Depending on the stage of the ovarian cancer, the doctor recommends a customised treatment plan which is a combination of:
Surgical treatment may be sufficient for malignant tumours that are well-differentiated and confined to the ovary. In addition, chemotherapy may be required for more aggressive tumours that are confined to the ovary. For patients with advanced disease, a combination of surgical reduction with a combination chemotherapy regimen is standard.
Surgery is the preferred treatment and is frequently necessary to obtain a tissue specimen for differential diagnosis via its histology.
The type of surgery depends upon how widespread the cancer is when diagnosed as well as the presumed type and grade of cancer. The surgeon may remove one ovary and one fallopian tube if the cancer is localised in that ovary (stage one ovarian cancer). This may preserve the ability to become pregnant. If the cancer is in both ovaries and has not spread (stage two ovarian cancer), then both ovaries and fallopian tubes are removed, while the uterus is intact. This may still allow the patient to become pregnant by using frozen embryos or eggs or eggs from a donor. If the cancer has spread to the uterus (stage three ovarian cancer), then along with the ovary removal, the patient may also undergo hysterectomy to remove the uterus, surrounding lymph nodes and a fold of fatty abdominal tissue (omentum).
For more aggressive cases, where the disease has spread to other organs in the abdomen, Cytoreductive Surgery is done (CRS). Ovarian cancer usually spreads through surface to peritoneum that is the inner lining of the abdomen. In CRS all the sites where cancer is present is removed including the peritoneum. In some cases it is followed by HIPEC. For more imformation on HIPEC – read HIPEC.
Chemotherapy has been a general standard of care for ovarian cancer for decades, although with highly variable protocols. Mostly chemotherapy is given after surgery to prevent recurrence. The type and number of cycles depends on the pathology report i.e. the report after checking all the organs that were removed during surgery under microscope. In some cases, there may be reason to perform chemotherapy first, followed by surgery.
Targeted therapy uses medications that target the specific vulnerabilities present within the cancer cells. Targeted therapy drugs are usually reserved for treating recurring ovarian cancer after initial treatment and/or cancer that resists other treatments. The cancer cells are tested to determine which targeted therapy is most likely to be effective.
Targeted therapy is an active area of cancer research. Many clinical trials are testing new targeted therapies.
Radiation therapy is not effective for advanced stages because when vital organs are in the radiation field, a high dose cannot be safely delivered. Radiation therapy is then commonly avoided as the vital organs may not be able to withstand the problems associated.