Therapies
Treatment depends on a number of factors, including the stage of the disease and the general health of the patient. Patients are often treated by a team of specialists. The team may include a gynecologist, a gynecologic oncologist, a medical oncologist, and/or a radiation oncologist. Many different treatments and combinations of treatments are used to treat ovarian cancer.
Surgery
Surgery is the usual initial treatment for women diagnosed with ovarian cancer. The ovaries, the
fallopian tubes, the uterus, and the cervix are usually removed. This operation is called a
hysterectomy with bilateral salpingo-oophorectomy. Often, the surgeon also removes the omentum (the
thin tissue covering the stomach and large intestine) and lymph nodes (small organs located along
the channels of the lymphatic system) in the abdomen.
Staging during surgery (to find out whether the cancer has spread) generally involves
removing lymph nodes, samples of tissue from the diaphragm and other organs in the abdomen, and
fluid from the abdomen. If the cancer has spread, the surgeon usually removes as much of the cancer
as possible in a procedure called tumor debulking. Tumor debulking reduces the amount of cancer
that will have to be treated later with chemotherapy or radiation therapy.
Surgery causes short-term pain and tenderness in the area of the operation. Discomfort or pain
after surgery can be controlled with medicine. Patients should feel free to discuss pain relief
with their doctor. For several days after surgery, the patient may have difficulty emptying her
bladder and having bowel movements.
When both ovaries are removed, a woman loses her ability to become pregnant. Some women may
experience feelings of loss that may make intimacy difficult. Counseling or support for both the
patient and her partner may be helpful. Also, removing the ovaries means that the body's natural
source of estrogen and progesterone is lost, and menopause occurs. Symptoms of menopause, such as
hot flashes and vaginal dryness, are likely to appear soon after the surgery. Some form of hormone
replacement therapy may be used to ease such symptoms. Deciding whether to use it is a personal
choice; women with ovarian cancer should discuss with their doctors the possible risks and benefits
of using hormone replacement therapy.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given to destroy any
cancerous cells that may remain in the body after surgery, to control tumor growth, or to relieve
symptoms of the disease.
Most drugs used to treat ovarian cancer are given by injection into a vein (intravenously, or
IV). The drugs can be injected directly into a vein or given through a catheter, a thin tube. The
catheter is placed into a large vein and remains there as long as it is needed. Some anticancer
drugs are taken by mouth. Whether they are given intravenously or by mouth, the drugs enter the
bloodstream and circulate throughout the body. Another way to give chemotherapy is to put the drug
directly into the abdomen through a catheter. With this method, called intraperitoneal
chemotherapy, most of the drug remains in the abdomen.
After chemotherapy is completed, second-look surgery may be performed to examine the abdomen
directly. The surgeon may remove fluid and tissue samples to see whether the anticancer drugs have
been successful.
Chemotherapy affects normal as well as cancerous cells. Side effects depend largely on the
specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include
nausea and vomiting, loss of appetite, diarrhea, fatigue, numbness and tingling in hands or feet,
headaches, hair loss, and darkening of the skin and fingernails. Certain drugs used in the
treatment of ovarian cancer can cause some hearing loss or kidney damage. To help protect the
kidneys while taking these drugs, patients may receive extra fluid intravenously.
Radiation therapy
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation). Some women receive a treatment called intraperitoneal radiation therapy in which radioactive liquid is put directly into the abdomen through a catheter.
Radiation therapy, like chemotherapy, affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Common side effects of radiation therapy to the abdomen are fatigue, loss of appetite, nausea, vomiting, urinary discomfort, diarrhea, and skin changes on the abdomen. Intraperitoneal radiation therapy may cause abdominal pain and bowel obstruction (a blockage of the intestine).
Follow-up care
Follow-up care after treatment for ovarian cancer is important. Regular checkups generally
include a physical exam, as well as a pelvic exam and Pap test. The doctor also may perform
additional tests such as a chest x-ray, CT scan, urinalysis, complete blood count, and CA-125
assay.
In addition to having follow-up exams to check for the return of ovarian cancer, patients may
also want to ask their doctor about checking them for other types of cancer. Women who have had
ovarian cancer may be at increased risk of developing breast or colon cancer. In addition,
treatment with certain anticancer drugs may increase the risk of second cancers, such as leukemia.