Formulating a treatment plan

There are many ways to approach treatment for ovarian cancer. For most women, it means surgery. This is usually combined with chemotherapy, hormone therapy, or targeted treatments.

Some factors that help guide treatment are:

  • your specific type of ovarian cancer
  • your stage at diagnosis
  • whether you’re pre- or postmenopausal
  • whether you plan to have children

Read on to learn more about ovarian cancer treatments and what they entail.

Surgery for ovarian cancer

Surgical options depend on how far your cancer has spread.

For early-stage ovarian cancer, it may be possible to preserve fertility. It’s important to consult with your doctor before you have surgery.

If cancer is found in only one ovary, your doctor can remove it as well as remove the fallopian tube it’s connected to. You’ll still ovulate and menstruate because of your remaining ovary, maintaining your option to get pregnant.

When cancer is found in both ovaries, both of your ovaries and both fallopian tubes might be removed. This will trigger menopause. Symptoms can include hot flashes, night sweats, and vaginal dryness. Your doctor may also advise you to have your uterus removed.

In early-stage ovarian cancer, less-invasive laparoscopic surgery may be an option. This is done with a video camera and long, thin instruments inserted through tiny incisions.

For more advanced ovarian cancer, open abdominal surgery is necessary.

A procedure called debulking cytoreductive surgery is used to treat stage 4 ovarian cancer. It involves removal of your ovaries and fallopian tubes, along with any other affected organs. This can include:

  • uterus and cervix
  • pelvic lymph nodes
  • tissue that covers your intestines and lower abdominal organs
  • part of your diaphragm
  • bowel
  • spleen
  • liver

If you have fluid in your abdominal area or pelvis, it may be removed and examined for cancer cells as well.

Chemotherapy for ovarian cancer

Chemotherapy is a type of systemic treatment. These powerful drugs travel throughout your body to seek and destroy cancer cells. It’s used before surgery to shrink tumors or after surgery to kill any remaining cancer cells.

These drugs can be given intravenously (IV) or orally. They can also be injected directly into your abdomen.

For epithelial ovarian cancer

Epithelial ovarian cancer starts in cells on the outer lining of your ovaries. Treatment typically involves at least two IV drugs. They’re given three to six times, usually three to four weeks apart. The standard drug combination is cisplatin or carboplatin plus paclitaxel (Taxol) or docetaxel (Taxotere).

For ovarian cancer that starts in germ cells

Sometimes ovarian cancer starts in your germ cells. These are the cells that eventually form eggs. The drug combination used for germ cell tumors is cisplatin (Platinol), etoposide, and bleomycin.

For ovarian cancer that starts in stromal cells

Ovarian cancer can also start in stromal cells. These are the cells that release hormones and connect ovarian tissue. This drug combination is likely to be the same used for germ cell tumors.

Other standard chemotherapy treatments

Some other chemotherapies for ovarian cancer are:

  • albumin-bound paclitaxel (Abraxane)
  • altretamine (Hexalen)
  • capecitabine (Xeloda)
  • cyclophosphamide (Cytoxan)
  • gemcitabine (Gemzar)
  • ifosfamide (Ifex)
  • irinotecan (Camptosar)
  • liposomal doxorubicin (Doxil)
  • melphalan (Alkeran)
  • pemetrexed (Alimta)
  • topotecan (Hycamtin)
  • vinblastine (Velban)
  • vinorelbine (Navelbine)

Side effects vary depending on dosage and drug combination. They may include:

  • nausea and vomiting
  • loss of appetite
  • fatigue
  • hair loss
  • mouth sores or bleeding gums
  • higher risk of infection
  • bleeding or bruising

Many of these side effects are temporary. Your doctor can help minimize them. Other side effects, such as kidney damage, can be more serious and long-lasting. Even if you still have one of your ovaries, chemotherapy can lead to early menopause.

Radiation for ovarian cancer

Radiation is a targeted treatment that uses high-energy rays to destroy tumors. It can be delivered externally or internally.

Radiation isn’t a primary treatment for ovarian cancer. But it can sometimes be used:

  • to help treat a small, localized recurrence
  • to ease pain from large tumors that are resistant to chemotherapy
  • as an alternative if you can’t tolerate chemotherapy

Before your first treatment, you’ll need a planning session to determine your exact positioning. The goal is to hit the tumor while limiting damage to healthy tissue. Pinpoint tattoos are sometimes used to permanently mark your skin.

