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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 goal of surgery is threefold:
The type of surgery depends upon how widespread the cancer is when diagnosed (the clinical stage). 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 may 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). Lymph nodes and the omentum, which is the fatty tissue covering the bowel and stomach, are also removed. Debulking 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 Following recovery from surgery, chemotherapy (often referred to as "chemo") is begun. Chemotherapy is the use of anticancer medicines (drugs) to destroy or damage cancer cells. Chemotherapy drugs work by interfering with the cell's ability to grow and multiply. It is considered a "systemic" therapy because it enters the bloodstream and travels throughout the body, affecting both normal and cancerous cells. Chemotherapy, after surgical cytoreduction, has proven to significantly prolong survival in advanced ovarian cancer. 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 into the peritoneal cavity. The peritoneal cavity is the space between the internal organs in the abdomen. This is a common site for the cancer to reappear. Intraperitoneal (IP) chemotherapy is a method of administration 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. In January of 2006, the National Cancer Institute made an announcement that based on clinical trial results, the combination of intravenous (IV) and intraperitoneal (IP) - in the abdomen - chemotherapy was superior to just intravenous chemotherapy alone. IP chemotherapy may be considered for some women with either Stage II or Stage III cancer when there is optimal removal of the tumor during surgery with less than 1 centimeter of tumor remaining. A thorough discussion with your physician regarding this type of chemotherapy should include benefit versus risk, as well as side effects. 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. While an increasing CA-125 may indicate active disease, it does not always mean that chemotherapy will be restarted. Chemotherapy Side Effects As with all cancer treatment, side effects from chemotherapy can occur and are highly individualized, varying among patients in both frequency and severity. Chemotherapy side effects depend on the drugs used, the amount taken, the method of administration (by mouth, IV infusion, in the abdomen (IP), etc.) and the duration of treatment. Side effects occur because chemotherapy drugs do not know the difference between a cancer cell and a normal healthy cell. Therefore, normal cells are damaged in the process of destroying the cancer cells resulting in side effects. The normal cells most affected by chemotherapy are cells that are rapidly growing and dividing, which include bone marrow cells (red blood cells, white blood cells, platelets), hair cells, cells lining the digestive tract (from the mouth to the rectum), and cells of the reproductive organs (ovaries). Side effects are generally short-term problems and are very manageable. They gradually go away during the recovery part of the chemotherapy cycle or after treatment is completed. The time it takes to recover from side effects varies from person to person and depends on many factors, including overall health and the specific drugs received. While most side effects are temporary and resolve rapidly, some may take months to years to disappear completely. There are effective drugs available now to help prevent or reduce the severity of side effects such as nausea and vomiting. A group of drugs called growth factors help bone marrow recovery after chemotherapy and minimize problems resulting from low blood counts such as persistent infections or anemia. Your doctor and oncology nurse will review the possible side effects for the drugs you will receive. It will be important to keep your doctor and oncology nurse informed of any side effects you develop so they can instruct you on home management and prescribe any medication, if needed. Although side effects can be unpleasant, for most patients the benefits of treatment usually far outweigh the risks and discomforts. It is important to keep in mind that most patients receiving chemotherapy are able to enjoy an active and good quality of life. The following list includes the more common and significant side effects or complications that may occur with the chemotherapy drugs used to treat ovarian cancer. You are encouraged to review these side effects with your doctor who will advise you on those applicable to your personal situation and risk level.
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 7/16/2010
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