Chemotherapy uses drugs that target and kill cancer cells. After surgery, most women with ovarian cancer get as a first-line chemotherapy a combined treatment with a platinum-based drug and a taxane.

• Platinum-based drugs, such as cisplatin, (trade name Platinol) and carboplatin (trade name Paraplatin) have the chemical element platinum as part of their molecular structure. These drugs form highly reactive platinum complexes that bind and crosslink DNA, a double-stranded molecule inside the nucleus of the cell that controls cellular activity. The chemical crosslinking within the DNA prevents cancer cells from growing and causes them to die.

• Taxanes, include paclitaxel, (trade name Taxol) or docetaxel, (trade name Taxotere), are a type of drug originally extracted from the Pacific yew tree, but now are chemically synthesized. Taxanes target microtubules, structures akin to internal highways inside cells. Taxanes prevent the microtubules from reorganizing themselves so cancer cells are no longer able to divide and grow.

Chemotherapy is delivered in cycles, with each treatment period followed by a rest period. How the chemotherapy is delivered depends on the stage of the disease and how much of the tumor was removed:

• Intraperitoneal chemotherapy is done through a surgically implanted catheter in the peritoneum, or abdominal cavity, to destroy cancer located in the abdomen or pelvis. The catheter inside the abdominal cavity is connected to a port, which the surgeon situates between a rib and abdominal muscle. The port has a chamber outside of the skin for delivery of drugs, which then enter the catheter to wash over internal organs. Some of the drug also diffuses into the bloodstream.
• Systemic chemotherapy is done by mouth or intravenously, through the vein to destroy or control cancer throughout the body.

The National Cancer Institute recommends that, for select ovarian cancer patients, chemotherapy can be given both intravenously or intraperitoneally.

Intraperitoneal chemotherapy has more short-term toxicity, but recent studies have shown that it may be associated with a longer survival rate. It is important that you talk with your team about the pros and cons of this approach.

Questions for your doctor

Here are some questions the National Cancer Institute suggests you might consider asking a doctor before you start chemotherapy:

• When will treatment start? When will it end? How often will I have treatment?
• Which drugs will I have?
• How do the drugs work?
• Do you recommend intravenous and intraperitoneal chemotherapy for me? Why?
• What are the expected benefits of treatment?
• What are the risks of treatment? What side effects might I have?
• How can I prevent or treat these side effects?
• How much will chemotherapy cost? Will my health insurance pay for all of the treatment?