Ovarian cancer: treatment options
Treatment for ovarian cancer usually involves surgery and chemotherapy. It may also include radiotherapy.
Surgery
The first treatment for ovarian cancer is usually an operation called a laparotomy. In this operation a long vertical cut is made in your abdomen to allow your doctor to find and remove as much tumour as possible.
In many cases, your doctor will do a biopsy of the tumour at the beginning of the operation to make sure it is a cancer. This is called a 'frozen section'. If cancer is confirmed the operation will continue. For most women the operation will then involve the removal of the ovaries and fallopian tubes, the uterus, the omentum (the 'apron' of fatty, protective tissue covering the abdominal organs), the appendix and some of the lymph nodes in the area. Sometimes it is necessary to remove part of the bowel.
After the operation, samples of tissue from the ovary itself, pelvic lymph nodes and other organs are sent to a laboratory for further examination. The results of these biopsies will provide more information about the type and extent of your cancer. This information is necessary before you and your doctor can make decisions about further treatment after the operation.
It may sound as if a lot of your body parts or organs are removed in the operation. However, these organs are quite small compared with everything else in your abdomen and pelvis and their removal will not leave a space. For some women, the operation and the scarring may not be so extensive. For instance, a young woman with an early ovarian cancer or borderline tumour may not need to have her uterus and both ovaries removed. In this case it may still be possible for her to have children.
After the operation
When you wake up from the operation, you will find that you have several tubes in place. You will have an intravenous drip which will give you fluid as well as medication. One or 2 tubes may have been inserted into your abdomen to drain away any fluid from the operation site.
You will also have a catheter in your bladder to drain away urine. These tubes will usually be removed within 3 to 5 days.
You will get pain relievers, which may be given through an intravenous drip or an epidural tube into your spine. This epidural pain relief is similar to that given to women during childbirth.
This operation is a major one and you may be in hospital for about one week. Before you go home, your doctor will discuss further treatment with you. This will depend on the type of cancer, the extent of disease and the amount of any remaining cancer. Further treatment, usually chemotherapy, is almost always needed for ovarian cancer.
Chemotherapy
Chemotherapy is the treatment of cancer using anti-cancer drugs. The aim is to destroy cancer cells while causing the least possible damage to normal cells. The drugs kill cancer cells by stopping them from multiplying.
Chemotherapy works best when the tumour is small and the cancer cells are actively growing. With ovarian cancer, even though most of the cancer may have been removed at the time of the operation, there may be some cancer cells left. For this reason, chemotherapy works best if started soon after the operation.
Chemotherapy is usually given through an intravenous drip. Your first treatment may be given while you are still in hospital, or a few days later. You will have one treatment every 3 to 4 weeks for a total of 6 sessions, or a variation of this. You may be required to stay in hospital overnight, but it is more likely that you will be treated as a day patient. This depends on the drugs you are given and how you are feeling. Blood tests are taken before each treatment to ensure your body's normal cells have had time to recover.
During chemotherapy you may also have other blood tests to monitor the effectiveness of the treatment. The doctor may look for the CA 125 tumour marker, which involves a simple blood test. After your third course of chemotherapy you may also have a CT scan to check that you are responding to treatment. The CT scan is usually done at a hospital or a special clinic. The scan involves taking X-rays at different positions so that a 2 and 3-dimensional image of the body can be built up.
Further chemotherapy may be needed if your cancer does not respond completely to your initial treatment. It may also be needed if your disease comes back sometime in the future. If your ovarian cancer does not respond completely to a particular type of chemotherapy, or if your disease comes back, other drugs are available. These include drugs such as Taxol.
Side effects of chemotherapy
The side effects of chemotherapy differ according to the particular drugs used. They may include feeling sick or off-colour and tired, and some temporary thinning or loss of hair. Your hair will grow back when treatment is completed.
You may also find yourself more at risk of infections. These side effects are usually temporary and measures are always taken to either prevent or reduce them.
If you are treated with the drug Taxol, you may find that you have joint and muscle pain, rather like flu symptoms, for a few days after treatment. These symptoms usually disappear after a few days. You may also find that you get numbness or tingling in your hands and feet. Let your doctor know if this happens to you.
Radiotherapy
Radiotherapy (treatment using radiation) is occasionally used for women with ovarian cancer, especially if it is confined to the pelvic cavity. If radiotherapy is advised, your doctor will discuss it with you.
Further surgery
After your last chemotherapy treatment, you will have more blood tests and a CT scan. You will also have a physical examination. If your treatment has had a good effect and there is no obvious sign of cancer your doctor may discuss the need to have another operation. In this operation more biopsies are taken just to be sure. This is called a 'second look operation'. It may be a small one known as a laparoscopy or a bigger operation similar to your first one.
What is my outlook if I have ovarian cancer?
The outlook (or 'prognosis') for women with the less common types of ovarian cancer (for example, borderline tumours or germ cell tumours) is usually very good. For women with the more common epithelial ovarian cancer, it is not so easy to predict the outcome.
Like most cancers, ovarian cancer can often be cured. Many women, even with advanced disease, respond very well to treatment, however repeated chemotherapy treatments and surgery may be necessary to achieve this.
A diagnosis of cancer can make your future seem very uncertain: it may help to think of it as a chronic illness. This means that even if your cancer cannot be cured it can still be treated. You can then return to a near normal life for long periods of time.
If you would like information about your own outlook, you need to speak to your specialist who is familiar with your medical history.
Last Reviewed: 20 April 2001
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