Oncologist-approved cancer information from the American Society of Clinical Oncology
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Ovarian Cancer

This section has been reviewed and approved by the Cancer.Net Editorial Board, 5/2013
Treatment Options

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ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Ovarian cancer is treated with one or a combination of treatments, most commonly surgery and chemotherapy. Each treatment option is described below, followed by an outline of the treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, the patient’s preferences and overall health, and personal considerations, such as the woman's age and if she is planning to have children. Women with ovarian cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins.

Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is usually the main treatment for ovarian cancer. A gynecologic oncologist is a doctor that specializes in gynecological cancer surgery (including ovarian cancer) and chemotherapy.

As mentioned in Diagnosis, surgery is often needed to find out the complete extent of disease. The goal is to provide an accurate stage, because in up to 30% of women with apparently early disease (after imaging tests) there is actually spread to other organs.

To determine whether the cancer has spread, the surgeon will remove lymph nodes, tissue samples, and fluid from the abdomen for testing. If, during the surgery, it is clear that the cancer has spread, the surgeon removes as much of the cancer as possible in order to reduce the amount of cancer that will need more treatment with chemotherapy or radiation therapy.

There are several surgical options for ovarian cancer, sometimes done during the same surgery:

Salpingo-oophorectomy. This surgery involves removal of the ovaries and fallopian tubes. If both ovaries and both fallopian tubes are removed, it is called a bilateral salpingo-oophorectomy. If the woman wants to become pregnant in the future and has early-stage cancer, it may be possible to remove only one ovary and one fallopian tube if the cancer is located in only one ovary. That surgery is called a unilateral salpingo-oophorectomy. For women with a germ cell tumor, surgery often only needs to remove only the ovary with the tumor, which preserves the woman’s ability to bear children.

Hysterectomy. This surgery focuses on the removal of a woman’s uterus and, if necessary, surrounding tissue. If only the uterus is removed, it is called a partial hysterectomy. A total hysterectomy is when a woman’s uterus and cervix are removed.

Lymph node dissection. The surgeon may remove lymph nodes in the pelvis and paraortic areas.

Omentectomy. This is surgery to remove the thin tissue that covers the stomach and large intestine.

Cytoreductive/debulking surgery. For women with later-stage ovarian cancer, the goal of this surgery is to remove as much tumor as is safely possible. This may include removing tissue from nearby organs, such as the spleen, gallbladder, stomach, bladder, or colon. It is felt such a procedure can reduce a person’s symptoms and can help increase the effectiveness of treatment, such as chemotherapy, given after surgery to control the disease that remains. Debulking surgery should be performed by an experienced gynecologic oncologist. Talk with your doctor before surgery about the risks and benefits of this procedure and ask about the surgeon’s experience with debulking surgery for ovarian cancer.

Side effects of ovarian cancer surgery

Surgery causes short-term pain and tenderness. If a patient is experiencing pain, the doctor will prescribe an appropriate medication. For several days after the operation, the patient may have difficulty emptying her bladder (urinating) and having bowel movements. Talk with your surgeon about what side effects to expect from your specific surgery and how they can be relieved. Learn more about the basics of cancer surgery

Studies have shown that women who have their surgeries performed by a gynecologic oncologist are more likely to be successfully treated with surgery and have fewer side effects.

If both ovaries are removed, a woman can no longer bear children. The loss of both ovaries also eliminates the body's source of sex hormones, resulting in premature menopause. Soon after surgery, the patient is likely to have menopausal symptoms, including hot flashes and vaginal dryness. Women are encouraged to talk with their doctors about sexual and reproductive health concerns and coping with gynecologic surgery, including ways to address these concerns before and after cancer treatment

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a gynecological oncologist or a medical oncologist. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

For ovarian cancer, chemotherapy depends on the goal of treatment:

Neoadjuvant chemotherapy: to reduce the size of the tumor before surgery. It will usually follow a biopsy so the doctors can determine the tumor’s site of origin. This type of chemotherapy is usually given for 3 to 4 cycles before considering surgery (called interval surgery).

