This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

After the tests are done, your doctor will suggest one or more choices for treatment. Think about these without feeling rushed. If there is anything you don't understand, ask to have it explained. The choice of treatment depends largely on the type of cancer and the stage of the disease. If you have not had surgery yet, the exact stage may not be known. In that case, treatment is based on what is known.

Other factors that could play a part in choosing the best treatment plan might include your general state of health, whether you plan to have children, and other personal considerations. Be sure you understand all the risks and side effects of different treatments before you make a decision.

The main treatments for ovarian cancer are surgery, chemotherapy, and radiation therapy. In some cases 2 or even all 3 of these treatments will be used.

Surgery

How much and what type of surgery you have depends on how far the cancer has spread, your health (other than the cancer), and whether or not you still hope to have children. For women of childbearing age who have certain kinds of tumors and whose cancer is in a very early stage, it may be possible to treat the disease without taking out both ovaries and the uterus.

Staging

Surgery for ovarian cancer has 2 main goals. The first goal is to stage the cancer -- to see how far the cancer has spread from the ovary. Staging is very important because ovarian cancers at different stages are treated differently. If the staging isn't done right, the doctor may not give the right treatment.

Usually staging calls for removing the uterus, both ovaries, and both fallopian tubes. The omentum (a layer of fatty tissue that covers the stomach area like an apron) is also removed. Some lymph nodes in the pelvis and belly (abdomen) are taken out to see if they contain cancer. If there is fluid in the abdominal area, it will also be removed.

Debulking

The other goal of surgery is to remove as much of the tumor as possible. This is called debulking. The aim of this surgery is to leave behind no tumors larger than 1 cm. Patients who have had successful debulking surgery have a better outlook than those left with larger tumors after surgery.

It is important that your surgeon is experienced in ovarian cancer surgery. Experts recommend that women see a gynecologic oncologist for surgery. These doctors are specialists who have training and experience in treating ovarian cancer. They know how to stage and debulk ovarian cancer properly. Women with ovarian cancer who don't have the right surgery the first time may need to go back for more surgery later to stage and debulk the cancer.

Most women will stay in the hospital for 3 to 7 days after the operation and can go back to their usual activities within 4 to 6 weeks. Taking out both ovaries and/or the uterus means that you will not be able to become pregnant. It also means that you will go into menopause if you have not done so already.

Chemotherapy

Chemotherapy (often called chemo) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein (IV) or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. This treatment is especially useful when cancer has spread beyond the ovaries.

The drugs can also be given right into the belly (abdomen). This aims the drugs right at the cancer cells and limits the amount reaching the rest of the body and helps to reduce side effects. This is called intraperitoneal (IP) chemotherapy.

The typical course of chemo for epithelial ovarian cancer involves 6 cycles. A cycle is a schedule that allows regular doses of a drug, followed by a rest period. Different drugs have different cycles. Your cancer doctor (oncologist) will prescribe the schedule for your chemo. You will likely get more than one drug. Most oncologists in the United States believe that combination chemo works better for ovarian cancer than one drug alone.

Side effects of chemo

While chemo drugs kill cancer cells, they also damage some normal cells, causing side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Short-term side effects might include the following:

• nausea and vomiting
• loss of appetite
• hair loss
• hand and foot rashes
• kidney damage
• nerve damage
• mouth sores
• an increased chance of infection (from a shortage of white blood cells)
• bleeding or bruising after minor cuts (from a shortage of platelets)
• tiredness (from low red blood cell counts)

Most side effects go away when treatment ends. Hair will grow back, although it may look different. Some side effects, such as menopause and infertility, can be permanent. Rarely, some cancer drugs may cause another cancer to develop. The small chance that this might happen should be weighed against the positive effects of treating the ovarian cancer. Anyone who has problems with side effects should talk with their doctor or nurse as there are often ways to help. To learn more about chemo and its side effects, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.

Radiation therapy

Radiation treatment uses high energy x-rays to kill cancer cells or shrink tumors. The radiation may come from outside the body or from radioactive materials placed into or near the tumor. Radiation is only rarely used in this country as the main treatment for ovarian cancer.

Radiation treatment may cause side effects. The skin in the area treated may look and feel sunburned. The skin returns to normal within 6 to 12 months. Many women also feel tiredness, nausea, or diarrhea. Be sure to talk with the doctor about any side effects. Often there are ways to help.

