The first step in the management of ovarian cancer is surgery. If the diagnosis of ovarian cancer is made during surgery, the most important goal is to remove all visible tumor disease. This usually requires a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes), a hysterectomy (removal of the uterus and cervix), removal of lymph nodes in the pelvis and abdomen and removal of the omentum (fat pad that is attached to the large bowel and may contain tumor cells). In some patients, a bowel resection is necessary to remove all the disease or an obstruction. In addition, the surgeon might decide to place a plastic tube into the abdomen for the infusion of chemotherapy following surgery.
It is very important that this surgery is done by a gynecologic oncologist who is experienced in the treatment of ovarian cancer.
Special consideration should be given to women that are young and desire preservation of fertility. In these cases, the surgeon may decide to remove only one ovary and fallopian tube and leave the uterus and other ovary for later childbearing.
If the ovaries are removed in patients before menopause, hot flashes after surgery are likely to occur since the body is deprived of its source of sex hormones. Women should talk with their doctors about ways to cope with these side effects.
Almost all patients diagnosed with ovarian cancer need to undergo chemotherapy. Chemotherapy uses drugs that kill cancer cells. The goal of chemotherapy after surgery of ovarian cancer is to destroy all remaining cancer cells and prevent a recurrence. In some cases, chemotherapy is given prior to surgery to reduce the amount of tumor disease. This is indicated in patients with widespread tumor disease, or in patients that are initially too sick to undergo surgery.
The most effective chemotherapeutic drugs for the treatment of ovarian cancer are so-called platinum agents, in particular carboplatin and cisplatin. These drugs are used for the chemotherapy after first surgery, also called first line chemotherapy. Most patients receive a second chemotherapeutic drug together with carboplatin, either taxol or taxotere. The chemotherapy is given in cycles. Each cycle is about three to four weeks long. Most regimens use six cycles of chemotherapy amounting to about five to six months of total chemotherapy treatment after surgery. Chemotherapy can be administered intravenously, or via a catheter placed in the abdomen. The latter delivery is called intraperitoneal chemotherapy. This is frequently done for patients after successful removal of all tumor in advanced disease stages.
After completion of first line chemotherapy, the physician might discuss continuation of a low dose chemotherapy or non-chemotherapeutic drug for up to two years. This is called consolidation therapy with the goal to prevent the recurrence of cancer.
Chemotherapy is also the most common treatment for patients with recurrent ovarian cancer. There is a long list of different drugs that can be used for treatment. Chemotherapeutic agents include carboplatin, cisplatin, gemcitabine, doxorubicin, topotecan, ifosfamide and pemetrexed. More recently, other non-chemotherapeutic drugs have been developed that show promising results in ovarian cancer patients. Bevacizumab for example is a drug that deprives the tumor of its blood supply. Other treatments use hormonal therapies for tumors that are stimulated to grow by estrogens.
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.
Radiation treatment is not a common treatment for ovarian cancer, but it may be used as a localized treatment for isolated sites of tumor disease.