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

Home treatment measures may help relieve some of the common side effects of cancer treatment, such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.

If both of your ovaries are removed, you are likely to experience menopausal symptoms after surgery. Home treatment measures may relieve some of these symptoms. If home treatment does not help your menopausal symptoms, talk to your doctor about other ways to manage your symptoms.

If you have recently been diagnosed with ovarian cancer, you may experience a wide variety of emotions in reaction to having cancer. Most women feel some denial, anger, and grief. There is no "normal" or "right" way to react to having cancer. You can take steps to manage your emotional reactions to learning that you have ovarian cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their cancer.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after being diagnosed with cancer such as yours can help you accept and deal with your cancer.

What to think about during initial treatment

In about 70% of women with ovarian cancer, the cancer has already spread (metastasized) outside the pelvis by the time it is diagnosed.¹⁷ Advanced-stage cancer spreads most commonly to the lining of the abdominal cavity, the pelvic lymph nodes, and the fatty tissue around some of the abdominal organs.

Your long-term outcome depends on your age, the stage and grade of your cancer, and the amount of cancer remaining after your initial surgery.

Your quality of life becomes a critical issue when considering your treatment choices. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

You may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of ovarian cancer.

For more information about specific ovarian cancer treatments, see the topics:

Ovarian Cancer – Health Professional Information [NCI PDQ].

Ovarian Cancer – Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for ovarian cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment, depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Your gynecologic oncologist or oncologist will schedule regular checkups, usually every 3 months for the first 2 years after treatment. Your doctor may then recommend checkups every 6 to 12 months depending on your stage of cancer. These checkups will include:

• A physical exam of your neck, lungs, and abdomen, and a pelvic exam to check for recurring cancer or swollen lymph nodes.
• A CA-125 blood test to see if the cancer has returned.
• An abdominal and pelvic CT scan or MRI to check to see if cancer has spread, especially when new symptoms, such as belly pain, are present or if CA-125 levels are high.

Second-look surgery, after 6 cycles of chemotherapy, may be done in research studies or clinical trials if no sign of cancer is found during a physical exam; in blood tests; or with X-ray, CT, or MRI. Additional biopsies are done at the time of second-look surgery to determine the need for more treatment. Second-look surgery is not recommended as standard treatment because of the chance of complications and because it does not clearly increase survival rates.

Treatment if the condition gets worse

The long-term outcome (prognosis) for ovarian cancer that has returned after treatment (is recurrent) depends on whether the cancer has spread. Even with no sign of cancer after treatment, between 30% and 50% of women who are treated for ovarian cancer have cancer return within 5 years.⁴ Women who have cancer return within 6 months after their initial treatment are less likely to respond to more treatment with the same chemotherapy medicines than women whose cancer has returned more than 6 months after their initial treatment. Other chemotherapy medicines may be recommended for further treatment.³

Palliative care

If your cancer gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

Some treatments for recurrent ovarian cancer, such as chemotherapy and radiation, are considered palliative care. These treatments cannot cure your cancer, but they can extend your life, control your symptoms, reduce your pain, and make you feel more comfortable.

In addition to helping your body feel better, palliative care can help you feel better emotionally and spiritually. Talking with a palliative care provider may help you cope with your feelings about living with a long-term illness. It may also help your loved ones better understand your illness and how to support you. Or it could help you make future plans concerning your health and medical care.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

Complementary therapies

In addition to conventional medical treatment, you may wish to try complementary therapies to help manage your symptoms. But complementary therapies are not a substitute for conventional medical treatment that is recommended for ovarian cancer. Complementary therapies include:

• Acupuncture.
• Herbs.
• Biofeedback.
• Meditation.
• Yoga.
• Visualization.
• Vitamins and nutritional supplements.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

What To Think About

Some women with ovarian cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries, for all stages of ovarian cancer.

Most treatments for ovarian cancer cause side effects. The side effects that you have depend on the type of treatment used, your age, and your overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

• Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
• Side effects of surgery depend on how much surgery was done to treat the stage of your cancer.

Nausea and vomiting are side effects of chemotherapy for ovarian cancer. Your doctor can prescribe medicines to control nausea and vomiting.Talk to your doctor about what to expect and when you should call if you are having nausea or vomiting. Home treatment measures can also help you manage other side effects of treatment.

End-of-life issues

Some women with advanced-stage cancer may choose not to have treatment focused on prolonging life because they decide that for them the time, costs, and side effects of treatment are greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Care at the End of Life

Hospice Care