Treatment for epithelial ovarian cancer

The treatment for epithelial ovarian cancer depends on how far the cancer has grown. Usually the first option is surgery to remove 1 or both ovaries. The doctor may also advise surgery to remove other female organs. Treatment may include chemo or radiation treatment for early stage cancers. For stage III and IV cancers, the tumor will also be debulked.

Chemo is often given after surgery. If cancer returns after treatment, more surgery and chemo may be given.

After treatment, blood tests will be done to see if your CA-125 tumor marker levels are normal.

Treatment for recurrent or persistent ovarian cancer

When ovarian cancer doesn't go away with treatment (persistent ovarian cancer) or comes back (recurs), more surgery may be recommended. Most patients are then treated with some form of chemo. Which chemo drugs are used depends on what was used the first time and how well it worked (how long the cancer stayed away). If the cancer comes back in less than 6 months (or if it never went away at all), different chemo drugs usually will be tried. A clinical trial for new treatments may be an option for women whose cancer has come back or not gone away. Ask your doctor if there is a clinical trial for your type of cancer.

High dose chemo with stem cell rescue (sometimes known as bone marrow transplant) has been used for women with cancer that has come back or not gone away at all. This treatment has serious side effects. And it has not helped patients to live longer. It should only be done as part of a clinical trial.

Palliative treatments

Palliative treatments are done to help the patient feel better rather than to try to cure the cancer. The most common problems in women whose cancer has come back are fluid build-up and blockage of the intestines. Numbing the skin and putting in a needle to draw off the fluid can give relief. This will often need to be done again from time to time. It can extend life and relieve symptoms for some women.

Dealing with the blocked intestines can be harder. Often the cancer has grown so much that surgery doesn't fix the problem. Doctors can place a tube through the skin and into the stomach to allow the stomach juices to drain off. This can help with pain, nausea, and vomiting. .

Treatment for low malignant potential (LMP) tumors

For LMP (borderline) tumors in women who are done having children, the uterus, ovaries, and the fallopian tubes are removed. If the woman wants to be able to become pregnant in the future, only the ovary with the tumor and the fallopian tube on that side is removed. Rarely, just the ovarian cyst containing the tumor is removed. Chemo and radiation are not used at first for treatment of these tumors, but they may be used if the tumor comes back after surgery. Experts recommend close follow-up with visits at least every 6 months for the first 5 years after the tumors are found.

If the tumor has spread outside of the ovary when it is first found, the surgeon will remove as much of it as possible. Treatment after surgery depends on something called invasion. Invasion is when cells grow into places where they don't belong. When LMP tumors spread, they can form tumor implants on the lining of the belly (abdomen) or on other organs. These implants can be invasive, in which case chemo may be offered. The chemo given is usually the same as the chemo used for invasive ovarian cancer. If the tumors don't grow into the abdominal lining or organs, they are called non-invasive, and the patient has close follow-up without further treatment.

If LMP tumors come back after the first surgery, more surgery, chemo, and (rarely) radiation may be used.

Treatment for germ cell tumors of the ovary

Women with benign germ cell tumors (germ cell tumors that are not cancer) are cured by taking out part or all of the ovary.

The treatment for malignant (cancer) germ cell tumors of the ovary depends on the exact type and the stage of the cancer. Because these tumors are so rare, it is a good idea to see a gynecologic oncologist. Surgery will be used to find out the stage and which organs should be removed. Most women with germ cell cancers will also have chemo.

Sometimes, the doctor might consider taking out only a part of one ovary to allow a woman to keep her ovarian function. Even when both ovaries need to be taken out, a patient may wish to keep her uterus to allow future pregnancy through in-vitro fertilization. The woman should see a gynecologic oncologist in these cases.

Treatment for stromal cell tumors

Most stromal cell tumors are within to the ovary. They are treated and often cured by taking out the ovary with the tumor. Chemo is an option for stromal cell cancers that have spread outside the ovary. Stromal cell cancers may come back years later. Even so, the outlook for the patient can still be good because they grow so slowly. If the tumor returns, more surgery and chemo may be used. Hormone therapy can also help slow or stop the growth of some stromal tumors that have come back after treatment.

Last Medical Review: 09/14/2009
Last Revised: 09/14/2009