Ovarian cancer is often caught in later, more advanced stages, because there are often few symptoms early on in the course of the disease. Unfortunately, late-stage ovarian cancer can cause pain and discomfort. And although treatment often helps alleviate pain, some therapies may actually add to the discomfort. If you find yourself in this situation, there are ways you can ease the pain.
The good news: Your ovarian cancer healthcare team will be very familiar with anything you face. And, in most cases, there are pain management techniques that can be tailor-made to deal with most, if not all, situations.
In its earliest stages, ovarian cancer may cause no symptoms or only mild ones. These symptoms include bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, and urinary urgency. Ovarian cancer pain may also extend into the back, cause pain during sex, and, in advanced stages, bring on leg pain.
Ovarian cancer pain can be tough to recognize initially. “Women often report that they feel vague pelvic pain that feels like a little pressure. This pressure [generally] comes and goes,” says Marilyn Huang, MD, head of gynecologic oncology at UVA Health in Charlottesville, Virginia.
“The ovary moves based on our movement and relaxes when we aren’t as active, and so sometimes women feel better when they slow down,” she says. Because of this, discomfort waxes and wanes, which also makes seeking care from a doctor more complicated. It’s easy to convince yourself that it’s nothing or that it’s no big deal unless you have “stabbing” or intense pain.
Women may experience different types of pain due to ovarian cancer: dull and constant aches in the bones, a sensation of bloating, sharp or shooting pains, or vague feelings of discomfort. Some women may have no pain at all until the ovarian cancer is in a more advanced stage, says Carmel Cohen, MD, professor emeritus of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in New York City.
Advanced ovarian cancer can lead to issues that create pain because the tumor has grown. “The pain has to do either with invasion of bone or intestinal obstruction and bowel dysfunction related to the expansion of the disease, which produces a blocked or kinked bowel,” says Dr. Cohen. “That’s usually a very late event in the course of ovarian cancer. It’s controlled with pain medication the same way that one would receive pain medication for any other significant amount of pain.”
When ovarian cancer is diagnosed, doctors will work to treat the disease and try to alleviate your pain. In addition to cancer treatment, disease management also includes medication to keep the pain under control.
The pain management strategy will depend on the symptoms. “A lot of patients do not have sharp, intense pain, so most do not require narcotics,” says Dr. Huang.
Cohen strongly recommends that women talk about pain management with their healthcare providers early and often. If pain becomes considerable, you should not try to self-medicate, he says. You should see a doctor, who can determine the most appropriate way to treat and manage the pain.
One review of studies evaluating the effectiveness of mind-body techniques for cancer-related pain found that therapies such as guided imagery, meditation, mindfulness, and yoga may be effective for helping improve pain. But the authors noted that the evidence is limited, and better research is needed for definitive proof that these therapies can alleviate pain.And a small study of female cancer survivors, including those with ovarian cancer, found that a mindfulness meditation-based stress reduction therapy program effectively improved physical and mental health, reduced anxiety and depression, and resulted in a better overall quality of life.At times, the treatments for ovarian cancer can seem worse than the disease itself. Chemotherapy, radiation therapy, and surgery each carry a set of possible side effects and complications, not the least of which can be pain.
Management depends on the cause of the pain, says Huang. For instance, if you had surgery to remove one or both ovaries (called an oophorectomy) or the uterus (a hysterectomy), then management includes treating postoperative pain, such as pain at the incision site. “This may include a combination of NSAIDs (nonsteroidal anti-inflammatory drugs) and small doses of narcotics as needed,” says Huang.
Women with advanced disease may also need therapies before surgery (called neoadjuvant therapies), says Huang. This is done to reduce the size of the tumor and make it easier to remove. Chemotherapy may also be used after surgery to prevent the spread of the cancer, but it can also cause neuropathic (nerve) pain.Neuropathy (nerve damage that leads to numbness, pain, or tingling in the hands and feet) is a common side effect of chemotherapy, and it affects many women after ovarian cancer treatment. It can be mild or severe and last for months after treatment ends. Neuropathic pain can be managed with medications such as duloxetine (Irenka), gabapentin (Neurontin), and pregabalin (Lyrica), says Huang.
Ovarian cancer is often diagnosed in more advanced stages, when pain and discomfort are more likely to occur.
Pain-relief strategies include medications.
Though limited, some evidence shows that mind-body techniques such as meditation, mindfulness, and yoga may also help improve pain in women with ovarian cancer.
