Ovarian Cancer Treatment
Treatment options, stages and the chances of recovery
- Treatment for ovarian cancer depends on the type of tumor, the stage of the disease and the patient's overall condition.
- Surgery and chemotherapy are the main treatments.
- Testing the genetic and molecular features of the tumor helps in choosing targeted therapy.
- Herbal remedies and cutting out sugar are not a substitute for medical treatment.
- Follow-up continues after treatment, and its schedule is based on the state of the disease and how it responded to treatment.
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Hearing the words “ovarian cancer” can be worrying for patients and their families. The type and stage of the disease differ from person to person, and the treatment plan is set accordingly.
What can you do while the treatment plan is being decided?
Until all the tests are complete, no conclusion about the type of disease or the treatment can be drawn from a single number or image. Write down your questions and symptoms, and ask your doctor to help you interpret results such as CA-125.
Grade and stage: what is the difference?
Grade
Grade shows how different the tumor cells look from normal cells under a microscope and how likely they are to grow. Grade does not show where the disease has spread.
Stage
Stage shows how far the disease has spread, from being limited to the ovary in stage I to reaching distant organs in stage IV. Treatment is chosen based on the stage, the tissue type and the grade together.
Statistics describe groups rather than individuals
In US statistics for invasive epithelial ovarian cancer, based on people diagnosed between 2015 and 2021, five-year relative survival is reported as about 92% for disease limited to the ovary, about 71% for regional spread to nearby tissues or lymph nodes, and about 32% for spread to distant areas.
Five-year relative survival compares the survival of patients with that of similar people in the general population. It does not mean a definite cure, and it does not mean life is limited to five years. These numbers do not predict what will happen to any one patient; the type of tumor, the response to treatment and overall health also matter.
Types of surgery for ovarian cancer
Surgery aims to find out the stage of the disease and to remove as much of the tumor as possible. The extent of surgery is not the same for everyone.
Removing only one ovary
In some early-stage ovarian cancers and in some germ cell or borderline tumors, the affected ovary may be removed together with the tube on the same side to preserve fertility, while the uterus (womb) and the other ovary are kept. Whether this approach is chosen depends on the type and stage of the tumor and the patient’s circumstances.
Removing both ovaries and the uterus
In many cases, surgery can include removing the ovaries, fallopian tubes, uterus and omentum (the fatty apron of tissue in the abdomen) and checking the lymph nodes.
Cytoreductive (debulking) surgery
In advanced stages, the surgeon tries to remove as much of the visible tumor as possible. The amount of tumor left behind is one of the important factors in the outcome of treatment.
Staging during surgery
To find out the exact stage, samples are taken from the necessary tissues so that the next treatment can be chosen based on more complete information.
Why does the surgeon's experience matter?
The quality of the first surgery, especially how much tumor tissue is left behind, can affect the outcome of treatment. That is why it matters that surgery is done under the care of a gynecologic oncologist.
Ovarian cancer is treated differently from uterine cancer
These organs develop different cancers, and treatments for uterine cancer and ovarian cancer are chosen based on where the disease starts and what type it is. Persistent infection with high-risk HPV types is linked to cervical cancer and is not a known cause of ovarian cancer.
What is HIPEC (heated chemotherapy inside the abdomen)?
HIPEC (hyperthermic intraperitoneal chemotherapy) is a method in which a heated solution containing chemotherapy drugs is put into the abdominal cavity after the tumor has been removed, during the same operation.
For some patients with stage III epithelial ovarian cancer who have had chemotherapy before surgery, this method may be considered at well-equipped specialist centers if the patient’s condition allows it (good kidney function and good general health). HIPEC is not suitable for every patient.
An important note about HIPEC
HIPEC does not replace intravenous (IV) chemotherapy and is not suitable for every patient. The decision should be made by the patient together with the specialist team, taking into account the stage of the disease, the response to previous treatment, whether complete surgery is possible, and the possible benefits and risks of HIPEC.
Can fertility be preserved?
If you want to get pregnant in the future
In the early stages and with some tumor types, it is sometimes possible to keep the uterus and one ovary with conservative (fertility-sparing) surgery. Whether this is possible depends on the tissue type and the stage of the disease. Before surgery or chemotherapy begins, talk to a gynecologic oncologist, and a fertility specialist if needed, about your options for preserving fertility.
Chemotherapy for ovarian cancer and its side effects
Chemotherapy may be given after surgery or, in some cases, before it. If the chance of removing the whole tumor in a first surgery is low, or if surgery carries a high risk for the patient, a few cycles of chemotherapy may be given first to shrink the tumor. A decision about surgery is then made based on the response to treatment and the patient’s condition. Chemotherapy given before surgery is called neoadjuvant treatment.
Commonly used drugs
In many cases, a combination of a platinum-based drug, such as carboplatin, and a taxane, such as paclitaxel, is used.
Side effects can be managed
Hair loss, nausea, tiredness and a temporary drop in blood cell counts are common side effects, but how severe they are varies from person to person, and many of them can be controlled. Hair loss is usually temporary. Talk to your care team about nutrition and ways to reduce the side effects of chemotherapy.
