Bilateral Salpingo-Oophorectomy (BSO)

In this procedure, your surgeon usually removes both fallopian tubes and ovaries.

Hysterectomy

A hysterectomy is surgery to remove the uterus and cervix. This procedure, together with the BSO, may be performed with a surgical incision in the abdomen, laparoscopically, or with the use of a robotic surgical system. This surgery is usually performed through a vertical (up and down) incision unless the ovarian mass is small, and the CT scan does not show a lot of disease.

Omentectomy

Your doctor removes the omentum to check for cancer spread. The omentum is a large fold of fatty tissue that hangs down from the stomach and large intestine and lies on top of the small intestine.

Depending upon the size and spread pattern of the cancer, your doctor may also remove nearby lymph nodes and tissue samples from the pelvis and abdomen. If there is extensive spread of disease, your doctor will try to remove as much of the cancer as possible (this is called a debulking surgery). Your doctor may completely or partially remove your ovaries, uterus, cervix, fallopian tubes, omentum, spleen, lymph nodes, liver, or a portion of your intestines during debulking. Tumor debulking is especially important because the more of the tumor that is successfully removed, the greater the chance of survival.

Chemotherapy

Chemotherapy is a treatment that attacks rapidly dividing cells in your body (like cancer.) Chemotherapy may be given though the vein (intravenous or IV) but may also be given intraperitoneally (IP). IP therapy involves administering chemotherapy directly into your abdominal cavity through a catheter or port that is placed at the time of surgery. The chemotherapy drugs will come into direct contact with the cancer and help eliminate any traces of cancer left after debulking. When your doctor decides to use IP chemotherapy, it is typically given in combination with IV chemotherapy.

Targeted Therapy

Targeted therapy uses drugs that target and attack certain parts of the cancer cell in order to stop the growth of cancer. An example of this is the drug bevacizumab which prevents the cancer cells from forming new blood vessels. Fallopian tube tumors create their own network of blood vessels to support their continued growth. Targeted therapy attacks this process, called angiogenesis, and prevents the growth of new blood vessels. This therapy may shrink the tumor or slow its growth, but can't cure the disease by itself.
Another example of targeted therapy includes a class of drugs called PARP inhibitors. PARP inhibitors work by preventing cancer cells from repairing their own DNA. When a cell can’t repair its faulty DNA, the cell dies. When these drugs were first being investigated, they were used in cancers that already had problems repairing cell damage (such as cancers with BRCA mutations.) Since cancer cells with BRCA gene mutations already have difficulty repairing their DNA, they seem to be particularly sensitive to PARP inhibitors. Your physician may recommend a PARP inhibitor if you have a BRCA mutation.

Maintenance Therapy

After completion of surgery and chemotherapy, your doctor may recommend the use of one or more targeted therapies to improve your progression free survival (time without cancer recurrence). This could include a PARP inhibitor and/or bevacizumab.

Immunotherapy

This is a novel therapy that stimulates the natural immune system to fight the cancer. Substances made by the body or made in the laboratory are used to boost, direct, or restore the body’s natural defense against cancer.

Clinical Trials

Clinical trials are studies of new cancer treatments that show promise but have not yet been proven effective in treating the disease. These trials may be the best treatment option for patients with advanced cancer who have not responded well to conventional treatments. Clinical trials also allows patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. There are no guarantees that you will benefit from a clinical trial – but it may help you or patients like you in the future. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.