Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
If you’re suspected of having ovarian cancer, you should be referred to a gynaecological oncologist. Research shows survival for women with ovarian cancer is improved when their surgical care is directed by a gynaecological oncologist.
Treatment for ovarian cancer depends on:
- the stage of the disease
- the location of the cancer
- the severity of symptoms
- your general health and wishes.
Treatment may involve the following.
Surgery is usually the initial treatment for ovarian cancer.The aim is to remove as much of the cancer as possible from the body by removing the cancer cells, and organs and tissues that the cancer cells have spread to. This allows adjuvant treatment, such as chemotherapy, to be more effective.
A laparotomy is usually performed – this is a cut through the wall of the abdomen from the belly button to the pelvic bone.
Depending on how far the cancer has spread, the surgery may remove the ovary and attached fallopian tube (or both ovaries and both fallopian tubes if the cancer is in both ovaries), and/or the uterus (in an operation called a hysterectomy). If the cancer has spread outside the pelvis (stages III or IV), other tissues and organs will probably also be removed, as well as lymph nodes that appear abnormal.
For early-stage ovarian cancer or borderline ovarian cancer, a less invasive surgery using laparoscopy (‘keyhole surgery’) might be possible. Laparoscopy involves a number of very small cuts in the abdomen, rather than a single large cut. A laparoscope – a tube with a light at the end – is inserted through one of the cuts to allow the doctor to see inside the abdomen, and surgical instruments are inserted through other cuts to remove tissue.
After the surgery, you may have some pain and tenderness in the pelvis and abdomen for a few days or weeks. Other side effects might include swelling in the legs (lymphoedema), constipation and difficulty urinating. Depending on the extent of the surgery, it might take several weeks for you to fully recover and return to normal activities.
If both ovaries are removed during surgery, you will go through menopause (i.e. your menstrual periods will permanently stop) and may experience symptoms associated with it. These can include hot flushes, night sweats, vaginal dryness and mood swings.
Most women with ovarian cancer will have both surgery and post-operative (adjuvant) chemotherapy to eliminate any cancer that remains after surgery.
For some women with stage III or IV ovarian cancer, chemotherapy before surgery (neoadjuvant chemotherapy) may be used to shrink the tumours before surgery.
See more about the types of chemotherapy and possible side effects.
Radiotherapy uses high-energy X-rays or other types of radiation to stop cancer cells growing. This treatment is not commonly used to treat ovarian cancer, but it can be used to help relieve symptoms caused by the cancer or when it has come back after treatment (recurred).
See more about the types of radiation therapy and possible side effects.
Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells.These types of medicines affect the way that cancer cells grow, divide, repair themselves or interact with other cells.
Medicines that might be considered for targeted therapy for some women with advanced ovarian cancer include bevacizumab and olaparib.
Bevacizumab is a monoclonal antibody that belongs to a class of medicines known as angiogenesis inhibitors. These medicines prevent the formation of new blood vessels that are needed for the cancer to grow and spread.
Olaparib is a different type of medicine, called a PARP inhibitor, that may be used to treat women who have advanced ovarian cancer with mutations (gene faults) in BRCA genes and who have already had treatment with other types of chemotherapy. BRCA genes are involved in repairing damaged DNA and normally work to suppress tumour growth. Olaparib acts by preventing tumour cells with a mutation in a BRCA gene from repairing themselves.
Bevacizumab and olaparib have both been shown to shrink or slow the growth of advanced epithelial ovarian cancers.
See more about the types of targeted therapy and possible side effects.
Hormone therapy, which uses hormones or medicines that block the action of hormones, is rarely used for epithelial ovarian cancer (the most common type of ovarian cancer) and is more likely to be used for ovarian stromal tumours.
Medicines used in hormone therapy for ovarian cancer include luteinising-hormone-releasing hormone (LHRH) agonists, tamoxifen and aromatase inhibitors. All of these act by preventing oestrogen from stimulating cancer cell growth (they either reduce the levels of oestrogen or act as anti-oestrogens).
See more about the types of hormone therapy and possible side effects.
Follow-up after treatment for ovarian cancer can be used to check whether the treatment worked, to manage side effects of treatment and to identify whether the cancer has come back (recurred). It also gives the woman the opportunity to talk about psychological and emotional issues. The type and timing of follow-up will be determined by the woman and her doctor, and may include a physical examination of the pelvic area, blood tests and imaging.
Because there is no screening test to detect ovarian cancer early, most women have advanced disease when they are diagnosed. In advanced (metastatic) ovarian cancer, cancer cells have spread in the bloodstream or lymphatic system to other areas of the pelvis, or to tissues and organs outside the pelvis. Stages II, III and IV of ovarian cancer are treated as advanced cancers.
Surgery for ovarian cancer may remove the uterus, both ovaries and fallopian tubes, omentum (fatty tissue around the organs in the abdomen) and lymph nodes. In advanced cases, the aim of surgery is to reduce the bulk (size) of the tumours, so no visible cancer remains. This is called maximal tumour resection. Research confirms that women have a better prognosis and survival when there is no visible cancer and the surgery is followed by chemotherapy. In many cases, other organs and tissues that the cancer has spread to will be removed, such as the intestines, bladder, diaphragm, liver, spleen, stomach, gall bladder, appendix, pancreas and peritoneum (the membrane lining the walls of the abdomen and pelvis).
Your gynaecological oncologist will discuss the procedure with you in detail before the surgery.
If the cancer is very advanced, maximal resection will not be possible. Other conditions (comorbidities) such as pre-existing heart, lung or other medical conditions may mean that anaesthetic and surgery is not a good option. Chemotherapy may be needed to shrink the tumours.
Ovarian cancer can recur (come back) after treatment. The cancer can recur in the pelvis or somewhere else in the body.
You may have signs and symptoms of recurrence of the cancer, or the recurrence might be detected during blood tests without producing any symptoms.
Treatment options for recurrent ovarian cancer include surgery, chemotherapy and targeted therapy.The type of treatment that is used will depend on the type of recurrence, the time since the first treatment and whether you have previously had chemotherapy.