Treatments for Ovarian Cancer

Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer are usually treated in the same way. Most women with epithelial ovarian cancer or primary peritoneal cancer will have surgery to remove as much of the tumor as possible. This surgery should be performed by a gynecologic oncologist, because when women with ovarian cancer are treated by gynecologic oncologists their outcomes are better.

There are several different surgeries that may be used to remove the cancer. Women may have:

a hysterectomy, surgery to remove the uterus

bilateral salpingo-oophorectomy, surgery to remove both ovaries and fallopian tubes

omentectomy, surgery to remove the omentum (a fat pad in the abdomen)

and/ or a lymph node biopsy, the removal of lymph nodes in the pelvis and abdomen, along with staging, a thorough sampling of tissue in the pelvis and abdomen.

Women who want to have children may have unilateral salpingo-oophorectomy, during which one ovary and one fallopian tube are removed, along with omentectomy and lymph node sampling and staging. During surgery, lymph nodes and other tissues in the pelvis and abdomen are removed and examined under a microscope for cancer cells. Chemotherapy may follow surgery.

Advanced epithelial or primary peritoneal cancer may be treated as described above, but the surgeon will also try to remove all of the cancer in the abdomen, called debulking.

After surgery, women may receive chemotherapy through the vein (intravenous) or directly into the abdomen (intraperitoneal). Targeted therapy, a type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells, causing less harm to normal cells in the body, may also be used.

In some situations, once a diagnosis is made, chemotherapy is given before surgery; this is called neoadjuvant chemotherapy.

Treatment options for germ cell tumors vary based on the size of the tumor, stage of the cancer, how cancer cells look under a microscope, and the patient’s overall health. Germ cell tumors often occur in younger women, so surgery often aims to preserve fertility by removing only one tube and ovary (unilateral salpingo-oophorectomy). Chemotherapy is used to treat advanced germ cell tumors or recurrent tumors, and it is also an treatment option after surgery for women diagnosed with early-stage disease to prevent recurrence and destroy any remaining tumor cells.

Treating germ cell tumors with chemo drugs usually involves a regimen of bleomycin, etoposide, and cisplatin. Though this treatment has shown to be effective in treating germ-cell tumors, side effects can be serious and should be weighed against the benefits. Physicians may adjust the frequency of this regimen, called the BEP program, based on side effects or if the cancer has spread, but over 90% of patients with germ cell tumors are disease-free after this treatment.

Many sex cord–stromal tumors can be treated with surgery only, preserving fertility for younger women. If patients are diagnosed at a later stage, surgery is often combined with chemotherapy. Some patients with early stage disease do have additional risk factors, and should receive chemotherapy after surgery.

Most women who receive ovarian cancer radiation will have external beam radiation therapy, where high-energy x-rays or other types of radiation is focused on to the body to kill cancer cells or prevent growth. Some women receive a treatment called intraperitoneal radiation therapy, in which radioactive liquid is put directly in the abdomen through a catheter. Intraperitoneal radiation therapy is still being studied to treat advanced ovarian cancer.

Side effects from radiation can include: skin irritation, fatigue, nausea, diarrhea, vaginal irritation, and bladder issues including blood in the urine, painful urination, difficulty urinating, or the urge to urinate more often. Women may also experience issues with fertility or early symptoms of menopause.

Premenopausal women will experience symptoms of early menopause once their ovaries are removed during surgery. Gynecological or sexual health specialists can help patients manage these hormonal changes, as they can be overwhelming. Some women will experience side effects shortly after surgery because of the surge in hormones, and all women’s experiences will vary. Physical symptoms can include hot flashes, vaginal discomfort and dryness, increased frequency or urgency of urination, brittle nails, thinning of the skin, hair loss, and aches and pains. Emotional or mental symptoms can include irritability, poor concentration, and poor memory. While these symptoms often improve on their own, patients can discuss hormone replacement therapy with their doctors as a potential treatment.

Chemotherapy, which can be given before or after treatment, can also impair fertility. Other physical side effects include hair loss, loss of appetite and weight loss, or weight gain as a result of steroids given with chemotherapy. Healthy diet and regular exercise can help manage some of these. Chemotherapy can also cause mental symptoms, such as changes in memory, thinking, and concentration. These changes often improve over time.

Side effects from radiation can include: skin irritation, fatigue, nausea, diarrhea, vaginal irritation, and bladder issues including blood in the urine, painful urination, difficulty urinating, or the urge to urinate more often. Women may also experience issues with fertility or early symptoms of menopause.