Treatment

The treatment of ovarian cancer depends on the size and location of the tumor, whether the cancer has spread, the woman's overall health, and personal considerations, such as the woman's age and if she is planning to have children. In many cases, a team of doctors will work with the woman to determine the best treatment plan. 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.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

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.

Surgery

Surgery is often the first treatment used for ovarian cancer. 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.

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.

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 require further 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 experience menopausal symptoms, including hot flashes and vaginal dryness. Women should talk with their doctors before and after surgery about ways to cope with these side effects.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects.

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.

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

The side effects of chemotherapy depend on the individual and the dose used, but 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 potential 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.

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 through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. 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 radiation therapy).

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.

For more information about radiation therapy, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.

Treatment options by stage

Stage I

• Surgery
  
  
• Surgery and chemotherapy

Stage II

• Surgery
  
  
• Chemotherapy

Stage III & IV

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

Recurrent ovarian cancer

If ovarian cancer recurs, the symptoms are similar to those experienced when the disease was first diagnosed. The four of the 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
  
  
• Lower back pain

Treatment for advanced cancer and recurrent disease

If standard treatment is not effective, the doctor may recommend options including "second-line" chemotherapy drugs and radiation therapy to help relieve side effects.

New therapies for ovarian cancer include experimental combinations of chemotherapy and new biologic agents, which are designed to boost the body’s natural defenses to fight the cancer. Since the benefits of these options remain unproven, their risks must be carefully weighed against possible improvements in symptoms and survival.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.

Clinical Trials Resources

Doctors and scientists are always looking for better ways to treat patients with ovarian cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating ovarian cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with ovarian cancer.

To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about Clinical Trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.