Treatment of ovarian cancer

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Treatment of ovarian cancer

The choice of treatment and the long-term outcome (prognosis) of your ovarian cancer depend on the stage and grade of your cancer. Your age, overall health, and quality of life must also be considered. Research studies are ongoing to find the best treatment choices or combination of treatments that increase survival rates without affecting your quality of life.

Your doctor confirms a diagnosis of ovarian cancer and determines its spread (or stage) by taking biopsies during laparotomy surgery. Laparoscopic surgery may be a choice for some women. Talk with your doctor about your choices.

Surgery in early-stage ovarian cancer

Surgery in early-stage ovarian cancer determines both the stage and grade of cancer. Surgery is also the first treatment for cancer. Surgical staging means looking at different organs or tissues in the abdomen for cancer. Surgery may include:

A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
Taking a sample of peritoneal fluid (peritoneal washings) from the abdominal cavity, to look for cancer cells.
Removing and checking the pelvic and aortic lymph nodes, to see if the cancer has spread.
Checking the abdominal organs and tissues for cancer cells. Biopsies may be done.
Removing and checking the fatty tissue (omentum) attached to the stomach and large intestine, to see if the cancer has spread.
An appendectomy, which removes your appendix.

Women with stage IA or IB and grade 1 or 2 have the earliest stages of cancer and have the best long-term outcomes when they are treated with surgery. Chemotherapy may also be recommended. The 5-year survival rate—the percentage of people who are still alive 5 years or longer after their diagnosis—is as high as 93%.¹

Women with stage I and grade 3 cancer are treated with both surgery and chemotherapy. The 5-year survival rate is about 80%.²

Surgery in advanced-stage ovarian cancer

Surgery in advanced-stage ovarian cancer involves removing as much of the cancer as possible. This is called tumor debulking or cytoreduction. The uterus, omentum, and any areas of visible cancer are removed. This may include surgery on the intestines, urinary system, or spleen, or scraping of the diaphragm to remove all the cancer. The long-term outcome (prognosis) is better if no cancer cells remain (there is no residual tumor).

Women with stage III cancer who are treated with surgery and chemotherapy have a long-term survival rate of about 30% if most of the cancer is removed in surgery.²

Women with stage IV cancer who are treated with surgery and chemotherapy have a long-term survival rate of about 10%.²

Chemotherapy is usually started 1 to 4 weeks after surgery. The standard medication therapy includes paclitaxel and carboplatin or cisplatin.

**Stages and treatments for ovarian cancer** ³
Stage	Treatments
IA and IB	Women with stage IA, grade 1 cancer who wish to have children Surgery will leave the uterus and one ovary if they have no sign of cancer. All of these will be done during surgery: Cancerous ovary and fallopian tube are removed. Other ovary is biopsied. Fatty tissue (omentum) is removed. Pelvic and aortic lymph nodes are removed. A sample of peritoneal fluid is taken. Appendix is often removed. Women with grade 1 cancer who do not wish to have children All of these will be done during surgery: Uterus (hysterectomy) and both ovaries and fallopian tubes (bilateral salpingo-oophorectomy) are removed. A sample of peritoneal fluid is taken. Pelvic and aortic lymph nodes are removed. Omentum is removed. Peritoneum and any tissue that may be cancerous are biopsied. Appendix is often removed. Most women with grade 2 and all women with grade 3 cancer Hysterectomy, bilateral salpingo-oophorectomy, surgical staging, and chemotherapy
IC	Hysterectomy, bilateral salpingo-oophorectomy, surgical staging, and chemotherapy
IIA, IIB, IIC, IIIA, IIIB, IIIC, and IV	Hysterectomy, bilateral salpingo-oophorectomy, periodic tumor debulking (may include surgery on intestines, urinary system, or spleen, or scraping the diaphragm), and chemotherapy

References

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Citations
Brennan K, et al. (2007). Premalignant and malignant disorders of the ovaries and oviducts. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 971–884. New York: McGraw-Hill.
Cannistra SA (2007). Gynecologic cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 10. New York: WebMD.
National Comprehensive Cancer Network (2007). Ovarian cancer. Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/ovarian.pdf.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Ross Berkowitz, MD - Obstetrics and Gynecology
Last Updated	July 10, 2007

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Last updated:	July 10, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Anne C. Poinier, MD - Internal Medicine, Ross Berkowitz, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC

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