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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 standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections.
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, including surgery, chemotherapy, and radiation therapy. 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. Learn more about making treatment decisions.
Surgery is the removal of the tumor and surrounding tissue during an operation. Surgery is often the first treatment used for ovarian cancer. A gynecologic oncologist is a doctor who specializes in using surgery to treat cancer in a woman’s reproductive organs. Usually, a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) and hysterectomy are performed. The surgeon may also remove the omentum, the thin tissue covering the stomach and large intestine. This type of surgery is known as cytoreductive or debulking surgery.
To determine whether the cancer has spread, the surgeon will often also remove lymph nodes, tissue samples, and fluid from the abdomen.
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 fallopian tube if the cancer is located in only one ovary. For women with a germ cell tumor, surgery is most often needed to remove only the ovary with the tumor, which preserves the woman’s ability to bear children.
If, during the surgery, it is clear that the cancer has spread, the surgeon removes as much of the cancer as possible. This may reduce the amount of cancer that will need more treatment with chemotherapy or radiation therapy.
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. Studies have shown that women who have their surgeries performed by gynecologic oncologists 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 ways to address them before and after cancer treatment. Learn more about coping with gynecologic surgery.
Learn more about cancer surgery.
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 medical oncologist, a doctor who specializes in treating cancer with medication. 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. The goal of chemotherapy can be to reduce the size of the tumor before surgery (neoadjuvant chemotherapy), destroy cancer remaining after surgery (adjuvant chemotherapy), slow the tumor's growth, or reduce side effects (palliative chemotherapy).
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, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
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.
After chemotherapy is completed, a second surgery may be performed to examine the abdomen and remove fluid and tissue samples to determine if any cancer cells remain.
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 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. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. 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). A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.
Radiation treatment is not usually used to treat ovarian cancer, but it may be used to relieve side effects. 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.
Treatment options by stage
- Surgery and chemotherapy
Stages III & IV
- Surgery and chemotherapy (either IV or IP or both combined)
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.
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, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. 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, 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.
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 Current 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 many patients, a diagnosis of metastatic cancer can be 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 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.
Palliative care given toward the end of a person’s life is called hospice care. 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 cope with the loss. Learn more about grief and bereavement.
Find out more about common terms used during cancer treatment.