Ovarian cancer treatment consists of surgery followed by chemotherapy in most cases. Some early stage tumors (stage I) may be treated with surgery alone, while some advanced stages (Stage IV) may be better served with chemotherapy prior to surgical intervention.
The ultimate treatment of ovarian cancer depends on a number of factors, including:
- Stage of the tumor
- Size of remaining tumor after surgery
- Overall health status
- Fertility desires
- Grade of the tumor
- Histology or cell type of the tumor
Surgery is generally the primary treatment choice for all women with ovarian cancer unless their overall health status makes this an unsafe option. During the surgical procedure, the stage of the tumor is determined. The surgeon will remove as much tumor as possible and this includes removal of the uterus, ovaries, omentum, lymph nodes, and all visible tumor. This process is called debulking of tumor).
Optimal debulking is achieved If less than 1 centimeter of tumor remains after primary surgery. Dr. Ivy’s surgical approach is to be as aggressive as possible while removing the tumor without compromising safety for the patient. In some instances, achieving optimal debulking may require the removal of other organs such as the spleen or intestines. Reducing tumor size improves the overall effectiveness of chemotherapy.
Most patients will receive chemotherapy after debulking surgery. The standard therapy consists of a combination of a platinum (cisplatinum or carboplatinum) and taxol. Most patients will receive 6 total cycles given at 3-week intervals. The use of intra-peritoneal chemotherapy (chemotherapy delivered directly into the abdomen) has achieved overall longer survival times for patients. This is the standard therapy for optimally debulked Stage III epithelial ovarian cancers.
Other cell types (germ cell and sex cord stromal tumors) are treated with a chemotherapy regimen consisting of bleomycin, etoposide, and cisplatinum. Certain chemotherapy providers have found that a combination regimen similar to that used to fight epithelial ovarian cancer provides similar results. For cancer affecting these cell types, 3-4 cycles of combination chemotherapy are usually given.
Ovarian cancer is exquisitely sensitive to the effects of radiation. However, radiation is rarely used to combat ovarian cancer. This is due to the fact that the cancer is rarely isolated to one specific area and radiation to the whole abdomen would be needed to attempt to cure the cancer. Administering radiation to the whole abdomen results in significant complications and is not well tolerated. Furthermore, studies have shown superior outcomes with the use of the platinum combination chemotherapy regimen when compared to radiation. Given the efficacy of chemotherapy and dangers of delivering radiation to the whole abdomen, radiation’s use is limited to treating site-specific recurrences.