The surgery can include a hysterectomy (removal of the uterus), bilateral salpingectomy (removal of the fallopian tubes), bilateral oophorectomy (removal of both ovaries) and an omentectomy (removal of part of the omentum, which is fatty tissue from the upper part of the abdominal cavity near the stomach and intestines).

During surgery, tissue samples of organs, omentum, lymph nodes, and the lining surfaces of the pelvic and abdominal cavities may be collected and sent to the laboratory for microscopic examination. This is done to find out if the cancer has spread.

Even if the cancer has not spread, if it turns out to be grade 2 or 3, chemotherapy may be recommended - especially if it is grade 3. The chemotherapy will usually be a platinum compound and paclitaxel. Anywhere from 3 to 6 courses of treatment will be given.

Sometimes, if a woman has a well-differentiated ovarian cancer and wants to have more children, the affected ovary and fallopian tube may be the only organs removed during surgery.

Grade 3 cancers are treated the same as stage IC cancers (see next paragraph).

Stage IC: For stage IC (or grade 3) cancer, surgery, as described for stages IA and IB, is the main treatment of choice. However, chemotherapy will be added, usually 3 to 6 courses of treatment with a platinum compound and paclitaxel.

Stage II (including IIA, IIB, IIC): Not many tumors are diagnosed at this stage. In such cases, the same type of surgery as described for stage I is done.

As much of the tumor in the pelvis should be removed as possible. This is called "debulking."

Additional (adjuvant) treatment will consist of combination chemotherapy or, less often, radiation therapy. Although in the past,radioactive phosphorus into the peritoneum was sometimes used, most doctors today prefer chemotherapy as adjuvant treatment.

Stage III and IV: For stages IIIA, IIIB, IIIC, and IV, the options are the same. Initial surgical treatment is usually the same as for 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 tumor also will be debulked. This means that its size will be reduced as much as possible. The smaller the remaining tumor, the better the outlook will be for the patient's future. Most surgeons try to leave behind no tumor larger than 2 cm (about 3/4 inch), but less residual cancer is even better. Sometimes this kind of surgery will require removing parts of the intestinal tract. After recovery from surgery, combination chemotherapy will be used. The combination used most often is carboplatin (or cisplatin) and a taxane, such as paclitaxel, usually for 4 to 5 months.

After surgery, during chemotherapy, and after chemotherapy, blood tests will be given to determine if you have normal levels of a tumor marker called CA-125. If CA-125 levels (normal is usually less than 35) and results of imaging studies (such as CT scans or sonograms) are normal, your cancer care team may want to do a "second-look" surgery (laparoscopy and/or laparotomy).

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 your 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 whether more radiation therapy or chemotherapy treatment is needed.

"Second-look" operations have not been shown to lead to improved outcomes. Because of this, they are not recommended as a standard part of ovarian cancer care but are usually done as part of clinical trials. In a clinical trial of new treatments, the second-look operation may be worthwhile to help determine how effective the new treatment is.

Recurrent or persistent ovarian cancer: Recurrent tumors are those that come back after the initial treatment. Persistent tumors are those that never disappeared even after treatment. If epithelial ovarian cancer recurs after initial treatment over a period of months or years, you may be offered additional surgery, followed by combination chemotherapy. Follow-up treatment like this is usually less successful than the initial treatment. However, if the initial disease-free period was long (a few years), there may be a good response to a second course of treatment.

The most common problems that can occur in women with recurrent ovarian cancer are fluid accumulation in the abdomen and blockage of the intestinal tract. Fluid in the abdomen is 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.

Dealing with the intestinal blockage can be harder. Often the cancer has grown within the abdomen so much that surgery cannot fix the problem. Doctors can place a tube through the skin and into the stomach to help relieve painful accumulation of fluid inside the digestive tract. At this point, the main concern is usually to relieve pain and keep the patient comfortable.

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 should only be done as part of a clinical trial that is studying improvements to this procedure.

Revised: 09/08/2004