How Is Ovarian Cancer Treated?

Ovarian cancer occurs when abnormal cells in the ovaries or fallopian tubes grow uncontrollably, forming a mass (tumor). Treatment options for ovarian cancer depend on the type and stage of the disease. It may include a combination of surgery, chemotherapy, radiation therapy, or targeted therapies. The goals of ovarian cancer treatment are to remove the tumor(s), eliminate cancer cells in the body, and prevent a recurrence (return) of cancer. 

If you have ovarian cancer, you may be referred to a gynecologic oncologist—a doctor with specialized training to treat ovarian cancer. Research shows that people with ovarian cancer who receive care from a gynecologic oncologist have better outcomes than those treated by general gynecologists. 

Treatment Overview 

Treatment plans for ovarian cancer are typically based on the type and stage of the disease. As your cancer care team develops your treatment plan, they will consider other factors, including your overall health, personal preferences, and whether you plan to have children in the future. 

Surgery

Surgery is the standard treatment for most ovarian cancers. A surgical oncologist will work with you to determine the most effective surgical procedure for the type and stage of ovarian cancer you have. 

To perform the surgery, your doctor may use a laparoscopy, a minimally invasive surgery involving making small incisions in the abdomen. A laparoscopy is now used more frequently than a laparotomy, a surgical procedure that involves doctors making a large incision to open the abdomen. This is because it yields similar results with the bonus of being less invasive and having a faster recovery time.

A laparoscopy or laparotomy may be used for: 

• Tumor debulking: Removal of as much of the tumor as possible
• Oophorectomy: Removal of one or both of the ovaries 
• Bilateral salpingo-oophorectomy (BSO): Removal of both ovaries and fallopian tubes
• Hysterectomy: Removal of the uterus 
• Omentectomy: Removal of the layer of fatty tissue that covers the abdominal organs 
• Biopsy: Taking a tissue sample from lymph nodes and other tissues in the abdomen and pelvis to see if the cancer cells have spread from the ovary/fallopian tube

In some cases, surgeons may need to remove a piece of other abdominal organs—including the colon, bladder, or small intestine—in order to access and remove the tumor. Talk to your surgeon about whether this is a possibility prior to your surgery. 

For some early-stage ovarian cancers, surgical removal of the tumor may be enough to remove all of the cancer. For certain types of tumors and more advanced stages, other treatments will be used in combination with surgery. 

Chemotherapy

With the exception of some stage 1 ovarian cancers, chemotherapy (chemo) is almost always recommended to treat ovarian cancer. Chemotherapy uses drugs designed to kill cancer cells. The most common chemotherapy drugs used to treat ovarian cancer include:

• Platinum compounds: Platinol (cisplatin) or Paraplatin (carboplatin)
• Taxanes: Taxol (paclitaxel) or Taxotere (docetaxel)

These drugs may be administered in one of two ways: 

• Intravenously (IV): Medicine is delivered through a needle or tube into a vein.
• Intraperitoneal (IP): Medicine is placed directly into the abdominal cavity through a thin tube.

Chemotherapy for ovarian cancer may be used before surgery to shrink a tumor prior to the procedure or after surgery to kill off any cancer cells that remain in the body. Between three to six cycles are typically recommended to treat ovarian cancer. A cycle includes regular doses of the drug followed by a rest period of three to four weeks. 

Side effects of chemotherapy drugs vary from person to person and can include: 

• Nausea
• Vomiting 
• Fatigue 
• Hair loss 
• Loss of appetite
• Mouth sores
• Increased risk of infection 

The side effects of chemo can be unpleasant, but they usually go away after the treatment is complete. Your doctor may prescribe medicines to prevent or reduce certain side effects, like nausea and vomiting. Some chemotherapy drugs can cause long-term side effects, including hearing loss (ototoxicity) and nerve damage (neuropathy), which can lead to numbness, tingling, and pain in the hands and feet. 

