Women with ovarian cancer are usually treated with surgery and chemotherapy. Radiation may be used in some cases. Your doctor will describe your treatment choices and the expected results of each, and develop the best treatment plan for you.
Treatment of ovarian cancer depends on a number of factors, including:
- The stage of the cancer
- The size of the tumor after debulking
- Your desire to have children
- Your age and overall health
Surgery is used to diagnose ovarian cancer, to determine how far the disease has progressed, and to remove as much as the cancer as can be removed. How much surgery you have depends on whether the cancer has spread outside the ovary or ovaries, your general health, your desire to have children, and whether the tumor can be completely removed; in some cases, this is impossible because it is attached to or involves other vital organs.
The surgery for ovarian cancer should ideally be performed by a gynecologic oncologist (a physician specifically trained to provide both surgical and medical care for women with gynecologic malignancies). Debulking (surgical cytoreduction), in which the surgeon tries to remove as much of the tumor as possible, is an important procedure for ovarian cancer. If you are a candidate for ovarian cancer surgery, you will havedebulking, which includes a total hysterectomy (removal of the uterus and cervix). In addition to the hysterectomy, you may also have a unilateral (one side) salpingo-oophorectomy, where one ovary and one fallopian tube is removed, or a bilateral (two sides) salpingo-oophorectomy, where both ovaries and both fallopian tubes are removed. Most women with ovarian cancer are treated with bilateral salpingo-oophorectomy. [changed first couple of sentences to reflect the description in the page on surgery, which makes it sound like the hysterectomy happens as part of debulking. if this is not accurate, please fix both here and on the other page.]
Once a diagnosis of ovarian cancer is made, your doctor will explain your prognosis and treatment options. Your prognosis is what the doctor thinks will happen with your cancer—your chance of recovery, the expected course of the cancer, or the length of time you are likely to be sick.
Your prognosis will depend on:
- The stage of the cancer
- The type of ovarian cancer (epithelium, germ, or sex cord-stromal cells)
- The size of the tumor after debulking
This section contains more information on:
- Staging
- Surgery
- Other surgery
- Chemotherapy
- Radiation therapy
- Treatment of recurrent or persistent ovarian cancer
- Complementary therapy
- Improving prevention, detection, and treatment survival
- Survival
Staging
The stage of a cancer describes whether the tumor has spread to nearby tissues and other parts of the body. Staging is accomplished during surgery—the same surgery in which a biopsy is performed and the diagnosis of cancer is confirmed. Staging generally requires removing lymph nodes, samples of tissue from the diaphragm and other organs in the abdomen, and fluid from the abdomen.
Stages of Ovarian Cancer
Stage I: The cancer is limited to the ovary or ovaries. When cancer is diagnosed at this stage, a woman has a 95 percent chance of being cured. However, only 25 percent of ovarian cancer cases are found at Stage I.
Stage IA: The tumor is limited to the inside of only one ovary.
Stage IB: The tumor is limited to the inside of both ovaries.
Stage IC: The tumor is limited to one or both ovaries. In addition, it appears on the surface of the ovary, a fluid-filled capsule has burst, or cancer cells are found in the fluid in the abdomen.
Stage II: The cancer is in one or both ovaries and has spread to other parts of the pelvis.
Stage IIA: The tumor has spread to the uterus, fallopian tubes, or both.
Stage IIB: The tumor has spread to the bladder, rectum, or colon.
Stage IIC: The tumor has spread to any of the above. Also, it appears on the surface of the ovary, a fluid-filled capsule has burst, or cancer cells are found in the fluid in the abdomen.
Stage III: The cancer is in one or both ovaries and has spread to nearby lymph nodes or to other abdominal organs. This does not include the liver.
Stage IIIA: The tumor has spread to the lining of the abdomen, but cannot be seen (it is microscopic). The cancer has not spread to the lymph nodes.
Stage IIIB: The cancer has spread into the abdomen, and is visible (less than 2 cm, about
Stage IIIC: The cancer has spread into the abdomen and the deposits measure larger than 2 cm. The cancer has spread to the lymph nodes.
Stage IV: The cancer has spread to the lung, liver, or other distant organs.
Recurrent ovarian cancer: The cancer has come back after it has been treated. The cancer may appear in other parts of the body, but it is still considered ovarian cancer.
Surgery
Surgery is the primary treatment for ovarian cancer. The first step in surgery is to take a sample of the suspicious tissue to find out if it is indeed cancer. This is the surgical biopsy. Once cancer is confirmed, the surgeon, preferably a gynecological oncologist, determines how far the cancer has spread so a stage can be assigned to the cancer. The oncologist will also determine whether surgery can be continued to remove the cancerous tissues.
If the disease appears to be limited to one or both ovaries, the surgeon will take samples of nearby tissues from the pelvis and abdomen to determine if the cancer has spread. Sometimes this can be done with laparoscopic or robotic surgery.
