Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.
Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body:
- Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
- Intraperitoneal chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
- Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.
You may want to know how treatment may change your normal activities. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
Ovarian cancer surgery should be performed by a gynecologist oncologist who is experienced in the best timing and the right things to look for while operating. Sometimes a patient will have chemotherapy given before they go into surgery to reduce the tumor size first.
Ovarian cancer surgery is often performed with an open incision called a laparotomy. During this surgery they will perform a procedure called “debulking”. This is aimed at decreasing the amount of cancer to remove as many cancer cells as possible. For many patients this requires the removal of the ovaries and uterus called a hysterectomy, as well as removal of the ovaries and fallopian tubes called a salpingo-oophorectomy.
During ovarian cancer surgery, the surgeon may also
- Look for other tumors that may be in or near the abdomen that can be seen and removed.
- Take a biopsy of the abdominal tissue to test for cancer cells.
- Collect abdominal and lymph node fluids for testing to see if the cancer has spread.
Laparoscopy, called DaVinci, may also be used by the gynecologic oncologist. The decision is based on what they find in the test results and images taken before surgery. Unlike a laparotomy, which involves a large abdominal incision, laparoscopy only requires a small incision in which the doctor inserts a thin, lighted tube (a laparoscope) to examine the ovaries and other pelvic tissues. Laparoscopic ovarian cancer surgery is typically more suited to smaller tumors.
If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum (abdominal lining) removed.
Chemotherapy drugs kill cancer cells throughout the body. Most women have chemotherapy for ovarian cancer after surgery. Some are also given chemotherapy before surgery to reduce the size of the tumor first.
Usually, more than one anticancer drug is given. Drugs for ovarian cancer can be given in different ways:
- By vein (IV): The drugs can be given through a thin tube inserted into a vein.
- By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
- By mouth: Some drugs for ovarian cancer can be given by mouth.
Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.
You may have your treatment in a clinic, at the doctor’s office, or at home.
Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. Each treatment takes only a few minutes and is administered at our St. Paul or Maplewood clinics or a partner radiation oncology clinic.
Targeted therapies are designed to treat only the cancer cells and minimize damage to normal, healthy cells. Cancer treatments that "target" cancer cells may offer the advantage of reduced treatment-related side effects and improved outcomes.
- Angiogenesis inhibitors are targeted therapy drugs that may prevent the growth of new blood vessels that tumors need to grow and may kill cancer cells. Bevacizumab (Avastin) is one such drug that has been shown to shrink or slow the growth of advanced epithelial ovarian cancers.
- PARP inhibitors block an enzyme involved in repairing damaged DNA. By blocking this enzyme, DNA inside cancer cells may be less likely to be repaired, leading to cell death and possibly slowing down or stopping tumor growth. Olaparib, rucaparib, and niraparib are PARP inhibitors that may be used to treat advanced ovarian cancer. Rucaparib may also be used as maintenance therapy to treat ovarian epithelial cancer.