Adjuvant chemotherapy: to destroy cancer remaining after surgery.

Maintenance chemotherapy: to slow a tumor’s growth and/or reduce the risk of its recurrence.

Recurrence chemotherapy: to treat the cancer if it comes back

Palliative chemotherapy: to reduce side effects from the disease, improving the patient’s comfort and quality of life. (see below, Getting care for symptoms.)

There are different ways to give chemotherapy to a patient. Although chemotherapy can be given orally (by mouth), most drugs used to treat ovarian cancer are given intravenously (IV) or intraperitoneally (IP). IV chemotherapy is either injected directly into a vein or through a catheter, a thin tube temporarily put into a large vein to make injections easier. IP chemotherapy is when a catheter is placed in the abdomen to deliver chemotherapy directly into the pelvic area. IP chemotherapy is used as a treatment for women with later-stage cancer and women with cancer remaining after surgery.

Several clinical trials have shown a significant benefit for combining IP and IV chemotherapy for patients with later-stage ovarian cancer. The National Cancer Institute recommends that women with later-stage ovarian cancer be offered this treatment option.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. In addition, possible side effects of chemotherapy include difficulty with cognitive (brain) functions (such as issues with attention span or memory) or neuropathy (a disorder where nerves are damaged causing numbness or pain). Other possible side effects include both the inability to become pregnant and premature menopause. Rarely, certain drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection. Before treatment begins, patients are encouraged to talk with their oncologist about possible short-term and long-term side effects of the specific drugs being given.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is uncommon as a first treatment for ovarian cancer, but it can an option for treating recurrent ovarian cancer, especially when confined to a small area.

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy is given either by delivering a small amount of radioactive material directly to the tumor or by injecting radioactive liquid directly into the abdomen through a catheter (called intraperitoneal or IP radiation therapy). External-beam radiation therapy is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy depend on the dose and the area of the body being treated, but may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction. Most side effects usually go away soon after treatment is finished.

Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.

Learn more about radiation therapy.  For more information on radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers. See more about treatment options for recurrent ovarian cancer, below.

Treatment options by stage

Stage I

  • Surgery
  • Surgery and chemotherapy

Stage II

  • Surgery
  • Chemotherapy

Stages III & IV

  • Surgery and chemotherapy (either IV or IP or both combined)
  • Chemotherapy

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy and surgery. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Recurrent ovarian cancer

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. It’s important to talk with your doctor about the possibility of the cancer returning. This is particularly important after treatment for ovarian cancer, as many women experience at least one recurrence. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery and chemotherapy) but they may be used in a different combination or given at a different pace. In addition, radiation therapy is used more commonly when there is a recurrence of ovarian cancer. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

The symptoms of recurrent ovarian cancer are similar to those experienced when the disease was first diagnosed. The four most common symptoms are bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary symptoms (urgency or frequency).  However, other symptoms may include persistent indigestion, gas, nausea, diarrhea, or constipation; unexplained weight loss or gain, especially in the abdominal area; abnormal bleeding from the vagina; pain during intercourse; fatigue; and lower back pain.

In addition to monitoring symptoms, doctors can also watch for ovarian cancer recurrence by measuring the level of CA-125 in the blood. As outlined in Diagnosis, CA-125 is a cancer antigen, or a substance that is found in higher levels on the surface of ovarian cancer cells. Most (95%) women who have a rise in CA-125 show a recurrence.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

Metastatic ovarian cancer

If ovarian cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

New treatments for ovarian cancer include experimental combinations of chemotherapy and new biologic agents, also called immunotherapy, which are designed to boost the body’s natural defenses to fight the cancer (see Latest Research). Since the benefits of these options remain unproven, their risks must be carefully weighed against possible improvements in symptoms and survival. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from ovarian cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and bereavement.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

© 2005-2014 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.

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