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Ovarian Cancer (cont.)

Ovarian Cancer Treatment

Treatment of ovarian cancer should be under the direction of an experienced gynecologic oncologist (a specialist in women's cancers).

Surgery is the usual first treatment for ovarian cancer. Whenever possible, the surgery takes place at the time of exploratory laparotomy. The operation is paused while the pathologist rapidly reviews the biopsy tissues. The pathologist's report determines the structures affected by cancer and if they should be removed. This spares the woman from undergoing another surgery.

For stage I tumors, only the involved ovary and fallopian tube may be removed for women who wish to become pregnant in the future. For women who do not wish to become pregnant, both ovaries, both fallopian tubes, and the uterus are removed. This is a hysterectomy with bilateral (2-sided) salpingo-oophorectomy. Usually this procedure removes the lymph nodes surrounding these organs and the omentum. If the tumor cell type is especially worrisome (grade 3 tumors and all stage IC tumors), chemotherapy is usually given as well.
Stage II cancer treatment involves removal of the uterus, ovaries, and fallopian tubes, resection (partial removal) of any tumor in the pelvic area, and resection of any other structures affected with cancer. Chemotherapy is strongly recommended. The best treatment at this time involves a platinum-based agent (carboplatin) and paclitaxel (Taxol). These agents are administered in 6 cycles of 3 weeks each.
Stage III treatment is identical to stage II treatment, except more aggressive chemotherapy and possibly experimental treatments are given. Some women may be candidates for direct abdominal treatment. This type of treatment is referred to as peritoneal therapy. This type of therapy is more difficult to take but may improve survival.
Stage IV treatment involves extensive debulking and multi-agent chemotherapy.

After chemotherapy is completed, the woman may undergo "second-look surgery." Her surgeon will examine her remaining pelvic and abdominal structures for evidence of residual cancer. Samples of fluid and tissues may be taken to check for residual cancer cells.