Careful attention is paid to positioning each time. Although that can take a while, the actual treatment only lasts a few minutes. Radiation isn’t painful, but it does require you to remain perfectly still. Treatments are given five days a week for three to five weeks.

Side effects usually resolve when treatment ends but can include:

  • red, irritated skin
  • fatigue
  • diarrhea
  • frequent urination

Hormone therapy for ovarian cancer

Epithelial ovarian cancer is rarely treated with hormone therapy. It’s more often used for stromal cancer.

Luteinizing-hormone-releasing hormone agonists are used to lower estrogen production in premenopausal women. Two of these are goserelin (Zoladex) and leuprolide (Lupron). They’re given by injection every one to three months. These drugs can cause symptoms of menopause. If taken for years, they can weaken your bones and cause osteoporosis.

Estrogen can promote tumor growth. A drug called tamoxifen keeps estrogen from stimulating growth. This drug can also cause symptoms of menopause.

Women who are postmenopausal can take aromatase inhibitors, such as anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). They block an enzyme that turns other hormones into estrogen. These oral medications are taken once a day. Side effects include:

  • hot flashes
  • joint and muscle pain
  • thinning of your bones

Targeted therapy for ovarian cancer

Targeted drugs find and change specific traits of cancer cells that aren’t found in healthy cells. They do less damage to healthy tissue than chemotherapy or external radiation treatments.

Tumors need blood vessels to grow and spread. An IV drug called bevacizumab (Avastin) is designed to stop tumors from forming new blood vessels. It’s given every two to three weeks.

Studies show that bevacizumab can shrink tumors or slow epithelial ovarian cancer progression. Potential side effects include:

  • high blood pressure
  • low white blood cell counts
  • diarrhea

Poly (ADP-ribose) polymerase (PARP) inhibitors are oral medications. They’re used when ovarian cancer is associated with BRCA gene mutations.

Two of these, olaparib (Lynparza) and rucaparib (Rubraca), can be used for later-stage ovarian cancer after trying chemotherapy. Olaparib is also used to treat recurrent ovarian cancer in women with or without BRCA mutations.

Another PARP inhibitor, niraparib (Zejula), can be given to women with recurrent ovarian cancer, with or without BRCA mutations, after trying chemotherapy.

Side effects of these medications can include:

  • nausea
  • anemia
  • muscle and joint pain

Clinical trials for ovarian cancer

Clinical trials compare standard treatment with innovative new therapies not yet approved for general use. Clinical trials can involve people with any stage of cancer.

Ask your oncologist whether a clinical trial is a good option for you. You can also visit the searchable database at ClinicalTrials.gov for more information.

Complementary therapies for ovarian cancer

You might find it helpful to supplement your cancer care with complementary therapies. Some people find they enhance quality of life. Some you might consider are:

  • Aromatherapy. Essential oils may improve your mood and reduce stress.
  • Meditation. Relaxation methods can help ease pain and improve sleep.
  • Massage therapy. This therapeutic treatment for your body might help lower stress and ease anxiety and pain.
  • Tai chi and yoga. Nonaerobic mind-body practices that use movement, meditation, and breathing can promote your overall sense of well-being.
  • Art therapy and music therapy. Creative outlets may help you deal with the emotional aspects of cancer and treatment.
  • Acupuncture. This form of Chinese medicine in which needles are strategically placed can relieve pain and other symptoms.

Check with your doctor before trying new therapies, especially dietary or herbal supplements. These can interact with your medications or cause other problems.

You might also want to consult with a palliative care doctor. These specialists work with your oncology team to provide symptom relief and improve quality of life.

Outlook

The overall five-year relative survival rate for ovarian cancer is 45 percent.

Survival rates vary according to the specific type of cancer, stage at diagnosis, and age. For example, when cancer is caught before it spreads outside your ovaries, the survival rate is 92 percent.

Also, survival statistics don’t include the most recent cases, when newer treatments may have been used.

Your doctor will give you an idea what to expect based on the specifics of your diagnosis and treatment plan.