that may be found on the ovaries. However, surgery is the only sure way to determine whether a cancer is present.

Laparoscopy vs. Laparotomy

Sometimes this initial surgical examination may be done using an instrument called a laparoscope. A laparoscope is a telescope with a tiny camera mounted on the end. This instrument can be inserted through a small incision just below your belly button, to look inside your abdomen. If necessary, it can also be used to remove tissue. The use of a laparoscope is not appropriate for everyone, and not all surgeons are comfortable with this type of surgery.

Your physician may recommend a more extensive surgery called a laparotomy. During a laparotomy, the abdominal wall is opened through a large incision and the surgeon can do a more extensive resection of other abdominal organs. If an initial laparoscopic exam does reveal cancer tissue, a subsequent laparotomy may be necessary.

During either of these exploratory procedures, the doctor will examine the ovaries and other abdominal organs for abnormal growths. This will allow the surgeon to determine the stage of the cancer. The surgeon will also remove tissue to examine later under a microscope. If one of the ovaries appears abnormal, the surgeon will remove the entire affected ovary and possibly both ovaries. Removing only a portion of the ovary might risk leaving cancerous cells in the ovary.
Surgical Treatment

If you are having a laparotomy, your doctor will discuss with you before the surgery what will happen if cancer is found. The first step in cancer treatment is to remove the affected organs. This may be done during the initial surgery to reduce the need for further surgery. Use our Treatment pages to learn more.

Staging Ovarian Cancer

Staging is the process of assessing whether the cancer has spread and how far it has spread. The stage of your cancer, along with the general state of your health and whether or not you plan to have children, will help determine the treatment best for you. Staging is done by combining information from imaging tests with the results of a surgical exam done during a laparotomy.

Numbered stages are used to describe the extent of the cancer and whether it has spread (metastasized) to more distant organs. Generally, there are four stages used to describe the extent of ovarian cancer.

Stage I: The disease is limited to the ovary.

Stage II: The cancer has spread beyond the ovaries, but is limited to the pelvis (below the navel). This may include the uterus, fallopian tubes, bladder, sigmoid colon or rectum.

Stage III: The cancer has spread beyond the ovaries, but is limited to the pelvis and abdominal cavity (excluding the liver). This may include the lining of the abdomen and the lymph nodes in the abdomen.

Stage IV: The cancer has spread to the liver or organs outside the abdomen.

The first step in the treatment of ovarian cancer is the surgical removal of cancerous tissue. This is often done during the initial surgery, when the cancer is first discovered. For early stage ovarian cancer (Stage 1), only the affected ovary may need to be removed. However, lymph nodes in the pelvis and para-aortic areas, and a fatty apron inside the abdomen, called the omentum, usually need to be removed as well. The surgical removal of an ovary is called an oophorectomy. If one ovary is retained, a woman of childbearing age does not usually experience early menopause after the surgery.

More commonly, ovarian cancer is diagnosed at a later stage and the ovaries, fallopian tubes, uterus and cervix are all removed. This procedure is called a hysterectomy with bilateral salpingo-oophorectomy.

For women with advanced ovarian cancer, chemotherapy is sometimes used both before and after surgery. This makes the complete removal of the tumour easier and more successful.

Along with the reproductive organs, the omentum and some lymph nodes from the abdomen may be removed. If there is evidence that the cancer has spread throughout the abdomen, the surgeon will usually attempt to remove as much of the cancer as possible. This is called tumour debulking.

After the Surgery

After the surgery, depending on whether you had a laparoscopic procedure or laparotomy, you may experience some pain and abdominal discomfort. (Laparoscopy is generally associated with less pain and a quicker recovery.) You may also feel nauseous and not feel like eating. These side effects are temporary and can be controlled. Talk to your doctors about how you can control your pain and nausea.

If you are of childbearing age, the removal of both of your ovaries will prompt the early onset of menopause and symptoms like hot flashes are likely to occur soon after surgery. The symptoms of menopause that occur after surgery are often more severe than the symptoms of a natural menopause. Your doctor may suggest hormone therapy (HT) to prevent or alleviate your symptoms. However, evidence that highlights some of the risks associated with HT make this a controversial subject. Discuss the risks and benefits of HT in your particular case with your doctor. Ultimately though, it is your choice whether or not to take hormones.

After the cancerous tissue is removed, chemotherapy is commonly recommended unless the cancer was in the earliest stages. Radiation therapy is not a commonly used treatment, but may also be a part of a woman’s therapy. Click on the links below to learn more about these therapies.

Chemotherapy

Chemotherapy means using a combination of drugs to kill cancer cells. Before surgery, it is used to reduce the size of the tumour so that it will be easier to remove. After surgery, it is used to destroy any remaining cancer cells. The most common drugs used to treat ovarian cancer are Paraplatin and Taxol; however, others are available if this initial combination does not prove successful.
How Chemotherapy Is Given

Chemotherapy is usually used systemically, which means that the drugs are taken intravenously, and circulate through your system. Recent evidence suggests improved survival in patients who receive IP (intraperitoneal) chemotherapy. This requires the use of a portocath, which is a small device that is placed under the skin of the abdominal wall, and is either inserted during your initial surgery or afterwards in the radiology department.

