Ovarian Cancer Treatment

Surgery and chemotherapy are key ovarian cancer treatments, as with other cancers. Early surgery can keep more than 90 percent of women from dying of the cancer.

The treatment plan for you will depend on the stage of your ovarian cancer and how quickly it seems to be growing. For cancers caught at stage 1, surgery alone may be the solution, preventing about 93 percent of patients from dying of the cancer.

First-line ovarian cancer treatment begins with surgery, followed by a chemotherapy regimen. About 80 percent of patients emerge with normal blood tests and no visible evidence of disease on imaging scans.

If your cancer returns after six months, you may repeat the process. For cancer that progresses or recurs (comes back) within six months, surgeons will look for other forms of chemotherapy. Another possibility is immunotherapy, using your own immune system.

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Surgery

The main ovarian cancer treatment is surgery. It is appropriate in the early and later stages and for cancers that have returned.

Laparatomy and laparoscopy

If the tumor hasn’t spread beyond your ovary, your surgeon can remove it using a traditional type of surgery with a large incision in the abdomen — a laparotomy.

A laparoscopy requires only smaller incisions. Your surgeon inserts a small video camera into your abdominal area through an endoscope (it has a light at the end) and guides the camera within your body. Through another incision, your surgeon uses small tools to remove the ovary. You may recover faster and have less scarring with this approach.

The procedure may be used to remove one of your fallopian tubes and ovaries along with the omentum, a thin fold of abdominal tissue that encases your stomach, large intestine, and other abdominal organs. Your lymph nodes may also be removed.

In a laparoscopy procedure, your surgeon can explore your abdomen to determine how far the tumor has spread, drain any fluid buildup, take samples for a biopsy, and see if you might benefit from other surgery. If your surgical team suspects fluid in your chest, possibly because cancer has spread, you may also have a scope there to explore and drain fluid.

Robotic surgery

Sometimes surgical instruments are mounted on three robotic arms, which the surgeon can operate with a finger or foot. A fourth arm carries a camera, creating magnified, three-dimensional images on a computer monitor, so the surgeon can see what is going on.

This approach also requires smaller incisions than a laparotomy, so it may produce less scarring.

Radical debulking

Also called cytoreduction, in this procedure your surgeons aim to leave no visible tumor behind and may remove your uterus, cervix, fallopian tubes, and any other areas containing diseased tissue.

If your cancer has spread beyond your pelvis, the surgeon may remove part of the omentum, the diaphragm (the thin muscle below your lungs and heart that separates your chest from the abdomen), and segments of your bowel, the spleen, and parts of your liver.

If your cancer comes back, a second debulking procedure may be helpful.

If you hope to bear children and your cancer is in an early stage, surgeons may remove only the affected ovary (called unilateral oophorectomy) and fallopian tube, omentum, and lymph nodes. The procedure may preserve your fertility.

Surgery for ovarian cancer can cause some pain at the surgical site. It can usually be managed with medication. You may also experience hot flashes or vaginal dryness, which also can be treated.

Chemotherapy

Tumor cells can remain after surgery even with the most skilled surgeon. So first-line treatment for advanced cancer includes chemotherapy as well. The drugs are designed to interrupt the growth of those cells. You may take your medication by mouth or through an injection called intraperitoneal chemotherapy, when the medication is inserted into the lining of your abdominal area (the peritoneum) following surgery.

If you have a BRCA1 or BRCA2 mutation, you may receive a drug that inhibits PARP-1, an enzyme involved in cell death. The Food and Drug Administration (FDA) has approved the PARP inhibitor olaparib (Lynparza) for women with BRCA mutations who have experienced a recurrence of ovarian cancer.

Other possibilities are bevacizumab (Avastin), which targets the blood vessels that supply the tumor, and pazopanib (Votrient), which helps stop new blood vessels from forming and has shown promise for ovarian cancer treatment.

Immunotherapy

Drugs that work with your immune system function are at the forefront of cancer research. Ask your doctor about immunotherapy clinical trials. For example, the drug pembrolizumab (Keytruda) has FDA approval to treat ovarian cancer treatment.

Follow-up

Your ovarian cancer treatment should include follow-up care. You’ll need checkups to catch any recurrences quickly and identify and treat late effects of your cancer and treatment. Eventually, you can shift to receiving care from your gynecologist rather than an ovarian cancer specialist.

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