Ovarian Cancer Treatment Options: An In-Depth Guide to Surgery, Chemotherapy, and More

June 12, 2024

Ovarian Cancer Treatment Options: An In-Depth Guide to Surgery, Chemotherapy, and More

Ovarian cancer is a complex and challenging disease that affects thousands of women worldwide. Being diagnosed with ovarian cancer can be overwhelming, but it’s crucial to understand that there are various treatment options available. 

Seeking treatment at a cancer center with an experienced team of gynecologic oncologists and specialists is essential for receiving the best possible care. This comprehensive guide will provide you with an overview of the different ovarian cancer treatments, helping you make informed decisions about your care.

Surgical Treatments for Ovarian Cancer

Surgery is often the first line of treatment for ovarian cancer. The extent of the surgery depends on the stage and type of ovarian cancer. 

  • For early-stage cancers, surgery may involve removing one ovary (unilateral oophorectomy) or both ovaries (bilateral oophorectomy). 
  • In some cases, the uterus may also be removed (hysterectomy). 
  • For advanced ovarian cancer, more extensive surgery may be necessary, including the removal of affected lymph nodes, fallopian tubes, and biopsies of surrounding tissues.

Minimally-invasive surgical procedures, such as laparoscopy or robotic surgery, may be an option for some early-stage ovarian cancer patients. These procedures involve making small incisions in the abdomen and using specialized instruments to remove the tumor and affected tissues. Minimally-invasive surgery can lead to faster recovery times, less pain, and fewer complications compared to traditional open surgery.

In some cases, surgery may be performed to remove as much of the tumor as possible (debulking surgery) before starting other treatments like chemotherapy. This can help improve the effectiveness of subsequent treatments and alleviate symptoms caused by the tumor.

It’s essential to discuss your fertility concerns with your healthcare team to determine the best surgical approach for your situation. Fertility-sparing surgery, which involves removing only one ovary and fallopian tube, may be an option for younger patients with early-stage ovarian cancer who wish to preserve their ability to have children in the future.

Chemotherapy for Ovarian Cancer

Chemotherapy is a systemic treatment that uses drugs to kill cancer cells throughout the body. It is often used in combination with surgery to treat ovarian cancer. Chemotherapy may be given after surgery (adjuvant chemotherapy) to eliminate any remaining cancer cells and reduce the risk of recurrence. In some cases, chemotherapy may be administered before surgery (neoadjuvant chemotherapy) to shrink the tumor and make the surgery more successful.

The most common chemotherapy drugs used to treat ovarian cancer are carboplatin and paclitaxel. These drugs are usually given intravenously (through a vein) in cycles, with periods of treatment followed by periods of rest to allow the body to recover. 

To facilitate the administration of chemotherapy, a portacath (also known as a port) is often used. A portacath is a small, implantable device that is inserted under the skin, typically in the chest area, through a minor outpatient surgical procedure. The port is connected to a catheter that leads to a large vein, allowing for easier access to the bloodstream during chemotherapy sessions. 

The portacath remains in place for the duration of the chemotherapy cycles and can be used for extended periods if additional treatment is necessary. The duration and frequency of chemotherapy cycles depend on the stage and type of ovarian cancer, as well as the patient’s overall health and response to treatment.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Intraperitoneal Chemotherapy (IP)

Two specialized forms of chemotherapy for ovarian cancer are hyperthermic intraperitoneal chemotherapy (HIPEC) and intraperitoneal (IP) chemotherapy. HIPEC involves delivering heated chemotherapy directly into the abdominal cavity during surgery, while IP chemotherapy delivers the drugs directly into the abdomen after surgery. These targeted approaches can be more effective in treating ovarian cancer that has spread within the abdominal cavity.

Throughout chemotherapy, your medical team will work closely with you to manage side effects and maintain your quality of life. Common side effects of chemotherapy include fatigue, nausea, hair loss, and increased risk of infection due to a weakened immune system. Your healthcare team can provide medications and supportive care to help alleviate these side effects. It’s important to communicate any concerns or symptoms you experience during treatment so that your team can provide the necessary support and care.

Targeted Therapy for Ovarian Cancer

Targeted therapy is a type of cancer treatment that focuses on specific molecules or pathways involved in cancer cell growth and survival. These therapies are designed to attack cancer cells while minimizing damage to healthy cells. Targeted therapies for ovarian cancer may include drugs that inhibit the growth of blood vessels that supply the tumor (anti-angiogenic agents) or drugs that target specific genetic mutations in cancer cells (PARP inhibitors).

Anti-angiogenic agents, such as bevacizumab (Avastin), work by blocking the growth of new blood vessels that tumors need to grow and spread. These drugs can be used in combination with chemotherapy to improve treatment outcomes and delay disease progression in advanced ovarian cancer.