The chemotherapy drugs used to treat ovarian cancer are often given in cycles, once every three to four weeks. The treatment is usually repeated six times. In most cases, you can receive these drugs as a day patient or through home care treatments. When administered intravenously, the total treatment may take up to five hours.

More recently, the standard intravenous therapy has been used in combination with chemotherapy injected directly into the abdominal cavity, using a catheter placed during the initial surgery. The chemotherapy drugs target the cancer cells attached to the lining of your abdomen. This combination has been shown to improve the survival rate of women with advanced ovarian cancer.

Side Effects

Chemotherapy drugs are most destructive to rapidly growing cells like cancer cells; however, they cause side effects because they are toxic to all of the body’s cells. But it is important to remember that not everyone experiences severe side effects from chemotherapy. The side effects will vary depending on the specific drugs being used, the dosage, and the length of time you are on the medication. Side effects may include:

  • nausea and vomiting
  • loss of appetite
  • anemia (low iron)
  • diarrhea or constipation
  • fatigue
  • headaches
  • hair loss
  • peripheral neuropathy (nerve damage that causes pain or numbness in the hands or feet)
    darkening of the skin and fingernails
  • hearing loss

You are not likely to experience all of these symptoms. Talk to your caregivers about what you are experiencing. In most cases, they can give you medications to relieve your symptoms, if, for example, you are feeling nauseous. They can also tell you more about how long your symptoms are likely to last and how other women have coped. Women using chemotherapy may need to drink extra fluids to prevent kidney damage.

Radiation Therapy

External radiation therapy (also called radiotherapy) uses high-energy x-rays to damage cancerous cells. This can be done by using a special machine that directs radioactive energy from outside the body at the cancerous cells or by implanting radioactive materials directly into or near the tumour. Radiation therapy is a useful way to target and reduce the size of a tumour, but because ovarian cancer cells have often spread throughout the abdomen, it is of limited use for treating ovarian cancer and is rarely used.

Radiation therapy is usually given five days a week, over the course of six or seven weeks.

Different people react in different ways to the treatment. The most common side effect of any radiation treatment is fatigue. You will likely feel very tired, particularly in the later weeks of treatment. It is common for fatigue to last for four to six weeks after your treatments are complete. Other side effects include red, itchy, sensitive skin and diarrhea. Most of these side effects stop once the radiation treatment has ended.

Monitoring Your Progress

Your doctor will do blood tests regularly, throughout your treatment, to monitor the side effects of your chemotherapy. The CA-125 blood test may also be used to gauge the effectiveness of treatment.

After your treatment is complete, your doctor will likely want to schedule regular check-ups. You should also watch for any unusual symptoms, such as:

  • abdominal bleeding
  • shortness of breath
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • vaginal bleeding

Most women have some of these symptoms occasionally, but if you experience these symptoms over a prolonged period, you should see your doctor.

What Happens If the Cancer Does Come Back?

You doctor will discuss the best treatment strategy for you. However, recurrences are most often treated with more chemotherapy, often using a different combination of drugs.

Ovarian cancer is a difficult illness. Like many cancers, the treatments can be exhausting and unpleasant, and even when treatment is complete, the fear of recurrence continues.

Your illness may mean new restrictions on your life and this may leave you feeling frustrated, angry or overwhelmed.

You may also be afraid of pain or what will happen in the future. The support of your family and friends will be important, but sometimes the people close to us don’t know what to say or how to help. This can be particularly true for women, who may have always been the caregivers. Talk to the staff where you get your treatments about the resources available to you. They may be able to refer you to support groups where you can meet other women who have had the same experiences. They can also direct you to counselling services or support services that can help you cope with new limitations.

As much as possible, try to continue with the activities that have always brought you pleasure. Your life and pleasure are important. Being able to continue enjoying your life is the main purpose of your treatments.

For Women of Child-Bearing Age

For women of childbearing age who are diagnosed with ovarian cancer in the early stages, it may be possible to preserve fertility, by removing one or both ovaries and keeping the uterus. Women with ovarian cancer who wish to have children also have the options of donating or freezing their eggs and surrogacy. If you wish to have children, ask your doctor or a fertility specialist to review your options with you.

The treatment for ovarian cancer often means that you will no longer be able to have children. This can be difficult for you and, if you have a partner, for your partner as well. Even if you do not plan on having any (more) children, this may be an emotional time for you. Give yourself time to grieve this loss.

Treatment for ovarian cancer often causes a woman to have early menopause. Early menopause may bring up concerns about aging and affect your feelings about your sexuality. For more information about sex and menopause, visit our Sexual Health Centre.

There are treatments available to alleviate your symptoms. You may be advised to consider hormone therapy (HT), to alleviate hot flashes. HT is a controversial subject. It can improve a woman’s quality of life after surgical menopause, and there is no evidence that HT adversely affects the prognosis of women with ovarian cancer. At the same time, research has shown that, when taken for 10 or more years, it may be linked to ovarian cancer as well as breast cancer and blood clots; however, these risks are small. Discuss the benefits and risks with your health-care providers. Ultimately, whether or not you decide to use HT is your choice.