Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for women who have ovarian cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to have children (preserve fertility) must also be considered.

• Surgery is done to confirm and treat cancer. Removal of all cancerous tissue and taking biopsies to check for the spread of cancer (surgical staging) is important for diagnosis and treatment, because the amount of cancer remaining (residual cancer) after the initial surgery may affect your outcome.
• Chemotherapy, which uses medicines to kill cancer cells, is recommended after surgery for most stages of ovarian cancer. Recent studies show that the addition of chemotherapy after surgery improves the outcome for some early-stage ovarian cancer.¹⁵ Chemotherapy is also recommended for all other stages of ovarian cancer. Chemotherapy that is given after a surgery is called adjuvant therapy.

Initial treatment

The goal of the initial surgery is to remove all visible cancer. The type of surgery you will need depends on the stage of your cancer and if you want to be able to have children after having the surgery.

If you have early-stage (stage I and low-grade [grade 1]) cancer and you wish to have children, your surgery may include:

• Removal of your cancerous ovary and fallopian tube.
• A biopsy of your other ovary.
• Removal of fatty tissue (omentum) that is attached to some of the abdominal organs.
• Removal of lymph nodes in the pelvis and near the large blood vessel (aorta) in the belly.
• Biopsies of other tissues and peritoneal fluids (peritoneal washings) from the belly to look for cancer cells.

Your uterus and the healthy ovary will remain, so it may be possible for you to become pregnant.

If you have a more advanced stage (stage II, III, or IV) of cancer or you have stage I and do not want to have children, your surgery may include:

• A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
• Collection of peritoneal fluid.
• Removal of pelvic and aortic lymph nodes (lymph node dissection).
• Removal of fatty tissue (omentum).
• Removal of as much cancerous tissue as possible.
• Biopsies of any tissue that may be cancerous.

Because this surgery removes all the reproductive organs, you will not be able to become pregnant after having it.

Chemotherapy is recommended after surgery for most women. The current standard of treatment is 6 cycles of paclitaxel (Taxol) and carboplatin or cisplatin. Each chemotherapy cycle is scheduled every 3 to 4 weeks, so chemotherapy may last 4 to 6 months. Studies are looking at delivering chemotherapy directly into the belly (intraperitoneal chemotherapy). One study compared women with stage III ovarian cancer who had already had surgery. In that study, one group had treatment with paclitaxel delivered into a vein (intravenous) followed by intravenous cisplatin; the other group had treatment with intravenous paclitaxel followed by intraperitoneal cisplatin and paclitaxel. Although the intraperitoneal group had more severe side effects, overall survival was better than for the intravenous group.¹⁶