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Treatment of ovarian cancer


Treatment of ovarian cancer

The choice of treatment and the long-term outcome (prognosis) of your ovarian cancer depend on the stage and grade of your cancer. Your age, overall health, and quality of life must also be considered. Research studies are ongoing to find the best treatment choices or combination of treatments that increase survival rates without affecting your quality of life.

Your doctor confirms a diagnosis of ovarian cancer and determines its spread (or stage) by taking biopsies during laparotomy surgery. Laparoscopic surgery may be a choice for some women. Talk with your doctor about your choices.

Surgery in early-stage ovarian cancer

Surgery in early-stage ovarian cancer determines both the stage and grade of cancer. Surgery is also the first treatment for cancer. Surgical staging means looking at different organs or tissues in the abdomen for cancer. Surgery may include:

  • A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
  • Taking a sample of peritoneal fluid (peritoneal washings) from the abdominal cavity, to look for cancer cells.
  • Removing and checking the pelvic and aortic lymph nodes, to see if the cancer has spread.
  • Checking the abdominal organs and tissues for cancer cells. Biopsies may be done.
  • Removing and checking the fatty tissue (omentum) attached to the stomach and large intestine, to see if the cancer has spread.
  • An appendectomy, which removes your appendix.

Women with stage IA or IB and grade 1 or 2 have the earliest stages of cancer and have the best long-term outcomes when they are treated with surgery. Chemotherapy may also be recommended. The 5-year survival rate—the percentage of people who are still alive 5 years or longer after their diagnosis—is as high as 93%.1

Women with stage I and grade 3 cancer are treated with both surgery and chemotherapy. The 5-year survival rate is about 80%.2

Surgery in advanced-stage ovarian cancer

Surgery in advanced-stage ovarian cancer involves removing as much of the cancer as possible. This is called tumor debulking or cytoreduction. The uterus, omentum, and any areas of visible cancer are removed. This may include surgery on the intestines, urinary system, or spleen, or scraping of the diaphragm to remove all the cancer. The long-term outcome (prognosis) is better if no cancer cells remain (there is no residual tumor).

Women with stage III cancer who are treated with surgery and chemotherapy have a long-term survival rate of about 30% if most of the cancer is removed in surgery.2

Women with stage IV cancer who are treated with surgery and chemotherapy have a long-term survival rate of about 10%.2

Chemotherapy is usually started 1 to 4 weeks after surgery. The standard medicine therapy includes paclitaxel and carboplatin or cisplatin.

Stages and treatments for ovarian cancer3
Stage Treatments

IA and IB

Women with stage IA, grade 1 cancer who wish to have children

Surgery will leave the uterus and one ovary if they have no sign of cancer. All of these will be done during surgery:

  • The cancerous ovary and fallopian tube are removed.
  • Fatty tissue (omentum) is removed.
  • Pelvic and aortic lymph nodes are removed.
  • A sample of peritoneal fluid is taken.
  • The appendix is often removed.

Women with grade 1 cancer who do not wish to have children

All of these will be done during surgery:

  • The uterus (hysterectomy) and both ovaries and fallopian tubes (bilateral salpingo-oophorectomy) are removed.
  • A sample of peritoneal fluid is taken.
  • Pelvic and aortic lymph nodes are removed.
  • Omentum is removed.
  • The peritoneum and any tissue that may be cancerous are biopsied.
  • The appendix is often removed.

Most women with grade 2 and all women with grade 3 cancer

  • Hysterectomy, bilateral salpingo-oophorectomy, surgical staging, and chemotherapy

IC

Hysterectomy, bilateral salpingo-oophorectomy, surgical staging, and chemotherapy

IIA, IIB, IIC, IIIA, IIIB, IIIC, and IV

Hysterectomy, bilateral salpingo-oophorectomy, periodic tumor debulking (may include surgery on intestines, urinary system, or spleen, or scraping the diaphragm), and chemotherapy

References

Citations

  1. Brennan K, et al. (2007). Premalignant and malignant disorders of the ovaries and oviducts. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 971–884. New York: McGraw-Hill.

  2. Cannistra SA (2007). Gynecologic cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 10. New York: WebMD.

  3. National Comprehensive Cancer Network (2009). Ovarian cancer, including fallopian tube cancer and primary peritoneal cancer. NCCN Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/ovarian.pdf.

Credits

ByHealthwise Staff
Primary Medical ReviewerJoy Melnikow, MD, MPH - Family Medicine
Specialist Medical ReviewerRoss Berkowitz, MD - Obstetrics and Gynecology
Last RevisedJune 15, 2009

eMedicineHealth Medical Reference from Healthwise

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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