Treatment
Both treatment and 5 year survival vary depending on the stage ovarian cancer has reached by the time it is diagnosed.
Surgery
To remove the affected ovary and all visible disease from the abdomen and pelvis. Usually the womb and other ovary are removed as well - total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). In stage 1 disease recovery from surgery is expected to take about 6 weeks.
In stage 3 or 4, any disease outside the pelvis is also removed if it is safe to do so. Recovery may be more prolonged if extensive surgery to remove advanced disease has been necessary and this may include:
- Bowel resection – prolongs recovery time.
- Removal of diaphragmatic deposits – prolongs recovery time.
In stage 4 disease, surgery may not be possible immediately and a woman may be treated with chemotherapy to reduce disease before surgery is carried out. Some women will have operations to remove cancer before and again after chemotherapy – this may be referred to as a ‘second look’ operation. Women with advanced disease may be entered into trials because it is not clear what treatment is best. If surgery is not possible the person is likely to be terminally ill.
Compared to other cancers ovarian cancer is unusual in that even in very advanced disease surgery is possible and it improves survival, even when not all the cancer can be removed. When not quite all the cancer is removed this is called ‘debulking’. In other cancers even leaving a few cells behind can render the surgery useless, but in ovarian cancer ‘debulking’ improves outcome. The treatment pathway usually follows this pattern.
Chemotherapy
Women with the best long term outcome may not need chemotherapy, for women who have a chance of the disease returning chemotherapy treatment is necessary –this is the majority of women. It may be given intravenously or rarely intraperitoneally. Chemotherapy typically starts quite soon after surgery; there may not be a period of being really well first. Standard treatment includes 6 cycles of taxol and carboplatin.
Radiotherapy
This is very rarely used except in localised stage 1 cancer. This is because abdominal organs especially the bowel, kidneys and liver are easily damaged by radiotherapy if a large area of the abdomen needs to be treated, as it would with more widely spread disease.
Click on the link for details of:
Amended April 2008