If there is obvious spread, the surgeon will attempt to remove as much as the cancerous tissue as possible right away, if the patient's condition and the tumor's location allow it. This procedure is referred to as "debulking" or "surgical cytoreduction." The goal of debulking is to remove as much of the tumor as possible. This improves the patient's prognosis. Debulking involves removing the ovaries, the body of the uterus, the cervix, the fallopian tubes and the omentum (fatty tissue around these organs), and any other visible deposits of cancer in the pelvic and abdominal areas. This may include the removal or partial removal of other organs such as the spleen, lymph nodes, liver, or intestines. Reducing the size of the tumor helps chemotherapy and radiation therapy work better, because they have less tumor to treat.
While debulking is generally performed at the time of the surgical biopsy, this can not always be done. Sometimes the patient's overall health is too poor to allow the surgery can continue. In other patients, the tumor may be attached to critical organs. For these patients, any remaining tumor will then be treated with chemotherapy. Your doctor will determine if another attempt to remove the remaining tumor is an option after chemotherapy.
Surgery for ovarian cancer is an open procedure and is performed in the operating room. It requires general anesthesia, so you will be asleep during the surgery. Most women will remain in the hospital for 3 to 7 days after the operation and can resume their usual activities within 4 to 6 weeks. Surgery usually causes some pain and tenderness in the area of the operation. Discomfort or pain after surgery is controlled with medicine. For several days after surgery, the patient may have difficulty emptying her bladder and having bowel movements.
Women who have had a hysterectomy will not be able to get pregnant. Women who have had the ovaries and fallopian tubes removed, but not the uterus, may be able to get pregnant with donor eggs, or may wish to freeze their own ovarian tissue to use later for in vitro fertilization.
Removing the ovaries means removing the body's natural source of estrogen and progesterone, female hormones that the ovaries produce until menopause. The lack of estrogen may cause osteoporosis and menopausal symptoms such as hot flashes and insomnia. Several medicines and other treatments are available for preventing or treating osteoporosis and menopausal symptoms, so talk with your doctor about your options. You may wish to take hormones, for example, or learn special exercises to maintain bone mass.
Other Surgery
Women who undergo treatment as participants in a clinical trial may need to have a second surgical procedure after chemotherapy or radiation therapy, to make sure all cancer is removed or to take samples of lymph nodes or other tissues.
If the cancer comes back (recurrent ovarian cancer), your doctor may recommend that you have a second attempt at debulking. Your doctor will discuss the merits of this procedure, which is usually based on the distribution and volume of recurrent disease, how well you responded to prior therapy, and how long it took for the cancer to recur. The goal of this secondary surgery is complete removal of cancer recurrence and is usually done only if that goal is thought to be achievable.
Advanced ovarian cancer can grow and completely block the bowels (intestines). If this happens, you may need to have part of your colon removed. In this procedure, a part of your bowel is brought up to the abdominal wall, making an opening to the outside of your body. You will have a temporary colostomy (pouch) that will collect your stool. Later, another surgery can be done to re-connect the bowel.
Chemotherapy
Most women with ovarian cancer have chemotherapy. Chemotherapy uses medicines to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Chemotherapy that is given by mouth or injected into a vein or muscle is called systemic chemotherapy. The medicines enter the bloodstream and reach cancer cells throughout the body.
When chemotherapy is placed directly into an organ or a body cavity, such as the abdomen, the medicines mainly affect cancer cells in that area. When chemotherapy is delivered directly into the peritoneal space (the abdominal cavity, between the abdominal muscles and the abdominal organs), it is called intraperitoneal therapy or IP therapy. IP therapy can be used to treat ovarian cancer if there is only a small amount of tumor remaining after debulking. The chemotherapy is infused into the peritoneal space, where it will come in direct contact with the cancer.
The standard chemotherapy treatment for ovarian cancer is paclitaxel plus a platinum based drug such as carboplatin or cisplatin. Platinum is a metal that is an important component of the anticancer drugs carboplatin and cisplatin. Most chemotherapy treatments are given on an outpatient basis and are delivered systemically in a 3 to 4 week cycle. However, the length of treatment and dose varies depending on the stage of the disease.
If you are a good candidate for surgery and there is little tumor left after surgery and bowel surgery is not needed, IP therapy should be strongly considered. IP therapy can be given in an outpatient or inpatient setting through an implanted port or external catheter and takes about two hours for the treatment. The chemotherapy is absorbed by the body over the next few days. During this time, a woman may feel bloated and have some abdominal pressure.
Chemotherapy affects normal cells as well as cancer cells. You may experience side effects from chemotherapy treatment such as nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood count, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails. Certain medicines used in the treatment of ovarian cancer may cause some hearing loss or kidney damage. To help protect the kidneys, patients may receive extra fluid through an IV while taking these medicines.
