Ovarian Cancer Treatment Options

Ovarian cancer is usually treated with surgery and chemotherapy. Radiation therapy is used only in very rare cases.

Treatment options for ovarian cancer may vary based on the stage, grade and subtype of the cancer. Your individual treatment plan will depend on several factors including the stage and grade of cancer, the pathology (or subtype), your age and general health.

The most common surgical procedure is the removal of the involved ovary, lymph nodes, and the fatty apron in the abdomen (omentum). Depending on the age of the patient, the other ovary and uterus might be removed. In cases of advanced ovarian cancer, other organs may also be removed.

Surgical Treatment of Ovarian Cancer

The first step in treating ovarian cancer is usually surgery. The most common procedure is a laparotomy, during which the surgeon makes an incision in the abdominal wall and attempts to remove as much of the cancer within the abdomen and pelvis as possible. In addition to a complete removal of all visible tumor, other goals of a laparotomy include determining the correct diagnosis and stage of the cancer and gaining information that can help determine whether additional therapy is necessary.

In some instances of early-stage ovarian cancer or even certain advanced ovarian cancers, minimally invasive surgery can be an option. Hoag is a Center of Excellence in Minimally Invasive Gynecology (COEMIG™) facility and our gynecologic oncologists are also accredited as such. As a COEMIG site, Hoag offers different types of minimally invasive surgery including robotic-assisted and laparoscopic approaches.

Robotic-assisted surgery is performed using robotic instruments, which are completely controlled by a skilled surgeon, who manipulates mechanical arms from a console near the patient’s bed. Hoag uses the Si da Vinci® Surgical System, and currently has four systems enabling patients to obtain surgery in a timely manner.

Laparoscopic surgery is performed by making several small incisions on the abdomen. A surgeon then uses the assistance of a video camera to illuminate the surgical field within the body. Manually operated instruments are inserted through the other incisions to perform the surgery.

Minimally invasive surgery has proven to have many patient benefits compared to open (or traditional) surgery including: fewer complications, less blood loss and faster return to normal activities.

If ovarian cancer is found, the gynecologic oncologist will perform the following procedures:

• Salpingo-oophorectomy: Removing both ovaries and fallopian tubes
• Hysterectomy: Removing the uterus
• Staging procedure: The fatty pad of tissue that covers the intestines, called the omentum, is removed along with adjacent lymph nodes, as well as tiny samples of tissue from the abdomen and pelvis.
• Debulking surgery: In cases where the cancer has spread, as much of the cancer is removed as possible. This can often involve extensive surgery including removal of sections of the small or large intestine, as well as tumors from the liver, diaphragm and pelvis.

If you have early Stage I ovarian cancer and hope to get pregnant at some point in the future, it is sometimes possible to spare one ovary and fallopian tube to preserve your fertility. It is important to discuss this option with your doctor prior to surgery.

Radiation Therapy for Ovarian Cancer

Radiation therapy, or radiotherapy, uses high-energy X-rays or other types of radiation to stop cancer cells from growing or kill them entirely.

If radiation is necessary, it is generally used following surgery to kill any remaining cancer cells. There are two types of radiation therapy used to treat endometrial cancer:

External radiation therapy: Uses a machine that directs the radiation towards an exact area of the body.

Internal radiation therapy (or brachytherapy): In this situation, only the lining of the vagina is treated with radiation.

Radiation Therapy for Ovarian Cancer

Hoag Family Cancer Institute offers a state-of-the-art facility for radiation therapy, equipped with the latest in radiation technology, handled by an expert team of radiation oncologists, medical physicists, medical dosimetrists, radiation oncology nurses and radiation therapists. Hoag’s Radiation Oncology department is the highest volume provider in Orange County, treating over 100 patients per day.

Learn more about Hoag Radiation Oncology.

Chemotherapy for Ovarian Cancer

When cancers are in more advanced stages at initial diagnosis or immediate surgery will be too difficult to tolerate, chemotherapy is often used to shrink the tumor before surgery. Surgery is then performed, and often followed by additional rounds of chemotherapy.

Chemotherapy is generally given intravenously, or through the vein, for ovarian cancer patients. It may be administered at the doctor’s office or in an outpatient treatment center. The medication travels through the bloodstream to reach all parts of the body, making it highly effective in treating ovarian cancer that has spread beyond the ovaries. The downside is that the same medication can also damage healthy cells.

Chemotherapy is generally given in cycles, with periods of treatment alternating with rest periods of no treatment. Most women with ovarian cancer receive treatment for about six months.

Another chemotherapy method is called intraperitoneal (IP) chemotherapy, and involves medication being injected into the abdominal cavity to reach the tumor location directly. IP is most commonly recommended for women with Stage III ovarian cancer when all of the tumor spots larger than 1 cm have previously been removed. Studies have shown that although IP chemotherapy has more short-term toxicity, it also results in increased survival rates.

Another form of intraperitoneal treatment is Hyperthermic Intraperitoneal Chemotherapy, or HIPEC. This is a technique where heated chemotherapy is circulated for 90 minutes in the abdominal cavity. This is done under anesthesia in the operating room and is typically given only once. It was originally used to treat colon cancer, but there is increasing data on its use in ovarian cancer. HIPEC can be used in combination with IP chemotherapy. For more details please contact a Hoag Gynecologic Oncologist.
Your doctor will provide specific treatment recommendations based on your individual condition and prognosis.

Clinical Research

Through innovative clinical trials, Hoag works to advance treatment options and improve healthcare by exploring the safety and effectiveness of new drugs, therapies, medical devices, and clinical and surgical methods. This ongoing collaboration between physician investigators and study volunteers is one of the foundations of modern health care because clinical trials help set the standards for patient care. Learn more about the clinical trials available at Hoag.