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Treatments and drugs
By Mayo Clinic staffTreatment of ovarian cancer usually involves a combination of surgery and chemotherapy.
Surgery
In most cases, you'll want to have a gynecologic oncologist perform ovarian cancer surgery because they often have more training and experience with this type of operation.
Generally, women with ovarian cancer require an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads.
During this procedure, your surgeon also removes as much cancer as possible from your abdomen (surgical debulking). Ideally, less than a total of 1 cubic centimeter of tumor matter remains in your abdominal cavity after surgery (optimal debulking). This may involve removing part of your intestines.
In addition, your surgeon will take samples of tissue and fluid from your abdomen to examine for cancer cells. This evaluation is critical in identifying the stage of your disease and determining if you need additional therapy.
If you want to preserve the option to have children and if your tumor is discovered early, your surgeon may be able to remove only the involved ovary and its fallopian tube. But, subsequent chemotherapy may cause infertility. However, in some cases, it is possible to successfully bear children after treatment. Be sure to discuss your desire to have children with your doctor.
Chemotherapy
After surgery, you'll most likely be treated with chemotherapy — drugs designed to kill any remaining cancer cells. The initial regimen for ovarian cancer includes the combination of carboplatin (Paraplatin) and paclitaxel (Taxol) injected into the bloodstream (intravenous administration). Clinical trials have found that this combination is effective, though researchers are continually looking for ways to improve on it.
A more intensive regimen has recently been shown to improve survival in women with advanced ovarian cancer by combining standard intravenous chemotherapy with chemotherapy injected directly into the abdominal cavity through a catheter placed at the time of the initial operation. This intra-abdominal infusion exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously.
Side effects — including abdominal pain, nausea and vomiting — may leave many women unable to complete a full course of treatment or others to forego treatment entirely. But even an incomplete course of this treatment may help women live longer.
Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the immune system to help combat cancer. The newest option, if standard chemotherapy fails, is a drug called bevacizumab (Avastin). It works by disrupting the blood supply to the tumor, possibly causing it to shrink. The most serious side effect associated with bevacizumab is bowel perforation, which occurs in about 7 percent of people taking it.
Radiation
While a mainstay in the treatment of some other cancers, radiation generally isn't considered effective for ovarian cancer. Sometimes, your doctor may recommend external beam radiation therapy (EBCT) to treat the symptoms of advanced cancer.
- Detailed guide: Ovarian cancer. American Cancer Society. http://documents.cancer.org/114.00/114.00.pdf. Accessed Aug. 20, 2008.
- Goff B. Early detection of ovarian cancer: Role of symptom recognition. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Chan LM, et al. Epithelial ovarian cancer: Clinical manifestations, diagnostic evaluation, staging, and histopathology. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Chan LM, et al. Epithelial ovarian cancer: Pathogenesis, epidemiology, and risk factors. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Zhou B, et al. Hormone replacement therapy and ovarian cancer risk: A meta-analysis. Gynecologic Oncology. 2008;108(3): 641-651
- Carlson KJ, et al. Patient information: Ovarian cancer screening. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Ovarian cancer: Treatment guidelines for patients. National Comprehensive Cancer Network and the American Cancer Society. http://www.cancer.org/downloads/CRI/NCCN_Ovarian_Cancer_2007.pdf. Accessed Aug. 19, 2008.
- Herzog TJ, et al. Patient information: Ovarian cancer treatment. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Benefits of good nutrition. American Cancer Society. http://www.cancer.org/docroot/MBC/content/MBC_6_2X_Benefits_of_nutrition_during_treatment.asp?sitearea=MBC. Accessed Aug. 24, 2008.
- Muto MG, et al. Risk reducing salpingo-oophorectomy in women at high risk of epithelial ovarian cancer. http://www.uptodate.com/home/index.html. Accessed Aug. 19, 2008.
- Timothy Moynihan (expert review). Mayo Clinic, Rochester, Minn. Aug. 28, 2008.