Radiation Therapy
Radiation therapy uses high energy X-rays or other types of radiation to kill cancer cells or shrink the tumor. Although radiation therapy is rarely used in the treatment of ovarian cancer, it sometimes is used to kill any remaining cancer cells in the pelvic area after other treatment. A woman may have it if she has already undergone treatment, but the cancer has come back. In most such cases, the main goal of radiation therapy is to control symptoms, not to treat the cancer.
Treatment of Recurrent or Persistent Ovarian Cancer
Cancer that doesn't respond to chemotherapy or is detected after the completion of primary therapy is referred to as "persistent" or "recurrent," respectively. Persistent or recurrent cancer is usually detected through a CA-125 blood test and CT imaging. Sometimes a biopsy is required to confirm the diagnosis. Treatment is the same for both persistent and recurrent ovarian cancer.
If ovarian cancer recurs or persists, treatment depends on how long it's been since the last treatment and the patient's age and overall health. A second surgical debulking may be performed to remove as much of the tumor as possible, as well as treatment with the same chemotherapy they received initially. When cancer recurs after six to 12 months, patients are considered "platinum sensitive" and are re-treated with one of the platinum-based drugs, along with other chemotherapy agents used to treat ovarian cancer.
For women who have a recurrence less than six months after stopping chemotherapy, they are considered "platinum-resistant" and may be given additional chemotherapy treatment with paclitaxel only or other treatment drugs that are different from their initial treatment drugs.
Sometimes with recurrent ovarian cancer, treatment has to focus on keeping the disease from growing or spreading rather than ridding the body of cancer entirely.
Complementary Therapies
Some women use complementary therapies in addition to standard medical treatment to help relieve stress and minimize side effects, such as fatigue, pain and nausea. Complementary therapy is a variety of health care practices that include acupuncture, aromatherapy, herbal medicine, massage, medicine, yoga, tai chi and qigong. Some complementary therapies may interfere with conventional medical treatment—for example, herbal medicines can interact with drugs, and some forms of massage can be dangerous for people with cancer. For that reason, before beginning any complementary therapy, it is important to discuss these approaches with your doctor. For more information, see the USNews.com module on using complementary and alternative therapy in cancer.
Improving Prevention, Detection, and Treatment
Clinical trials are research studies that involve people. The main purpose of a clinical trial is to find a better way to prevent, diagnose or treat a disease. Research to improve detection, screening and treatment methods for ovarian cancer is ongoing. Some of these advancements may still be in the investigational stage and not yet approved or available.
- Researchers are studying tumor markers, substances found in the blood of women with ovarian cancer, to develop blood tests that may one day be used to detect the cancer. A reliable blood test for tumor markers would allow diagnosis of early-stage ovarian cancer.
- Consolidation therapy is treatment given after the initial therapy to help prevent recurrences. For example, one study showed a slight benefit to taking paclitaxel for a year after chemotherapy would normally end. A number of clinical trials are exploring other therapies that could be used in this way.
- High-dose chemotherapy with stem cell transplant (also known as bone marrow transplant) has been used for women with recurrent ovarian cancer. This treatment has very serious side effects, and has not been proven to help patients live longer. It is only done as part of a clinical trial that is studying improvements to this treatment.
- Angiogenesis is the formation of new blood vessels. Because tumors need blood to grow, doctors and scientists are seeking ways to inhibit angiogenesis and short-circuit cancer development. Cancer cells initiate angiogenesis by sending signals to nearby tissue and activating proteins that foster blood vessel growth. As researchers gain an understanding of this process, they hope to discover new methods to block those signals and stop blood vessels from growing. Researchers also are investigating whether a tumor's established blood vessel network can be used to fight the cancer.
- Researchers are also looking at gene therapy, a technique that might someday be used to repair damaged genes and decrease a woman's chances of developing ovarian cancer that runs in her family.
For more information about clinical trials focusing on ovarian cancer, visit the National Cancer Institute's clinical trials database.
Survival
These treatment statistics for ovarian cancer are based on the American Cancer Society's 2008 Cancer Facts and Figures.
- The 5-year survival rate is 92 percent for women whose ovarian cancer is found in only one ovary. Only 19 percent are found at this stage.
- The one-year survival rate for all women with ovarian cancer is about 75 percent.
- The 5-year survival rate for women who have just been told they have ovarian cancer is about 45 percent.
- The 5-year survival rate for women whose disease has spread only to nearby places is 71 percent.
- The 5-year survival rate for women whose cancer has spread to distant sites in their bodies is about 30 percent.
Survival of ovarian cancer varies by age. Women younger than 65 are about twice as likely (56 percent) to survive 5 years after diagnosis as women 65 and older (29 percent)
Last reviewed on 7/22/09
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