Treatment
Treatment options for ovarian cancer depend on the stage of the cancer, the amount of tumor remaining after surgery, your age, your overall health, and sometimes your plans to have children. Surgery is typically the first part of treating ovarian cancer, followed by chemotherapy. The more of the tumor that is successfully removed, the greater the chances for survival.
Treatment of Early-stage (I/II) Ovarian Cancer
- Surgery or surgery followed by chemotherapy
Treatment of Advanced-stage (III/IV) Ovarian Cancer
- Surgery followed by chemotherapy or chemotherapy followed by surgery and additional chemotherapy.
Surgery
Surgery is the main treatment for ovarian cancer. Your surgeon will remove a portion of tumor and have it examined by a pathologist to determine if it is cancer. If it is malignant, your doctor may recommend any of the following surgical procedures:
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Bilateral salpingo-oophorectomy
In this procedure, your surgeon removes your ovaries and fallopian tubes. Both ovaries are usually removed to see if the cancer involves both ovaries.
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Hysterectomy
A hysterectomy is surgery to remove the uterus and cervix, but not any surrounding tissues or lymph nodes. 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.
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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 it has spread far, your doctor will try to remove as much of the cancer as possible (debulking). 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 removal of the maximum amount of tumor is linked to increased survival.
Additional Treatments
The doctor may also recommend any of the following treatments:
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Chemotherapy
Chemotherapy is a drug that attacks rapidly dividing cells like cancer. Chemotherapy may be given though the vein (intravenous or IV). Chemotherapy may also be given interaperitoneally (IP). IP therapy is a concentrated chemotherapy treatment in which your doctor administers the drug 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. IP chemotherapy is typically given in combination with IV chemotherapy.
Hormone Therapy
In some cases of ovarian cancer, the female hormone estrogen may cause the cancer to grow more aggressively. Hormone therapy blocks the effect of estrogen or lowers its levels, preventing the hormone from fueling cancer growth. Hormone therapy is used for ovarian stromal tumors, but may be used in certain types of epithelial cell tumors.
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Targeted Therapy
Targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific molecules needed to turn normal cells into cancer cells and make them grow. An example of this is the drug bevacizumab, which prevents the tumor from forming new blood vessels. Ovarian 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 typically can't cure the disease by itself.
Immunotherapy
This is a novel type of 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.
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).
Clinical Trials
Clinical trials allow 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. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
In addition, newer clinical trials are combining targeted agents with conventional IV or IP chemotherapy in the upfront setting. There are no guarantees that you will benefit from a clinical trial – but it may help you or patients like you in the future.
Ovarian cancer can develop in any woman, regardless of age, health status, or race. The more you learn about this disease, the better equipped you will be to fight it. Women who are diagnosed at earlier stages live longer. See your OB/GYN immediately if you have any of the symptoms discussed earlier. Paying attention to your body may help save your life.
