The ovarian cancer treatment depends on the type of ovarian cancer, stage of the disease, performance status of the patient, along with other factors.
Following are the preferred treatment approaches for different stages of ovarian cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.
|I||In case of Stage I epithelial ovarian cancer, upfront cytoreductive surgery is generally preferred. Chemotherapy may be added after surgery depending upon stage (IA/IB/IC), grade, and other factors.|
|II||In case of Stage II epithelial ovarian cancer, cytoreductive surgery followed by chemotherapy may be done in most cases.|
|III||In case of Stage III epithelial ovarian cancer, chemotherapy may be given before or after surgery. If the performance status of patient is poor or the disease is not upfront resectable, chemotherapy may be given before surgery, otherwise after surgery.|
|IV||In case of Stage IV epithelial ovarian cancer, chemotherapy is considered as the first-line treatment. Surgery may also be employed after chemotherapy depending on response. Other palliative treatment may be used to relieve the symptoms of advanced disease.|
Treatment types for ovarian cancer:
1. Surgery: Surgery is the mainstay of treatment for ovarian cancers. There are mainly 2 aims of surgery in ovarian cancer: first is to stage the disease and second is to remove maximum possible cancerous tissue (this is also called as debulking). For staging, the tissue removed during surgery is thoroughly tested in a laboratory.
This help in establishing accurate stage and thus selecting an appropriate second-line treatment for the disease. For most patients, surgery for ovarian cancer involves removal of the uterus (hysterectomy), along with both ovaries and fallopian tubes (salpingo-oophorectomy or BSO). Depending upon the extent of disease, omentum (the fatty tissue layer covering abdominal organs) may also be removed (omentectomy) along with the affected lymph nodes and/or other structures with high suspicion of involvement by the disease.
Any fluid present in the pelvis or abdominal cavity along with peritoneal washings are also collected for analysis. Blind biopsies may also be taken from certain places in case no gross disease is visible in abdomen. For a young patient with disease limited to one ovary/fallopian tube and who wish to retain fertility, fertility preservation surgery (involving removal of the affected ovary/fallopian tube and retention of the uterus and other ovary/fallopian tube [unilateral salpingo-oophorectomy, USO]) is generally employed.
2. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement.
Sometimes, intraperitoneal chemotherapy is employed to deliver the anti-cancer drug directly in the affected tissue, which may reduce the systemic side effects. Chemotherapy may be used in the neoadjuvant (prior to surgery), adjuvant (after surgery) and palliative (metastatic disease) settings. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells. Common side effects of chemotherapy include nausea, vomiting, hair loss, diarrhea, mouth ulcers, increased chances of infection, fatigue, decrease in the number of blood cells, etc.
3. Targeted Therapy: Targeted drugs are designed to target a specific gene or protein characteristic of the ovarian cancer cells. With the advancement in diagnostic techniques, a number of genetic abnormalities for breast cancer have been identified that can be targeted with the help of targeted drugs. Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy. For example, bevacizumab targets vascular endothelial growth factor (VEGF) that stimulates the formation of blood vessels in the cancerous tissue.
It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes, patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals of treating ovarian cancer:
- Prolongation of life
- Reduction of symptoms
- Improvement of overall quality of life
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Watch the video below to better understand the treatment of ovarian cancer and the indications of fertility preservation surgery.
Now we will discuss the ovary cancer treatment.
Surgery and chemotherapy are the main treatment modalities for ovarian cancer.
First, we have to decide whether the patient is a candidate for fertility preservation surgery in which only one side ovary is removed, and the other one with a uterus is left behind.
It is an option in early stage epithelial ovary tumors and sex cord-stromal tumors when the tumor is limited to one ovary.
And maybe considered in the most of the cases of low grade or borderline ovary tumors and germ cell tumors of the ovary.
First, we have to ask the patient whether her family is complete or she wants more children. If she wants more children and is will for it, fertility preservation surgery may be done.
CancerBro, that means it is best for a patient like me who has a germ cell tumor at a very young age, when I am not even married.
Absolutely, but the final decision will be taken by the oncologist after assessing your disease in detail. Now, let’s discuss the treatment further.
In most cases, the surgery which we do for ovary tumors is known as cytoreductive surgery.
It may be called as primary cytoreductive surgery or interval debulking surgery, depending upon whether we are giving chemotherapy before or after surgery.
If the surgery is done when there is a relapse of the disease after the patient has completed treatment previously, it is known as secondary cytoreductive surgery.
CancerBro, how is it decided whether to do surgery first or give chemotherapy first?
It is decided by the oncologist after assessing the condition of the patient and seeing the scans.
If the disease appears upfront resectable on the scans, and the performance status of the patient is good as assessed by the oncologist, we can proceed directly with the surgery.
When surgery is done first before chemotherapy, it is called as primary cytoreductive surgery.
Sometimes, the disease may not be upfront resectable, or the performance status of the patient may be poor. In either of these conditions, the surgery might not be possible upfront.
In these cases, interval debulking surgery is preferred in which chemotherapy is given first, and then the decision for surgery is depending upon the response to chemotherapy.
CancerBro, is chemotherapy required in all the cases after primary cytoreductive surgery?
No, it depends upon the stage and the subtype of the tumor. In some early stage and low-grade tumors, chemotherapy is required after surgery.
CancerBro, we all are so grateful to you for making us understand our disease so nicely. It reduces our anxiety and helps us a lot to take better treatment decisions.
It is helpful for me also if you have some baseline knowledge of your disease, I can discuss the various ovary cancer treatment option in detail. May God bless you all.