Targeted therapy and biomarker testing
Targeted therapies are used for some patients with ovarian cancer, both in the first treatment plan and when the cancer comes back. Testing the genetic and molecular features of the tumor, along with a review of previous treatments and the patient’s condition, helps in choosing the right treatment.
PARP inhibitors
For some patients with advanced epithelial ovarian cancer, these drugs may be considered as maintenance therapy after the cancer has responded to platinum-containing chemotherapy. The choice of drug depends on the results of BRCA and HRD (homologous recombination deficiency) tests, previous treatments and the patient’s condition. These drugs are not suitable for every patient.
Bevacizumab (Avastin)
It may be used together with first-line chemotherapy and then as maintenance therapy, or in some cases when the cancer comes back. Whether it is used depends on the patient’s condition.
Olaparib plus bevacizumab
This combination may be considered as maintenance therapy for some patients with HRD-positive advanced ovarian cancer, after the cancer has responded to first-line chemotherapy containing platinum and bevacizumab. The decision should be based on test results, taking into account previous treatments and the patient’s condition.
Ask your doctor about BRCA and HRD testing
These tests can help in choosing targeted therapy, and for many newly diagnosed patients they are part of planning treatment.
An important note about targeted therapy
The use of some PARP inhibitors has become more limited in recent years, and the benefit is not the same in all groups, especially in HRD-negative disease. Treatment should be chosen based on up-to-date information and the features of the tumor.
Hormone therapy and radiation therapy (radiotherapy)
Hormone therapy
It is mainly considered for low-grade serous cancer or some stromal tumors, such as granulosa cell tumors, and not for most epithelial ovarian cancers.
Radiation therapy
It is not a main treatment for ovarian cancer, but it may be used in some specific situations when the cancer comes back.
Is ovarian cancer treatable?
Yes, ovarian cancer can be treated, but the chance of full recovery and the risk of the cancer coming back are not the same for everyone. The outcome of treatment depends on the type of tumor, the stage of the disease and how the body responds to treatment. In the early stages, the chance of lasting recovery is usually higher.
Five-year survival does not mean the patient will live only five years. Survival statistics are calculated from data on large groups of patients and cannot predict for certain how long one person will live or how their treatment will turn out.
A common myth
Myth: “Sugar feeds cancer, so you have to cut it out completely”
Cancer cells, like other cells in the body, get energy from glucose, but there is no evidence that cutting out sugar makes a tumor shrink or disappear. During treatment, a balanced diet and eating enough matter more than strictly cutting out a whole food group.
Care after treatment ends and warning signs that the cancer may have come back
After treatment ends, your follow-up plan is set according to the type of disease and your situation. The aim is to check your general health, your symptoms and the outcome of treatment.
Persistent bloating, a swelling abdomen, abdominal or pelvic pain, feeling full quickly, or new and persistent changes in your bowel or bladder habits are symptoms to tell your care team about. These symptoms do not necessarily mean the cancer has come back.
On the schedule your doctor sets
An exam, a review of symptoms and, if needed, a CA-125 test
If a new or persistent symptom appears
Contacting your care team and getting checked before your next scheduled appointment
A small fluctuation in CA-125 does not always mean the cancer has come back. What matters is how the number changes over time, together with symptoms and other tests.
A rising CA-125 alone does not decide when treatment should start
In studies, starting treatment for a recurrence based only on a rise in CA-125, without symptoms, has not led to longer survival. When to investigate further or start treatment should be decided with your doctor, taking into account symptoms, other results and your own preferences.
For family and friends: coping with stress and supporting your loved one
You can play an important part by writing down questions, going with her to appointments and helping in practical ways after surgery or chemotherapy. Looking after your own mental health is essential too. Feeling tired and afraid along the way is not a sign of weakness.
Frequently asked questions about ovarian cancer treatment
Does ovarian cancer mean someone has only five years to live?
No. Five-year survival is a statistical measure for a large group of patients and does not decide how long one person will live. The type and stage of the disease and the response to treatment differ from person to person.
Is it dangerous if CA-125 goes up or down?
A small change on its own does not prove the cancer has come back. Your doctor interprets the trend in the number together with symptoms and other tests.
Does chemotherapy help with granulosa cell tumors?
Surgery is the main treatment for this tumor. Chemotherapy may be considered in some advanced cases or when the tumor comes back, but it is not needed for every patient.
Does chemotherapy always cause hair loss?
Some drugs cause hair loss, but how much depends on the treatment combination, and it is usually temporary. Ask your care team about the possible side effects of your medicines.
Does it matter which doctor does the surgery?
Yes. Experience in ovarian cancer surgery matters, and it is best for surgery to be done under the care of a gynecologic oncologist.
Does fluid in the abdomen mean the disease is in its final stage?
No. Ascites (fluid in the abdomen) on its own does not determine the stage of the disease and has to be assessed together with imaging, an exam and other results.
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