The mainstay of treatment of ovarian cancer is surgery, combined with chemotherapy. The role of radiation therapy in the treatment of ovarian cancer is limited.
The specific type of treatment to be undertaken for ovarian cancer will depend upon :
- Age of the patient
- General health of the patient
- Type of ovarian cancer
- Stage and grade of ovarian cancer
- Degree of spread and metastasis of the cancer
- Desire to have children
- Recurrence of cancer
- Side effects of treatment vs benefits
The aim of surgery is to detect, confirm, stage, and finally treat the disease. Surgery should ideally be done at the time of an exploratory laparotomy for the diagnosis of ovarian cancer. As much of the cancer tissue should be removed as possible for the best results. This may reduce the possibility of persistence or recurrence of cancer.
The type of surgery to be performed will depend upon the stage of cancer and the desire to have children.
In women with early stage cancer, (stage 1, where the tumor is confined to the ovary), and in patients who also desire to have children, the uterus and the unaffected ovary are left intact. However, a biopsy is taken from this healthy ovary to rule out the possibility of any cancerous changes in it. Usually, only the cancerous ovary and the fallopian tube of that side are removed (salpingo-oophorectomy). Early stage 1 cancer may be cured by surgery alone.
In women with more advanced cancer (stage 2, 3, and 4), and those with stage 1 cancer who do not want any more children, or if both the ovaries are involved, the surgery will be more extensive than a salpingo-oophorectomy. The surgery will involve removal of the :
- uterus with the fallopian tubes and ovaries of both sides (total hysterectomy with bilateral salpingo-oophorectomy).
- omentum (the fold of peritoneum attached to the stomach and other abdominal organs, containing mainly fatty tissue, blood vessels and lymphatics).
- regional lymph nodes
- any other cancerous issue
Chemotherapy is prescribed following surgery in most ovarian cancers except in stage 1 cancers.
Cytoreductive or Debulking Surgery
A cytoreductive or debulking surgery is done primarily when the cancer has spread extensively, or in those patients in whom debulking was not done at the time of initial surgery. This involves removal of as much of the tumor as possible. The goal in debulking surgery, which is likely to give the best prognosis, is to leave behind tumors no larger than 1 cm (centimeter).
Sometimes, a second-look surgery is performed after completion of chemotherapy to check for residual cancer in the remaining pelvic and abdominal structures. Any remaining cancer may be removed during the second-look surgery. In some cases, chemotherapy may shrink the tumor, thus making surgery possible the second time where it was not so in the first instance. Fluid and tissue samples may be taken at the time of surgery and examined for cancer cells.
Preventive (Prophylactic) Surgery
This type of surgery is not really a treatment for ovarian cancer but rather a preventive measure. Women at high risk of developing ovarian cancer, such as those with mutations in BRCA1 and BRCA2 genes, may be advised on undergoing bilateral salpingo-oophorectomy for the prevention of ovarian cancer. This surgical option has to be carefully assessed keeping in mind that future pregnancy will not be possible (unless donor eggs are used) following removal of both ovaries. It will also bring on menopause.
The use of drugs to destroy cancer cells is known as chemotherapy. Drugs commonly used are paclitaxel, carboplatin, and cisplatin, which may be used singly or in combination. In ovarian cancer, chemotherapy is commonly used as an adjuvant therapy meaning it is most effectively used after surgery, to destroy any remaining cancer cells. In some cases, chemotherapy is given prior to surgery to reduce the size of the tumor, thus making surgery easier. Chemotherapy may also be used in case of recurrent cancer and also in palliative therapy.
Chemotherapy for ovarian cancer may be administered by the intravenous (IV) or the intraperitoneal (IP) route – into the vein (IV) or into the abdominal or pelvic peritoneal cavity (IP). Although IP treatment may offer better results in terms of survival, the side effects may be more intolerable than IV treatment.
The side effects of chemotherapy may include :
- Nausea and vomiting
- Loss of appetite
- Severe weakness
- Extreme fatigue
- Abdominal pain
- Weakened immune system
- Hair loss
With radiation therapy, high-energy rays are usually focused on specific points to kill cancer cells. Radiation therapy is not usually considered for ovarian cancer because of widespread dissemination of the cancer in the abdominal cavity by the time it is diagnosed. The amount of radiation that would be necessary for treatment would cause more harm than good in most cases. Radiation therapy is used more often in palliative therapy to provide symptomatic relief in advanced cases.
When the cancer does not improve or seems to get worse even after treatment, palliative therapy may be considered. This will not make the cancer go away but may help to prolong the life of a patient, reduce symptoms such as pain, and help the patient cope with the disease. Chemotherapy or radiation therapy may be considered such cases.