The first step in treating most stages of ovarian cancer is surgery to remove and stage the cancer. Debulking is also done as needed (see the "Surgery" section for details).

Stage I

The initial treatment is surgery to stage the cancer and remove the tumor (see the section "Surgery" for details).

In stages IA and IB (T1a or T1b, N0, M0), cancer was found inside one or both ovaries, without spread to lymph nodes or other organs. The treatment after surgery depends on the way the cancer looks under the microscope (called the tumor grade).

The tumor is grade 1 when the cancer cells look a lot like normal ovarian cells. The outlook is good for grade 1 tumors, and most patients require no treatment after surgery. If someone with a grade 1, Stage IA, ovarian cancer wants to be able to have children after treatment, the initial surgery may be changed. Instead of removing the uterus, both ovaries, and both fallopian tubes, the surgeon may offer the option of removing only the affected ovary and fallopian tube.

For a grade 2 cancer (meaning the cancer has some similarities to normal ovarian cells), patients are either watched closely after surgery without further treatment, or they are treated with chemotherapy. The chemotherapy used most commonly is carboplatin and paclitaxel (Taxol) for 3-6 cycles.

Grade 3 cancers do not look very much like normal ovarian tissue under the microscope. The treatment of these tumors usually includes chemotherapy (like the chemotherapy that is given for grade 2).

Stage IC (T1c, N0, M0): For stage IC ovarian cancer, standard surgery to stage and remove the cancer is still the first treatment. After surgery, chemotherapy is recommended, usually 3 to 6 cycles of treatment with carboplatin and paclitaxel.

Stage II (including IIA, IIB, IIC)

For all stage II cancers, treatment starts with surgery for staging and debulking (see the section "Surgery" for details). The surgeon will try to remove as much of the tumor as is possible.

After surgery, chemotherapy is recommended for at least 6 cycles. Some women with stage II ovarian cancer are treated with intraperitoneal (IP) chemotherapy instead of intravenous (IV) chemotherapy.

Stage III:

Stages IIIA, IIIB, and IIIC are given the same treatments as stage II cancers. First, the cancer is surgically staged and the tumor is debulked (like stage II). The uterus, both fallopian tubes, both ovaries, and omentum (fatty tissue from the upper abdomen near the stomach and intestines) are removed. The surgeon will also try to remove as much of the tumor as possible. The goal is to leave behind no tumor larger than 1 cm. When this goal is reached, the cancer is said to have been "optimally debulked." Sometimes tumor is growing on the intestines, and in order to remove the cancer, part of the intestine will have to be removed. The smaller the remaining tumor, the better the outlook will be.

After recovery from surgery, combination chemotherapy is given. The combination used most often is carboplatin (or cisplatin) and a taxane, such as paclitaxel (Taxol^®), given IV (into a vein) for 6 cycles.

Another option is to give intraperitoneal (IP) chemotherapy after surgery (instead of IV chemotherapy). This was discussed in more detail in the section "Chemotherapy." IP chemotherapy is usually only considered if the cancer was optimally debulked - it may not work as well if a lot of tumor is left in the abdomen. Intraperitoneal chemotherapy seems to work better than IV chemotherapy, but it also causes worse side effects. These side effects can make it hard for someone to continue their treatment. For that reason, IP chemotherapy may not be for everyone. Still, it is an option for women with advanced ovarian cancer to consider.

After surgery, and during and after chemotherapy, blood tests will be done to determine if you have normal levels of a tumor marker called CA-125. A CT scan may also be done to evaluate your response to treatment.

Patients who are too weak to have a full staging and debulking surgery are sometimes treated with chemotherapy as the first treatment. If the chemo works and the patient becomes stronger, surgery to debulk the cancer may be done. This is often followed by more chemotherapy.

Second look surgery: In the past, many experts recommended another operation (laparoscopy/laparotomy) to see if the cancer was all gone after chemotherapy. This is known as a "second look" surgery. But these operations have not been shown to have any real benefit. Because of this, they are not usually a standard part of ovarian cancer care. Still, they may be done as part of a clinical trial. In a clinical trial of new treatments, the second-look operation may be worthwhile to help determine how effective the new treatment is.

