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Ovarian cancer treatments have come a long way in the past couple of decades, and new treatments are constantly being developed in clinical trials. Surgery and chemotherapy are common treatments for women with ovarian cancer, but doctors may recommend other therapies as well. Different treatments may be used for different goals. In some cases, the goal is to completely eliminate all traces of cancer. Other times, the goal is to slow the growth of the tumor and manage symptoms.
All ovarian cancer is not treated the same way. The treatment you receive is based on many factors. Your oncologist, or cancer specialist, can help you understand which treatment options are a good fit for you. There are many factors that go into coming up with a treatment plan, such as:
Your doctor can make recommendations about which treatments would be a good fit for you, but ultimately, the choice of which treatment you receive is up to you.
Women with ovarian cancer may undergo surgery, chemotherapy, targeted therapy, immunotherapy, or hormone therapy. Many women receive a combination of these treatments. Other options, such as radiation therapy or clinical trials, may also play a role.
For most women with ovarian cancer, surgery is the first step in treatment. There are different kinds of surgery for ovarian cancer, and each has different goals.
An initial surgery for ovarian cancer treatment is often performed by a gynecologic oncologist — a doctor who specializes in cancers of female reproductive organs. This doctor will usually make an incision in the abdomen to look at the cancer and remove tumors. Goals of initial surgery may include:
Sometimes, after undergoing initial surgery and chemotherapy, a woman may have second-look surgery. In this procedure, a surgeon cuts a small incision and uses a camera attached to the end of a narrow tube to look inside the abdomen and see if the cancer is shrinking or going away. Second-look surgery is not performed often.
The goal of debulking surgery is removing as much cancer as possible from the abdomen. Depending on where the cancer has spread, debulking may include removing tumors throughout the belly or removing organs, such as the ovaries, fallopian tubes, uterus, appendix, spleen, pieces of the liver, or segments of the colon or small intenstine. When surgeons are able to successfully remove all visible tumors, there is a better prognosis.
Surgeons may try to debulk the tumor during initial surgery, or there may be another debulking surgery to remove more cancer following initial treatment. Possible goals of debulking surgery include:
Surgery can be hard on the body, so debulking surgery may not be a good option for people who aren’t in good health.
Surgery for ovarian cancer usually involves removal of one or both ovaries, a procedure known as an oophorectomy. When both ovaries are removed, the procedure is called a bilateral oophorectomy. During this process, the surgeon may also remove one or both fallopian tubes, a procedure known as a salpingectomy.
Whether or not you have your ovaries removed depends on a few factors, such as the type of ovarian cancer. Most epithelial cell tumors are treated by removing both ovaries, but stromal and germ cell tumors are often treated by removing only one ovary. Another factor is the tumor stage. Stage 1, or occasionally stage 2, ovarian cancer might also be treated by removing only one ovary or fallopian tube, but stage 3 or 4 cancer usually necessitates removing both.
Removing both ovaries or fallopian tubes will leave you unable to give birth. If you want children in the future, and cancer is only found in one ovary, doctors may be able to leave the other ovary in place so you can still get pregnant.
If the cancer has spread to the uterus, the surgeon will also remove the womb in a procedure known as a hysterectomy. Hysterectomy is usually performed on women who have already gone through menopause or women with advanced-stage ovarian cancer. A hysterectomy also takes away a woman’s ability to give birth.
Chemotherapy, or chemo for short, refers to drugs that kill cancer cells. Chemotherapy medications may be pills or capsules that are taken by mouth or liquids that are given intravenously (by IV). Doctors who specialize in chemotherapy treatment are called medical oncologists.
Goals of chemotherapy treatment may include:
Chemotherapy is usually given in cycles. Each cycle includes one or a couple of doses of medication followed by a rest period. Most people with ovarian cancer will go through three to six cycles of chemotherapy. How many doses you receive, how long a cycle is, and how many cycles you need depends on the chemotherapy and the type and stage of tumor.
The most common types of chemo used to treat epithelial ovarian cancer are platinum compounds and taxanes. Platinum compounds, such as cisplatin and carboplatin, work by damaging cells' DNA and making them unable to form new copies of themselves. Taxanes, such as Taxol (paclitaxel) and Taxotere (docetaxel), also stop cells from reproducing. Other types of ovarian cancer may be treated with other chemotherapy drugs like bleomycin or etoposide. If one type of chemotherapy is not working or is causing problems, your doctor may change your dose or have you try a different drug.
Different types of chemotherapy work in different ways, although all of these drugs make it harder for tumors to grow and spread. People with ovarian cancer are often given more than one form of chemo, because using a combination often leads to better results.
Chemotherapy most strongly affects cancer cells, but it can damage the normal cells of your body, too. Because of this, chemotherapy often causes side effects. Some of the most common side effects of ovarian cancer chemotherapy are nausea and vomiting, reduced appetite, rashes, mouth sores, infections, tiredness, and hair loss. Your doctor may be able to recommend other treatments, such as medication, that make these side effects easier to deal with. In some cases, chemotherapy can also cause long-term side effects, like kidney damage, hearing loss, or blood cancer.
Intraperitoneal chemotherapy (IP therapy) may also be used to treat ovarian cancer. IP therapy uses the same types of chemotherapy drugs, but delivers them to the body in a different way. Rather than supplying chemotherapy to the whole body through an IV, the drugs are put directly into the abdomen through a tiny tube. This way, the chemotherapy can directly affect and kill local cancer cells in that area. IP therapy may be used after a debulking surgery in order to remove any remaining tumor.
