Ovarian Cancer Treatment Options
Ovarian cancer is usually treated with surgery and chemotherapy. Radiation
therapy is used only in very rare cases.
Treatment options may vary based on the stage, grade and subtype of ovarian
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.
Surgery
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:
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Salpingo-oophorectomy: Removing both ovaries and fallopian tubes
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Hysterectomy: Removing the uterus
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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.
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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 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
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.
Hoag Radiation Oncology
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
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.