PARP inhibitors, such as olaparib (Lynparza), rucaparib (Rubraca), and niraparib (Zejula), are targeted therapies that work by exploiting a weakness in cancer cells with ovarian cancer mutations in the BRCA1 or BRCA2 genes. These mutations impair the cells’ ability to repair damaged DNA, making them more susceptible to the effects of PARP inhibitors. PARP inhibitors can be used as maintenance therapy after chemotherapy to help delay disease recurrence in patients with BRCA mutations or other forms of homologous recombination deficiency (HRD).

Before starting targeted therapy, your healthcare team may test your cancer cells to determine if they have specific genetic mutations that can be targeted by these drugs. This personalized approach to treatment can help improve outcomes and minimize side effects.

Hormone Therapy for Ovarian Cancer

Some types of ovarian cancer, such as stromal tumors, may be sensitive to hormones like estrogen. Stromal tumors develop in the connective tissue cells that hold the ovary together and produce estrogen and progesterone. These tumors are rare and tend to grow slower than other types of ovarian cancer. 

In cases where stromal tumors are sensitive to hormones, hormone therapy may be used to block the effects of estrogen on cancer cells, slowing their growth. It is important to note that this type of hormone therapy is different from hormone replacement therapy (HRT), which is used to alleviate symptoms of menopause. 

While HRT adds estrogen to the body, hormone therapy for ovarian cancer aims to remove or block estrogen to slow cancer growth. Hormone therapy is typically used in combination with other treatments, such as surgery or chemotherapy, and may be an option for recurrent or advanced ovarian cancer.

Common hormone therapy drugs used to treat ovarian cancer include:

  • Aromatase inhibitors (AIs): These drugs, such as letrozole (Femara) and anastrozole (Arimidex), block the production of estrogen in the body, thereby reducing the amount of estrogen available to stimulate cancer cell growth.
  • Tamoxifen: This drug works by blocking the effects of estrogen on cancer cells, preventing them from growing and dividing.
  • Luteinizing hormone-releasing hormone (LHRH) agonists: These drugs, such as goserelin (Zoladex) and leuprolide (Lupron), work by reducing the amount of estrogen produced by the ovaries.

Keep in mind that hormone therapy’s side effects can include hot flashes, vaginal dryness, and an increased risk of bone loss (osteoporosis). Your healthcare team will monitor you closely during hormone therapy and can guide managing any side effects that may occur.

Immunotherapy for Ovarian Cancer

Immunotherapy is a type of cancer treatment that harnesses the power of the body’s immune system to fight cancer cells. Immunotherapy drugs stimulate the immune system to recognize and attack cancer cells more effectively. While immunotherapy is not yet a standard treatment for ovarian cancer, ongoing clinical trials are investigating its potential benefits.

One type of immunotherapy being studied for ovarian cancer is immune checkpoint inhibitors. These drugs work by blocking proteins that cancer cells use to evade detection by the immune system. By removing these “brakes” on the immune response, immune checkpoint inhibitors can help the body’s natural defenses better recognize and destroy cancer cells.

While immunotherapy has shown promise in treating some types of cancer, its role in ovarian cancer treatment is still being defined through ongoing research and clinical trials. If you are interested in exploring immunotherapy options, discuss the potential risks and benefits with your healthcare team.

Radiation Therapy for Ovarian Cancer

Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells in a specific area of the body. While radiation therapy is not commonly used to treat ovarian cancer, it may be recommended in certain situations, such as treating isolated recurrences or alleviating symptoms like pain.

Two types of radiation therapy that may be used for ovarian cancer are intensity-modulated radiation therapy (IMRT) and brachytherapy. IMRT uses advanced computer technology to precisely target the tumor while minimizing exposure to healthy tissues. This technique allows for higher radiation doses to be delivered to the tumor while sparing surrounding organs and tissues.

Brachytherapy involves placing radioactive material directly inside or near the tumor. This approach allows for a high dose of radiation to be delivered directly to the tumor site while minimizing exposure to nearby healthy tissues. Brachytherapy may be used to treat isolated recurrences of ovarian cancer in the pelvis or vagina.

If radiation therapy is recommended for your ovarian cancer treatment, your radiation oncologist will work with you to develop a personalized treatment plan. They will carefully plan the radiation doses and treatment schedule to maximize the effectiveness of the therapy while minimizing potential side effects.

Supportive (Palliative) Care for Ovarian Cancer

Palliative care is an essential aspect of ovarian cancer treatment that focuses on managing symptoms, improving quality of life, and providing emotional support for patients and their families. 

