Treatment & Management

of Ovarian Cancer

The optimal treatment of ovarian cancer requires a combination of surgery, surgery, systemic treatment with precision cancer medicines or chemotherapy, and occasionally radiation therapy. Specific treatment can depend on both the stage and the genomic profile of the cancer.

Individuals should seek care from a gynecologic oncologist, these are the doctors specifically trained to diagnose and treat patients with ovarian cancer.  The single most important thing a patient can do may be to seek care at a “high volume” cancer center where providers have experience treating ovarian cancer.  “High-volume” centers have more extensive experience in treating ovarian cancer and this is associated with improved survival rates.1

Surgery for Ovarian Cancer

The role of surgery in the initial management of ovarian cancer is to obtain a biopsy specimen of the cancer to confirm the diagnosis, determine the stage of the cancer and to provide local treatment of the cancer in the pelvis and abdomen. The tissue sample is also evaluated for prognostic information and may be sent for genomic testing to determine whether any precision cancer medicines can be used. Learn more about surgery.

Radiation Therapy for Ovarian Cancer

Radiation therapy or radiotherapy uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment and is not useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer. Learn about radiation therapy.

Systemic Therapy: Precision Cancer Medicine, Chemotherapy, and Immunotherapy

Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Many patients with ovarian cancer already have small amounts of cancer that were not removed with surgery. These patients require systemic treatment to decrease the chance of cancer recurrence. More advanced cancers that cannot be treated with surgery can only be treated with systemic therapy. Systemic therapies commonly used in the treatment of ovarian cancer include:

Chemotherapy

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. The drugs are usually given in cycles so that a recovery period follows every treatment period.

Initial chemotherapy treatment of ovarian cancer typically consists of a combination of platinum and taxane chemotherapy. These and other chemotherapy drugs are used for recurrent or resistant cancer.

  • Carboplatin, Platinol (cisplatin), Eloxatin (oxaliplatin)
  • Taxol (paclitaxel), Taxotere (docetaxel)
  • Abraxane (paclitaxel liposome injection)
  • Alimta (pemetrexed)
  • Doxil (doxorubicin liposome injection)
  • Camptosar (ironotecan)
  • Gemzar (gemcitabine)
  • Hexalin (altretamine)
  • Hycamtin (topotecan)
  • Xeloda (capecitabine)

Precision Cancer Medicines

The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Patients should ask their doctor about whether testing is appropriate. Learn about precision cancer medicines.

Intraperitoneal Chemotherapy

Intraperitoneal chemotherapy (IP) is a type of regional chemotherapy that is used to treat some stage III ovarian cancers. During IP chemotherapy the anticancer drugs are infused directly into the peritoneal cavity (the space that contains the abdominal organs) through a thin tube.

Ovarian Cancer Stages

Following surgical removal and staging of ovarian cancer, a final stage will be given. A Roman numeral from I to IV describes the stage and a letter from “A” to “C” describes a sub-stage. All new treatment information concerning ovarian cancer is categorized and discussed by the stage.

Stage I: Cancer is found only in one or both of the ovaries. Cancer cells may also be found in abdominal fluid, or ascites.

Stage II: Cancer is found in the ovaries and has spread to the uterus (womb), the fallopian tubes, or other areas within the pelvis. Cancer cells may also be found in abdominal fluid, or ascites.

Stage III: Cancer is found in the ovaries and has spread to other body locations within the abdomen, such as the surface of the liver, intestine or lymph nodes.

Stage IV: Cancer is found in the ovaries and has spread outside the abdomen  or inside of the liver.

Recurrent or Refractory: Recurrent disease means that the cancer has returned (recurred) after it has been treated. Refractory disease means the cancer is no longer responding to treatment.

References


1 Armstrong, D. Ovaries and fallopian tubes. In: Abeloff MD ed. Abeloff’s Clinical Oncology, 4th ed. Philadelphia: Churchill Livingstone, 2008: 1827-50.