Targeted Therapies 

Targeted therapies are treatments that are designed to slow or stop the growth of cancer cells. Ovarian cancer targeted therapies include: 

• Angiogenesis inhibitors: Cancers need to make new blood vessels in order to grow and spread. Avastin (bevacizumab) is a monoclonal antibody that may slow the growth of cancer by cutting off the tumor’s blood supply. This is administered intravenously (IV) every two to three weeks. Common side effects include fatigue, bleeding, headaches, mouth sores, loss of appetite, high blood pressure, and diarrhea. 
• Poly(ADP-ribose) polymerase (PARP) inhibitors: Normally, PARP enzymes help repair cells’ damaged DNA. PARP inhibitors can make it hard for tumors with BRCA gene mutations to repair damaged DNA, which often makes these cells die. PARP drugs include Lynparza (olaparib), Rubraca (rucaparib), and Zejula (niraparib). PARP inhibitors are pills or capsules taken orally. Common side effects include joint and muscle pain, anemia, and nausea.  
• Folate receptor alpha-targeted drugs: Many ovarian cancer cells have high levels of a protein called folate receptor alpha. Elahere (Mirvetuximab soravtansine) is a lab-made antibody that attaches to the folate receptor alpha on the surface of cells and delivers chemo drugs directly to the cell. The drug is approved for use in people with epithelial ovarian cancer that does not respond to chemotherapy drugs. It is administered intravenously once every three weeks and may cause side effects including headaches, nausea, vomiting, fatigue, and abdominal pain. 

Other Therapies

Ovarian cancer may be treated with additional therapies, depending on the type or stage of the disease. Other treatments for ovarian cancer include: 

• Hormone therapy: Hormones or hormone-blocking drugs, including Nolvadex (tamoxifen), aromatase inhibitors, and luteinizing hormone-releasing hormone (LHRH) agonists may be used to treat ovarian stromal tumors (tumors that develop in the tissue that hold the ovary together). These drugs are designed to lower estrogen levels or block estrogen-producing enzymes to prevent cancer growth. 
• Radiation therapy: Radiation therapy uses high-energy X-rays to kill cancer cells. During treatment, a machine sends energy beams to the area of the body affected by cancer. It is rarely used to treat ovarian cancer but may be recommended if there are many tumors in the abdomen and pelvis or if the cancer has spread to more distant parts of the body, like the brain. Radiation therapy sessions last only a few minutes, and you’ll have treatment five days a week for several weeks. 

Clinical Trials 

Ovarian cancer clinical trials are research studies that evaluate the effectiveness and safety of surgical procedures, combination therapies, and new drugs to treat the disease. Clinical trials use human volunteers to test novel treatments for ovarian cancer to determine if it works better than the current standard treatments. 

Ovarian cancer patients who participate in clinical trials have the opportunity to try a new therapy before it becomes widely available. They also help researchers and doctors make advancements in the way ovarian cancer is treated and managed. If you are interested in joining a clinical trial, talk to your healthcare provider about clinical trials that may be a good fit for you. 

Living With and Managing Ovarian Cancer

Getting a diagnosis of ovarian cancer can affect nearly every aspect of your life. Between symptoms of the disease, side effects from treatment, and the emotional impact on you and your loved ones, you may feel like your world has turned upside down. It's normal to feel a wide range of emotions and wonder what the future holds when facing a cancer diagnosis. 

The prognosis of ovarian cancer varies depending on when the disease was diagnosed. Ovarian cancer is easiest to treat if caught early, and people diagnosed with stage 1 ovarian cancer have a five-year survival rate of 93%. Survival rates drop when cancer is more advanced and spreads to other areas of the body. Overall, the overall five-year survival rate for people with all types of ovarian cancers is 49%. 

If you have questions or concerns about how your diagnosis is affecting your day-to-day life, talk to your cancer care team. They can help find support groups so you can talk to others with a similar diagnosis or help you connect with ovarian cancer survivors who can provide an understanding shoulder to lean on. It’s important to remember that even the strongest, most resilient people need support. Asking for support from family, friends, and healthcare providers is one of the best things you can do as you navigate your ovarian cancer journey.

A Quick Review

Ovarian cancer is treated through surgery, chemotherapy, targeted therapies, and, more rarely, radiation therapy or hormone therapy. The type of treatments your healthcare provider recommends will depend on the stage and type of ovarian cancer along with other factors, including your overall health and personal preferences.