Treating 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 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 possible remaining cancer cells in the body. Radiation therapy, which uses high energy rays to kill cancer cells, is not typically utilized in ovarian cancer.
After an Ovarian Cancer Diagnosis
Before surgery, a doctor, preferably a gynecologic oncologist, will explain to a woman the nature of the operation and the extent of tissue that will be removed. During the operation, the doctor will assess how far the tumor has spread, to determine the stage of the cancer, and will give tissue samples to a pathologist, who will determine the grade of the cancer.
After the operation, the doctor will discuss the nature of the chemotherapy that will be given, which will depend on the stage of the disease and how much of the tumor was removed. A doctor might also offer a woman the possibility of enrolling in a clinical trial, if she meets the criteria for the research study. See Clinical Trials section.
Making a list of questions before an appointment with a doctor can be useful because the shock and stress of the diagnosis can make it hard to remember things and medical care can be complicated and difficult to understand. Taking notes of the doctor’s responses or having a friend or relative with you during appointments can be helpful.
Here are some questions the National Cancer Institute suggests you might consider asking a doctor early in treatment:
- What is the stage of my disease? Has the cancer spread from the ovaries? If so, to where?
- What are my treatment choices? Do you recommend intraperitoneal chemotherapy for me? Why or why not?
- Would a clinical trial be appropriate for me?
- Will I need more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment? What can we do to control side effects? Will they go away after treatment ends?
- What can I do to prepare for treatment?
- How long will I need to stay in the hospital? If you live in a rural area, ask about getting your chemotherapy at your local hospital if it is too far to drive to a major medical center.
- What is the treatment likely to cost? Will my insurance cover the cost?
- How will treatment affect my normal activities?
- Will treatment cause me to go through early menopause?
- Will I be able to get pregnant and have children after treatment?
If a woman doesn’t feel comfortable with a doctor or wants to seek a second opinion about her care, she has the right to do so.
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. Learn more.
Patients undergo chemotherapy in an effort to kill any cancer cells that remain in the body after surgery. Women will usually have either systemic chemotherapy or systemic chemotherapy and intraperitoneal therapy.
Besides the gynecologic oncologist taking care of you, 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 s/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 about ways to manage them. For more information, see Chemotherapy Side Effects.
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. The National Cancer Institute recommends that, for select ovarian cancer patients, chemotherapy be given by both IV and IP.
Some patients may receive chemotherapy before having surgery. This is known as neoadjuvant chemotherapy.
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.
Women are encouraged to ask their healthcare provider if tumor testing is appropriate for them. Testing of tumor samples to identify the estimated 3%-9% of patients with somatic BRCA1/2 mutations who, in addition to germline carriers, could benefit from PARP inhibitor therapy.
Radiation Therapy or Radiotherapeutic Procedures
These procedures may be used to kill cancer cells that remain in the pelvic area.
Researchers carry out ovarian cancer clinical trials to find ways of improving medical care and treatment for women with this disease. A woman is eligible to participate in a clinical trial at any point in her experience with ovarian cancer: before, during or after treatment. Many women think of clinical trials as an option only after other treatments have failed. In reality, many equally important trials are available for women earlier in their fight against ovarian cancer. Learn about the clinical trial process. Read more about Clinical Trials.
With a diagnosis of cancer, some women might opt to try complementary to help themselves. Complementary therapies are those used along with conventional medicine. Acupuncture, massage therapy, herbal products, vitamins, special diets and meditation are examples of these approaches. There is some evidence that some complementary therapies help patients cope with nausea, pain, neuropathy and other side effects of chemotherapy.
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.
Gynecologic Oncologists and Treatment
A gynecologic oncologist is a specialist in treating women’s reproductive cancers. Women with ovarian cancer are strongly encouraged to seek care from one of these specialists.
Multiple studies conducted over the past decade have shown that an ovarian cancer patient’s chance of survival is significantly improved when her surgery is performed by a gynecologic oncologist. One analysis of multiple studies found that women whose surgeries were performed by gynecologic oncologists had a median survival time that was 50 percent greater than women whose surgeries were done by general gynecologists or other surgeons inexperienced in optimal debulking procedures.
Sometimes referred to as cytoreductive surgery, debulking involves removal of as much of the tumor as possible. As part of the debulking procedure, doctors try to stage the disease definitively and identify the optimal treatment for the cancer. Proper staging and optimal debulking by a gynecologic oncologist can lead to improved overall survival for women at any stage of ovarian cancer.
Gynecologic oncologists have greater success in treating ovarian cancer as a result of their tendency to perform more aggressive surgery. Women whose tumors have been reduced to less than one centimeter have a better response to chemotherapy and improved survival rate. Gynecologic oncologists also are more likely to perform the multiple peritoneal and lymph node biopsies necessary to ensure adequate surgical staging.