While chemotherapy destroys any cell that grows quickly, targeted therapy can affect cancer cells more specifically while damaging fewer normal cells. Cancer cells tend to work differently than the normal cells in your body. Since cancer cells have genetic mutations, they may make particular molecules or have unusual needs. Targeted therapies specifically target cancer cells that have these abnormal features. There are three general types of targeted therapies for ovarian cancer: angiogenesis inhibitors, poly (ADP-ribose) polymerase inhibitors — or PARP inhibitors, and tropomyosin receptor kinase (TRK) inhibitors.
Avastin (bevacizumab) is an angiogenesis inhibitor often used to treat ovarian cancer. It targets a molecule called vascular endothelial growth factor (VEGF). Some types of normal cells — such as certain blood, skin, and kidney cells — make VEGF, but most cells in the body do not. Cancer cells make large amounts of VEGF, which helps create new blood vessels to feed the tumor. Avastin blocks VEGF, causing tumors to starve and shrink.
Both normal and cancerous cells use several different molecules to fix damage. One of these molecules is poly (ADP-ribose) polymerase, or PARP. When PARP is blocked using a PARP inhibitor, cells can’t use it for repair. Normal cells are usually fine if PARP is blocked — they can use other methods to fix themselves. However, ovarian cancer cells often have gene mutations in BRCA1 and BRCA2 or related genes, which are also used for repair. This means that cancer cells rely more on PARP for healing, because other repair molecules are missing. When cancer cells that are missing BRCA genes are treated with PARP inhibitors, damage builds up, and the cancer cells die.
PARP inhibitors may be used for initial therapy, when a woman is first diagnosed with ovarian cancer. They may also be prescribed later as maintenance therapy. Maintenance therapy is used to help prevent a cancer from coming back or to slow down the growth of cancer.
PARP inhibitors that may be used to treat ovarian cancer include:
Some ovarian cancers have changes in NTRK genes. These genes cause cells to grow and divide. In normal cells, NTRK genes are usually turned off. In some cancer cells, NTRK genes are turned on at high levels, triggering cells to grow out of control. TRK inhibitors block this process. Potential ovarian cancer therapies in this category are:
Hormones are chemicals that act as messengers, transmitting signals from one part of the body to the other. Estrogen is a hormone that is important for sexual development and reproductive function in women. Unfortunately, estrogen can also act as fuel for some types of ovarian cancer cells, spurring tumor growth.
Hormone therapy medications can block estrogen to slow down cancer cell reproduction. Drugs called luteinizing hormone-releasing hormone (LHRH) agonists, including Zoladex (goserelin) and Lupron (leuprolide), make the ovaries stop producing estrogen. Nolvadex (tamoxifen) blocks estrogen from reaching cancer cells.
Aromatase inhibitors block a molecule that converts other types of hormones into estrogen. These therapies are more likely to be used for stromal ovarian cancer.
Most people who have ovarian cancer won’t get radiation therapy, but in some cases an oncologist may recommend it. Radiation therapy uses beams of energy, such as X-rays, to destroy cancer cells. Radiation may be an option for ovarian cancer that has come back after initial treatment or for treating the symptoms of advanced cancer.
Clinical trials are the only way researchers can study the safety and efficacy of brand new treatments, medical devices, or combinations of existing treatments. Some trials examine whether diet changes, exercise, or complementary practices such as meditation or acupuncture can help manage side effects or improve quality of life for people with cancer. Regardless of the type or stage of your ovarian cancer, there may be a clinical trial for which you could qualify.
One potential risk of a clinical trial is that the safety or efficacy of a new treatment may not yet be clear. However, there are several possible benefits. New treatments may work better than old ones. For people with advanced cancer who have already tried standard treatments, clinical trials may be a way to access experimental therapies. Taking part in a clinical trial is also a way for you to help researchers make new discoveries that can help other women with ovarian cancer.
In every clinical trial, volunteers are protected by the process of informed consent and the oversight of an institutional review board.
Not much is currently known about how exercise affects people with ovarian cancer. However, some early studies have shown some possible benefits. In one study, researchers asked participants to complete 150 minutes per week of brisk walking or other moderate aerobic exercise. Women who exercised had less fatigue and better physical quality of life. People with ovarian cancer who have a better quality of life tend to have better outcomes, so researchers think exercise may be worth it for people with ovarian cancer. Another study found that women with ovarian cancer who were more physically active tended to be in better health and were less likely to have anxiety and depression.
Experts think exercising during ovarian cancer treatment is safe for most people, but be sure to ask your doctor if working out is a good option for you. Certain kinds of exercise may be better than others depending on your age and other health factors. Additionally, if you have surgery for ovarian cancer, make sure to follow your doctor’s recommendations for physical activity while healing. Some surgeries may require you to rest for a certain amount of time afterward or may prohibit you from lifting heavy items for several weeks following the procedure.
Diet and nutrition play a major role in good health. Unfortunately, many cancer treatments can affect appetite or cause food to taste bad. A good goal for people going through cancer treatment is to try to keep your weight stable. To do this, it’s important to consume enough calories and protein. Eating foods that have high levels of vitamins and minerals can also help your body function at its best. Some research has shown that people with ovarian cancer who eat balanced, nutritious diets may live longer.
Work with your care team to come up with a nutrition plan that works for your needs. If you have a hard time eating because of treatment side effects, your doctor may be able to help you manage these challenges.
It is possible to live a long and healthy life after an ovarian cancer diagnosis. More effective treatments are continuously being developed and tested. In some cases, ovarian cancer responds well to treatment and doesn’t come back, meaning it is essentially cured. How well treatment works depends on factors including how soon the cancer is caught, what type of cancer it is, and what genetic mutations your cancer cells have. Even for more advanced cases of ovarian cancer, treatment may be able to slow down tumor growth and reduce symptoms, extending survival and improving quality of life.
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Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.
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