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The choice of treatment depends on the woman's age, general health, the histologic type of ovarian cancer, the stage of the disease, the volume or amount of tumor present at initial diagnosis, and the presence of abdominal fluid that contains cancer cells (ascites). In all but the earliest stages of ovarian cancer, a combination of surgery followed by chemotherapy is the standard, traditional treatment. Radiation therapy may also be used in some women but it is not part of current standard therapy and is usually only used in the setting of a clinical trial. Surgery Surgery is usually the first treatment for ovarian cancer. The type of surgery depends upon how widespread the cancer is when diagnosed (the cancer stage), as well as the type and grade of cancer. The surgeon may remove one (unilateral) or both ovaries (bilateral), the fallopian tubes (salpingectomy), and the uterus (hysterectomy). For some very early tumors (stage 1, low grade or low-risk disease), only the involved ovary and fallopian tube will be removed (called a "unilateral salpingo-oophorectomy," USO), especially in young females who wish to preserve their fertility and have children.  If all of these structures are removed, the surgery is called a "total abdominal hysterectomy and bilateral salpingo-oophorectomy." (TAH-BSO). The surgeon will also "stage" the tumor by taking biopsies from all suspicious areas as well as samples from multiple tissues in the abdomen and pelvis including lymph node sampling to see if the cancer has spread beyond the ovary. Fluid in the abdomen and pelvis will be tested for cancer cells and is called peritoneal fluid cytology or peritoneal washing.  The surgeon will remove as much tumor as is safely possible (called primary or initial cytoreductive surgery or tumor debulking). This helps increase the effectiveness of chemotherapy after surgery as there is a smaller volume of tumor to attack. Surgery Side Effects Surgery for ovarian cancer is a major abdominal surgical procedure. Side effects of surgery may include fatigue, premature menopause (which may cause hot flashes, vaginal dryness, irritation and insomnia), decreased sex drive, infertility, and wound complications, such as an infection. In addition, typical side effects that may occur with any major surgery are postoperative pain, difficulty emptying the bladder or having a normal bowel movement, and nausea and vomiting. Surgery can also weaken the pelvic muscles, which can cause the bladder, vagina, and/or rectum to partially protrude (prolapse). Most prolapses can be surgically repaired and don't occur until years after the surgery. Chemotherapy Chemotherapy drugs usually work by interfering with cell division. If a cancer cell can't divide and multiply, it can't grow. Chemotherapy is referred to as "systemic" therapy because the drug(s) travel throughout the body to destroy normal cells. Most chemotherapy is given intravenously (IV), but some may be taken by mouth. Intravenous chemotherapy is typically administered in the doctor's office or hospital clinic. The treatment is repeated at regular intervals which can be weekly, every 2, 3 or 4 weeks. The timing of the chemotherapy and the number of times it is given will depend on the type of treatment. Some patients may receive more chemotherapy depending on the individual's situation. Because the chemotherapy affects both normal cells and cancer cells, the "rest period" between chemotherapy cycles is necessary in order to give the normal cells a chance to recover. Chemotherapy may also be administered by an intraperitoneal (IP) method in which the drug(s) are instilled directly into the peritoneal cavity through a small, special tube or catheter placed into the abdominal wall. Recent studies have resulted in recommendations that certain women will benefit from a combination of intravenous and intraperitoneal chemotherapy. The use of high-dose chemotherapy in ovarian cancer is currently not part of standard treatment as its effectiveness has not been proven. It is still experimental and should only be used in the setting of a clinical research trial. The current recommended chemotherapy for the initial treatment is a combination of a platinum drug (carboplatin or cisplatin) and a taxane drug. The two taxane drugs are paclitaxel (Taxol TM) or docetaxel (Taxotere TM). This combination is referred to as "first-line chemotherapy" and is considered the most effective drug combination at this time. The physician often monitors the effectiveness of the chemotherapy by doing frequent physical exams and following the woman's CA-125 level. About 80 percent of ovarian cancers produce a protein called CA-125 that can be detected in the blood. CA-125 is usually measured during the diagnostic work-up and evaluation before treatment as well as during and after treatment. Patients whose elevated CA-125 normalizes with effective treatment will still need to be monitored for elevated CA-125 level's because this may indicate an active disease. Chemotherapy Side Effects Because chemotherapy can't tell the difference between normal cells and cancer cells, it attacks any rapidly dividing cells. This includes hair cells and the cells lining the inside of the mouth, stomach, and intestines. This is why patients undergoing chemotherapy often have side effects such as hair loss, mouth sores, nausea, and vomiting. Chemotherapy also temporarily damages the bone marrow where blood cells are made, and patients are more susceptible to infection, bruising and bleeding, and anemia. Women may also be quite fatigued, and feel numbness, tingling or burning in their hands and feet. This is called neuropathy. Allergic reactions during the infusion may occur with paclitaxel and carpoplatin. Paclitaxel may also cause joint and muscle pain, a change in heart rate while receiving paclitaxel, as well as, local irritation at the IV (intravenous) site. Alterations in kidney function or kidney damage may occur with cisplatin or carboplatin. The side effects listed above are the most common ones, but they may not be the only ones. Fortunately, most of these side effects usually resolve once chemotherapy is completed. Most patients receiving chemotherapy are able to enjoy an active and enjoyable quality of life. Radiation therapy Radiation therapy has a limited and controversial role in treating ovarian cancer .It is not “standard of care” for treatment of ovarian cancer outside of clinical trials. Currently there are clinical trials using low dose radiation in combination with chemotherapy. The purpose is to increase the effectiveness of the chemotherapy. This is called “chemosensitization”. Chemosensitization has been proven to be effective in other types of cancers such as rectal and pancreatic cancers. Further clinical trials must be done to determine its role and benefit in the treatment of ovarian cancer. At times radiation may be given to relieve symptoms of the disease. This is called palliative treatment rather than curative. Radiation Side Effects Side effects from radiation may include fatigue, nausea, diarrhea, and a sunburn-like appearance to the skin.  This content is reviewed regularly. Last Updated 6/12/2008
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