For laparoscopy, a small opening is made below the navel and a slender tube with a light is placed so the doctor can inspect the abdominal cavity to see how successful treatment has been.

Laparotomy requires an incision or surgical opening long enough to allow the surgeon to look inside the pelvis and abdomen and take biopsy samples. Based on the results of the "second-look" surgery, your cancer care team can decide if you need more chemotherapy.

Consolidation therapy: For some patients, the doctor will recommend giving additional chemo after the cancer appears to be gone from the initial treatment. This is called consolidation therapy. Consolidation therapy is aimed at killing any cancer cells that were left behind but are too small to be seen with medical tests. The goal of consolidation therapy is to keep the cancer from coming back after treatment. One study showed a slight benefit to an additional year of paclitaxel. Several clinical trials are investigating using other therapies as "consolidation" therapies.

Stage IV

In stage IV, the cancer has spread to distant sites, such as the inside of the liver, the lungs, or bone. This stage is not able to be cured with current treatment, but it can still be treated. The goals of treatment are to help patients feel better and live longer. Stage IV can be treated like stage III -- with surgery to remove the tumor and debulk the cancer, followed by chemotherapy (chemo). Another option is to treat with chemo first. Then, if the tumors shrink from the chemo, surgery may be done. This is often followed by more chemo. Another option is to limit treatment to those aimed at improving comfort (that don't attack the cancer). This type of treatment is called palliative, and is discussed in more detail in the next section.

Recurrent or persistent ovarian cancer

Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). Persistent tumors are those that never went away completely after treatment. Advanced epithelial ovarian cancer often comes back months or years after the initial treatment.

Sometimes, more surgery is recommended. Most patients with recurrent or persistent ovarian cancer are treated with some form of chemotherapy. Which chemotherapy drugs are used depends on what was used the first time and how well it worked (how long the cancer stayed away). The longer it takes for the cancer to come back after treatment, the better the chance that additional chemotherapy will work. If it has been at least 6 months since any chemotherapy, the patient may be treated with carboplatin/paclitaxel (again). Giving carboplatin with another drug is also an option.

If the cancer comes back in less than 6 months (or if it never went away at all), different chemotherapy drugs usually will be tried. Some women may receive several different chemotherapy regimens over several years. Many chemotherapy drugs can be used to treat ovarian cancer. Altretamine, bevacizumab, cyclophosphamide, docetaxel, gemcitabine, ifosfamide, irinotecan, liposomal doxorubicin, melphalan, oxaliplatin, topotecan, and vinorelbine are all active against ovarian cancer. In addition, some patients benefit from hormonal treatment with drugs like anastrozole, letrozole, or tamoxifen. Someone who didn't initially receive chemotherapy can be treated with the same drugs that are used for newly diagnosed cancer -- usually carboplatin and paclitaxel (Taxol).

A clinical trial for new treatments may provide important advantages for women with recurrent or persistent ovarian cancer. Ask your cancer care team for information about suitable clinical trials for your type of cancer.

High-dose chemotherapy with stem cell rescue (sometimes known as bone marrow transplant) has been used for women with recurrent or persistent ovarian cancer. This treatment has very serious side effects, however, and has not been proven to help patients live longer. It is best done as part of a clinical trial that is studying improvements to this procedure.

Palliative treatments: A common problem that can occur in women with ovarian cancer is the build up of fluid in the abdomen. This is called ascites. It be very uncomfortable but can be treated with a procedure called paracentesis. After the skin is numbed, a needle is used to withdraw the fluid, usually about 2 to 4 quarts, into a bottle. This will often need to be repeated from time to time. Sometimes chemotherapy injected directly into the abdomen will be recommended. All these treatments can extend life and relieve symptoms for some patients. Often, however, their effects are temporary, and the cancer returns or persists.

Ovarian cancer can also cause the intestinal tract to become blocked. This is called obstruction, and can cause abdominal pain, nausea, and vomiting. Dealing with an intestinal blockage can be difficult. Often, the cancer has grown so much in the abdomen that surgery to unblock the intestine doesn't work. To help make the patient comfortable, doctors may place a tube through the skin and into the stomach to allow the stomach juices to drain, so that the digestive tract is not completely blocked. This can help with pain, nausea, and vomiting.

Last Medical Review: 08/27/2009
Last Revised: 08/27/2009