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, and the landscape is rapidly evolving with groundbreaking new therapies.

Recent FDA approvals have introduced the first targeted treatments specifically for certain ovarian cancer subtypes, offering new hope for patients who previously had limited options.

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.

Understanding Different Types of Ovarian Cancer

Before diving into treatment options, it’s important to understand that ovarian cancer isn’t just one disease. There are multiple types and subtypes, each with distinct characteristics and treatment approaches. Here, we’ll focus on two key distinctions that significantly impact treatment decisions:

High-Grade vs. Low-Grade Ovarian Cancer

High-grade ovarian cancer:

• Exhibits rapid growth and spread
• Features highly abnormal cell appearance
• Generally more aggressive but often initially responsive to chemotherapy
• Primarily impacts older women (average age 62.6 years)

Low-grade serous ovarian cancer:

• Characterized by slower growth
• Cells appear more similar to normal tissue
• Less aggressive but historically more challenging to treat
• Often less responsive to standard chemotherapy protocols
• Primarily impacts younger women (median age 45, as young as 19)

This distinction matters because treatment approaches — and success rates — can vary dramatically between subtypes. For too long, rare subtypes like low-grade serous ovarian cancer have been understudied, leaving patients with fewer treatment options.

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). (Learn more about oophorectomy surgery.)
• In some cases, the uterus may also be removed (ovarian cancer 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 (for example, robotic surgery, which is a type of laparoscopy), 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 for ovarian cancer) before starting other treatments like chemotherapy. This can help improve the effectiveness of subsequent treatments and alleviate symptoms caused by the tumor.

For younger patients concerned about fertility, fertility-sparing surgery may be an option for certain early-stage cancers. This involves removing only one ovary and fallopian tube, preserving the ability to have children in the future.

It’s essential to discuss your fertility concerns with your healthcare team to determine the best surgical approach for your situation.

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 for ovarian cancer 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 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 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.

It’s important to note that different ovarian cancer subtypes respond differently to chemotherapy. For example, chemotherapy for LGSOC has historically shown lower response rates compared to high-grade cancers, which is why targeted therapies have become so crucial for these patients.

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 ovarian cancer chemotherapy side effects and maintain your quality of life. Common side effects 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 essential to communicate any concerns or symptoms you experience during treatment so your team can provide the necessary support and care.

Targeted Therapy for Ovarian Cancer

Targeted therapy is a type of cancer treatment focusing 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. 

Antibody-Drug Conjugates: A Game-Changing Breakthrough

One of the most significant recent advances in ovarian cancer treatment is the development of antibody-drug conjugates (ADCs). In 2024, the FDA granted full approval to mirvetuximab soravtansine-gynx (Elahere) for FRα-positive, platinum-resistant epithelial ovarian cancer.

This groundbreaking treatment:

• Improved overall survival from 12.7 months to 16.5 months compared to standard chemotherapy
• Represents the first novel therapy ever to improve overall survival in platinum-resistant ovarian cancer
• Targets folate receptor alpha (FRα), which is overexpressed in about 80% of high-grade serous epithelial ovarian cancers
• Works like a “guided missile,” delivering chemotherapy directly to cancer cells while sparing healthy tissue

The drug showed particularly impressive results:

• 42% overall response rate compared to 16% with standard chemotherapy
• Reduced risk of cancer progression by 35%
• Better tolerated with fewer severe side effects than traditional chemotherapy

Revolutionary Treatment for Low-Grade Serous Ovarian Cancer

For decades, patients with low-grade serous ovarian cancer had no FDA-approved treatments specifically designed for their cancer subtype. This changed dramatically with the FDA’s accelerated approval of avutometinib and defactinib for KRAS-mutated recurrent LGSOC.

This combination therapy:

• Achieved a 44% confirmed overall response rate in KRAS-mutated LGSOC patients
• Represents the first-ever FDA-approved treatment specifically for recurrent KRAS-mutant LGSOC
• Offers hope for younger women who are disproportionately affected by this cancer subtype
• Addresses a critical unmet need, as there were previously no approved treatments for this rare but distinct cancer

The approval was based on the RAMP 201 trial, which demonstrated substantial and durable responses in patients who had exhausted other treatment options. This breakthrough exemplifies why funding research for rare ovarian cancer subtypes is so crucial, and why organizations like Not These Ovaries focus specifically on these underserved areas.

PARP Inhibitors

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.

