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. Age alone is not a limiting factor. Studies have shown that older women can take ovarian cancer treatments well. 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 a woman has depends on how far the cancer has spread, her general health, and whether or not she still hopes to have children. Don’t be afraid to ask your doctor to explain your condition and your surgery choices in simple, non-medical terms.

There are several different types of surgery for ovarian cancer. The names of these operations are based on the Greek or Latin names of the organs that are removed. When something is removed, the name of the operation often ends in "--ectomy." So, removing the uterus is a hysterectomy. Because there are two ovaries, we need to show whether one or both have been removed. Removing one ovary is a unitlateral (one side) oophorectomy, and removing both is a bilateral (two sides) oophorectomy. Likewise, removing one or both fallopian tubes is a unilateral salpingectomy or a bilateral salpingectomy.

If both ovaries or the uterus are removed, you will not be able to get pregnant. It also means that you will go through change of life if you haven’t already. Most women will be in the hospital for 3 to 7 days after surgery. Recovery usually takes about 4 to 6 weeks.

If all of the tumor can’t be removed, the surgeon might remove as much as possible in a procedure called debulking (cytroreduction). Most doctors believe this greatly improves a woman’s chance for survival.

Your surgeon should be experienced in ovarian cancer surgery. Many gynecologists are not prepared to do this kind of cancer operation, which calls for careful staging and, perhaps, debulking. For this reason, many doctors refer their patients to doctors with special training called gynecologic oncologists. A gynecologic oncologist is a doctor who works with women who have cancer of the uterus, ovary, breast, or other part of the female system.

Chemotherapy

Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein 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 directly into the abdomen. This approach aims the drugs right at the cancer cells and limits the amount reaching the rest of the body. This helps reduce side effects. Chemotherapy is usually given in cycles of treatment followed by a rest period. Chemotherapy is prescribed by an oncologist (cancer doctor).

While chemotherapy 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. Temporary side effects might include the following:

• nausea and vomiting
• loss of appetite
• hair loss
• hand and foot rashes
• kidney or nerve damage
• mouth sores
• an increased chance of infection
• bleeding or bruising after minor cuts
• tiredness

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 (acute myeloid leukemia) to develop. The small chance that this might happen should be weighed against the positive effects of the drugs in treating ovarian cancer. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.

Radiation Therapy

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

Radiation therapy may cause side effects. The skin in the area treated may look and feel sunburned. The skin returns to normal within six 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 one or both ovaries. The doctor may also advise surgery to remove other female organs. Treatment may include chemotherapy or radiation therapy for early stage cancers. For stage III and IV cancers, the tumor will also be debulked. Debulking means that the tumor will be shrunk as small as possible. Chemotherapy is often given after surgery. If cancer returns after treatment, more surgery and chemotherapy may be given.

After treatment, blood tests will be done to see if your tumor marker levels are normal. If they are normal, your doctor may want to do a “second-look” surgery to see if more treatment is needed. This surgery is usually done by laparoscopy (placing a thin tube with a light on the end into the abdomen). If the surgeon cuts an opening in the stomach, he can take samples of tissue to check for the presence of cancer.

The most common problems that can occur in women whose cancer has come back are fluid build-up and blockage of the intestinal tract. Numbing the skin and inserting a needle to draw off the fluid can relieve fluid build-up. This will often need to be done again from time to time. This can extend life and relieve symptoms for some women.

Dealing with the intestinal blockage 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 relieve fluid build-up in the digestive tract. The goal is to relieve pain and keep the woman comfortable.

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

Treatment for LMP Tumors

For LMP (borderline) tumors, the ovary with the tumor and the fallopian tube on the affected side are usually removed. In certain cases, just the ovarian cyst with the tumor is removed. If the woman might want to become pregnant in the future, and if there appears to be no cancer beyond the one ovary, no further surgery is done at that time.

If the woman is not concerned about being able to have children, the ovaries, the fallopian tubes, and the uterus are removed. Chemotherapy and radiation are not generally used at first for treatment of these tumors, although they may be used if the tumor comes back after surgery.

Treatment for Germ Cell Tumors of the Ovary

Women with benign germ cell tumors are cured by removing part or all of the ovary. It’s a good idea to consult with a specialist since these tumors are so rare.

The treatment for germ cell cancers of the ovary depends on the exact type and the stage of the cancer. Surgery will reveal the stage and which organs should be removed. Most women with germ cell cancers will also have chemotherapy.

Treatment for Stromal Cell Tumors

Most stromal cell tumors are benign, but if a stromal cell tumor is cancer, the doctor will remove as much of the tumor as possible. If the tumor returns, chemotherapy may also be used.

Ovarian Cancer Survival by Stage

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years. Five-year relative survival rates exclude patients dying of other diseases. This means that anyone who died of another cause, such as heart disease, is not counted.

Stage	Five-year Relative Survival Rates
I	80% to 90%
II	65% to 70%
III	30% to 60%
IV	20%

These numbers provide an overall picture, but keep in mind that every person’s situation is unique and the statistics can’t predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your personal chances of a cure, or how long you might survive your cancer. They know your situation best. The numbers above are based on women treated more than 5 years ago. Newer treatments today often have better results.

Revised: 11/9/2004