Treatment for Ovarian Cancer

Navigating and understanding treatment options are critical for an ovarian cancer patient’s survival. All treatment decisions should be made by a patient and her family in consultation with her medical professional.

The standard treatment for ovarian cancer consists of debulking surgery followed by six rounds of chemotherapy. The goal of treatment for ovarian cancer is to surgically remove as much of the cancer as possible through the debulking and then to provide what is called adjuvant, or additional therapy, such as chemotherapy, to kill any possibly remaining cancer cells in the body. Radiation therapy is not typically utilized in ovarian cancer.

After Diagnosis

Before surgery, a doctor, preferably a gynecologic oncologist, will explain to a woman the nature of the operation and the expectation for the extent of tissue that will be removed.

Surgery: During surgery, doctors attempt to remove all visible tumors (tumor debulking). Women whose surgery was performed by a gynecologic oncologist have better outcomes than patients whose surgeons were not oncologists, including improved survival and longer disease-free intervals.

Staging and Grading: In order to make a definitive diagnosis of ovarian cancer, a gynecologic oncologist must perform surgery to gather samples for analysis by a pathologist. During the surgery, the surgeon will assess how far the disease has spread. This assessment is called “staging.” Along with grading (see below), these assessments help your doctor recommend a treatment plan.

Staging in ovarian cancer and other gynecologic cancers has been standardized by the International Federation of Gynecology and Obstetrics (FIGO). While other factors impact prognosis, FIGO stage is by far the most important predictor of long term survival.

For more detailed information on ovarian cancer diagnosis by stage, please see below.

Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen (ascites). At this stage, cancer cells have not spread to other organs and tissues in the abdomen or pelvis, lymph nodes, or to distant sites.

  • IA – Limited development in either one ovary or fallopian tube, where the outer ovarian capsule is not ruptured. There is no tumor on the external surface of the ovary and there is no ascites and/or the washings are negative.
  • IB – Cancer is present in both ovaries or fallopian tubes, but the outer capsule is intact and there is no tumor on external surface. There is no ascites and the washings are negative.
  • IC – The cancer is either Stage IA or IB level but the capsule is ruptured or there is tumor on the ovarian surface or malignant cells are present in ascites or washings.

Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, the bladder, the sigmoid colon, or rectum in the pelvis. Cancer cells may be found in fluid collected from the abdomen.

  • IIA – Extension or implants onto the uterus and/or fallopian tube. The washings are negative washings and there is no ascites.
  • IIB – Extension or implants onto other pelvic tissues. The washings are negative and there is no ascites.
  • IIC – Pelvic extension or implants like Stage IIA or IIB but with positive pelvic washings

Stage III: Cancer cells have spread to tissues outside the pelvis or to regional lymph nodes in the back of the abdomen (retroperitoneal lymph nodes). Cancer cells may be found on the outside of the liver.

  • IIIA – Tumor is largely confined to the pelvis but with micro-scopic peritoneal metastases beyond pelvis to abdominal peritoneal surfaces or the omentum.
  • IIIB – Same as IIIA but with macro-scopic peritoneal or omental metastases beyond pelvis less than 2 cm in size
  • IIIC – Same as IIIA but with peritoneal or omental metastases beyond pelvis, larger than 2 cm or lymph node metastases to inguinal, pelvic, or para-aortic areas. Cancer may have also spread to the lymph nodes, but it has not spread to the inside of the liver or spleen or to distant sites.

Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the spleen, the liver, in the lungs and in other organs located outside the peritoneal cavity.

  • Stage IVA: Cancer cells are found in the fluid around the lungs (this is called a malignant pleural effusion) with no other areas of cancer spread outside the pelvis or peritoneal cavity.
  • Stage IVB: Cancer has spread to the inside of the spleen or liver, to lymph nodes besides the retroperitoneal lymph nodes, and/or to other organs or tissues outside the peritoneal cavity. This includes the lungs, the brain, and the skin.

Cancer Grading: By looking at the cells in the tissue and fluid under a microscope, a pathologist describes the cancer as Grade 1, 2, or 3. Grade 1 is most like ovarian tissue and less likely to spread; Grade 3 cells are more irregular and more likely to metastasize. However, many ovarian cancers are categorized simply as “low grade” or “high grade.” Chemotherapy is often not used to treat low grade Stage I cases.

After the operation, the doctor will explain the nature of the chemotherapy that will be given, which will depend on the stage of the disease and how much of the tumor could be removed.

Chemotherapy: Patients generally undergo chemotherapy in an effort to kill any cancer cells that remain in the body after surgery. Women will usually have either chemotherapy alone or chemotherapy and intraperitoneal therapy. Besides the gynecologic oncologist, a chemotherapy nurse will assist in providing the drug treatment that will attempt to kill remaining cancer cells in the body. The chemotherapy nurse is a very important health care professional in a patient’s life because she or he assesses the side effects of the drugs and helps alleviate them. Side effects are common with chemotherapy and depend on the type and length of treatment. Each woman is different in her response to chemotherapy and the doctor and nurse will explain possible side effects and provide suggestions and treatments to help manage them.

Intraperitoneal Chemotherapy: This therapy places the medicine directly into the peritoneal area through a surgically implanted port and catheter. While intraperitoneal (IP) therapy has been in use since the 1950s, new advances have combined it with intravenous (IV) therapy, using chemotherapy agents that work best for treating ovarian cancer.

Neoadjuvant Chemotherapy: Some patients may receive chemotherapy before having surgery to remove or shrink some tumors. This is known as neoadjuvant chemotherapy.

Other Drugs: Other drugs, including angiogenesis inhibitors and targeted therapies, may be recommended either in conjunction with chemotherapy or as single agents. These drugs may have very different side-effects than chemotherapies and may be useful only for specific populations.

Complementary Therapies: With a diagnosis of cancer, some women might opt to try complementary therapies. Complementary therapies are those used along with conventional medicine. Acupuncture, massage therapy, herbal products, vitamins, special diets and meditation are examples of these approaches. You should talk with your doctor about treatments you may use because although products, such as herbal teas, are routinely sold, they may interact with cancer drugs and change the drugs’ effectiveness. More and more healthcare facilities these days are offering integrated medical approaches that combine both conventional and complementary therapies for which there is evidence of safety and effectiveness.