Recent developments include:

• Combination therapies: The FDA has approved olaparib with bevacizumab for maintenance treatment of high-grade epithelial ovarian cancer
• Expanded use: PARP inhibitors are now used both as maintenance therapy and in combination with other treatments
• Biomarker testing: Advanced genetic testing helps identify which patients will benefit most from these therapies

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.

Immunotherapy for Ovarian Cancer

Immunotherapy for ovarian cancer harnesses the power of the body’s immune system to fight cancer cells. This field is rapidly evolving with several distinct approaches:

Anti-Angiogenic Therapy

Bevacizumab (Avastin) is an established immunotherapy treatment that works by targeting blood vessel growth. It’s widely used both in combination with chemotherapy and as maintenance therapy, becoming a standard part of care for many patients with advanced ovarian cancer.

Checkpoint Inhibitors

Two FDA-approved checkpoint inhibitors show promise for specific ovarian cancer patients:

• Dostarlimab (Jemperli)
• Pembrolizumab (Keytruda)

These treatments are specifically approved for subsets of patients with advanced ovarian cancer who have certain genetic markers, such as DNA mismatch repair deficiency (dMMR), high microsatellite instability (MSI-H), or high tumor mutational burden (TMB-H).

CAR-T Cell Therapy: The Next Frontier

One of the most exciting developments in ovarian cancer treatment is CAR-T cell therapy, where a patient’s T cells are genetically modified to specifically target cancer cells. Several promising trials are underway:

Current clinical Trials:

• City of Hope’s TAG72-targeting CAR-T cells for advanced epithelial ovarian cancer patients
• FSHR-targeting CAR-T therapy at Moffitt Cancer Center, which has shown promising early results
• Multiple antigen targets being explored, including mesothelin, folate receptor α, HER2, and MUC16

Early results have been encouraging, with some patients experiencing prolonged responses. The FDA has even approved second doses for individual patients showing clinical benefit, highlighting the potential of this approach.

While immunotherapy faces challenges in solid tumors like ovarian cancer due to the immunosuppressive tumor environment, ongoing research continues to develop strategies to overcome these obstacles.

Hormone Therapy for Ovarian Cancer

Some types of ovarian cancer, particularly stromal tumors and certain low-grade cancers, may be sensitive to hormones like estrogen. Hormone therapy for ovarian cancer may be used to block the effects of estrogen on cancer cells, slowing their growth.

This approach is especially relevant for patients with hormone-sensitive tumors and may 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 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). Tamoxifen can also increase your risk for endometrial cancer. 

Your healthcare team will monitor you closely during hormone therapy and can guide managing any side effects that may occur.

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 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 for ovarian cancer is an essential aspect of 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. In contrast, 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 are crucial 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.

Recent breakthrough trials have led to game-changing approvals:

• MIRASOL trial led to the approval of mirvetuximab soravtansine for platinum-resistant ovarian cancer
• RAMP 201 trial resulted in the first approved treatment for KRAS-mutated LGSOC
• OVATION 2 trial studying IMNN-001 showed promising results, extending median overall survival by 11.1 months when combined with standard chemotherapy

Current areas of active research include:

• Combination therapies pairing ADCs with PARP inhibitors
• CAR-T cell therapies targeting various ovarian cancer antigens
• Immunotherapy combinations to overcome treatment resistance
• Novel biomarker testing to better match patients with optimal treatments

If you are interested in participating in a clinical trial, you may visit ClinicalTrials.gov, but also make sure you discuss the options with your healthcare team.

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.

Treatment approaches now vary significantly based on cancer subtype:

For High-Grade Serous Ovarian Cancer:

• Surgery followed by chemotherapy (carboplatin and paclitaxel)
• Bevacizumab as maintenance therapy
• PARP inhibitors for BRCA-mutated cancers
• Mirvetuximab soravtansine for platinum-resistant, FRα-positive disease

For Low-Grade Serous Ovarian Cancer:

• Surgery when possible
• Hormone therapy (aromatase inhibitors may be more effective than chemotherapy)
• Avutometinib plus defactinib for KRAS-mutated recurrent disease
• Clinical trials investigating novel approaches

For Borderline Ovarian Tumors:

• Conservative surgery when appropriate to preserve fertility
• Close monitoring rather than aggressive chemotherapy
• Specialized care due to the unique nature of these tumors

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?

Remember, you are a key member of your healthcare team, and your input is valuable in making treatment decisions.

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, allowing patients to access cutting-edge therapies and contribute to advancing 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.