It is important to note that palliative care is not the same as hospice care. While both prioritize comfort and quality of life, palliative care can be provided alongside curative treatments at any stage of the disease, whereas hospice care is typically reserved for those with a life expectancy of six months or less and focuses on comfort rather than cure.

A multidisciplinary palliative care team may include doctors, nurses, social workers, counselors, and other healthcare professionals who work together to address the physical, emotional, and spiritual needs of ovarian cancer patients. 

Palliative care can help manage a wide range of symptoms associated with ovarian cancer and its treatment, such as pain, nausea, fatigue, anxiety, and depression. The palliative care team can provide medications, therapies, and support services to alleviate these symptoms and improve overall well-being. 

In addition to symptom management, palliative care also focuses on providing emotional and practical support for patients and their families. This may include counseling services, support groups, and assistance with advance care planning and decision-making. 

Integrating palliative care early in the course of ovarian cancer treatment can lead to better quality of life, improved symptom control, and even prolonged survival. If you are facing ovarian cancer, don’t hesitate to ask your healthcare team about palliative care services that may be available to you, and discuss how they differ from hospice care to ensure you receive the most appropriate support for your needs.

Clinical Trials for Ovarian Cancer

Clinical trials play a crucial role in advancing ovarian cancer treatment by investigating new therapies, drug combinations, and treatment strategies. The benefits of ovarian cancer clinical trials include access to innovative treatments that are not yet widely available. Clinical trials for ovarian cancer may include studies of biologic therapies that harness the immune system to fight cancer, as well as targeted therapies that attack specific vulnerabilities in cancer cells.

If you are interested in participating in a clinical trial, discuss the options with your healthcare team. They can help you understand the potential benefits and risks, as well as determine if you meet the eligibility criteria for specific trials. Participating in a clinical trial not only offers the potential for personal benefit but also contributes to the advancement of ovarian cancer research and treatment for future patients.

Which Ovarian Cancer Treatment is Right for Me?

Determining the most appropriate treatment for your ovarian cancer depends on several factors, including the stage and type of your cancer, your age, overall health, and personal preferences. Your healthcare team will work closely with you to develop a personalized treatment plan that takes these factors into account.

In general, early-stage ovarian cancer is often treated with surgery, which may be followed by chemotherapy to reduce the risk of recurrence. For advanced-stage ovarian cancer, a combination of surgery and chemotherapy is typically recommended. The goal of surgery in advanced cases is to remove as much of the tumor as possible (debulking), while chemotherapy helps to eliminate remaining cancer cells and prevent or delay disease progression.

Targeted therapies, such as PARP inhibitors and anti-angiogenic agents, may be recommended for patients with specific genetic mutations or tumor characteristics. These therapies can be used in combination with chemotherapy or as maintenance therapy to help prolong remission.

For patients with recurrent ovarian cancer, treatment options may include additional surgery, chemotherapy, targeted therapy, immunotherapy, or radiation therapy, depending on the location and extent of the recurrence, as well as previous treatments received.

When considering your treatment options, it’s essential to have open and honest discussions with your healthcare team about your goals, concerns, and quality of life preferences. Some ovarian cancer questions you may want to ask include:

  • What are the potential benefits and risks of each treatment option?
  • How will the treatment affect my daily life and ability to carry out normal activities?
  • What side effects can I expect, and how can they be managed?
  • Are there any clinical trials that may be appropriate for me?
  • What is the likelihood of the treatment controlling my cancer and for how long?
  • How will we know if the treatment is working, and what follow-up tests will be necessary?

Remember, you are a key member of your healthcare team, and your input is valuable in making treatment decisions. Don’t hesitate to ask questions, express your concerns, and seek support throughout your ovarian cancer journey.

Advocate for Your Needs as You Explore Ovarian Cancer Treatments

Ovarian cancer treatment is a complex and multifaceted process that requires the expertise of a dedicated healthcare team. By understanding the various treatment options available, including surgery, chemotherapy, targeted therapy, hormone therapy, immunotherapy, and radiation therapy, you can work with your healthcare providers to develop a personalized plan that meets your unique needs and goals.

Advances in ovarian cancer research continue to provide new insights into the disease and lead to the development of innovative treatment approaches. Clinical trials play a vital role in this progress, offering patients the opportunity to access cutting-edge therapies and contribute to the advancement of ovarian cancer care.

Throughout your ovarian cancer journey, remember that you are not alone. Your healthcare team, family, and support network are there to provide guidance, support, and compassion every step of the way. By staying informed, advocating for your needs, and taking an active role in your treatment decisions, you can navigate the challenges of ovarian cancer with strength and resilience.

As we look to the future, there is hope for continued progress in ovarian cancer treatment and outcomes. With ongoing research, collaboration, and dedication from the scientific and medical communities, we can work towards a world where more women can overcome this disease and live long, fulfilling lives.