Sisterhood Ovarian Cancer Foundation

Improving the Lives of Those Affected by Ovarian Cancer

Most Common Treatments

Three forms of treatment for ovarian cancer are most common:

  1. Surgery to remove cancerous tissue.
  2. Chemotherapy to destroy cancer cells using strong anti-cancer drugs.
  3. Radiation to destroy cancer cells by high-energy radiation exposure.

There are also various combinations of these treatment methods that are used; therefore it is often recommended to get a second opinion before selecting and entering into a specific program. Treatment depends upon a numerous factors (i.e. stage and grade of the disease, the patient's age and overall health).

Surgery

Surgery usually is required to treat ovarian cancer. Most patients undergo surgery in addition to another form of treatment (e.g., chemotherapy and/or radiotherapy). Surgery often helps the physician to accurately stage the tumor, make a diagnosis, and perform debulking (removal of as much tumor mass as possible). Debulking surgery is especially important in ovarian cancer because aggressive removal of cancerous tissue is linked with improved survival. Patients with no remaining tumor mass, or tumor masses that measure less than 1cm, have the best opportunity for cure. The surgeon often performs a laparotomy (through an abdominal incision) or laparoscopy (using a tube containing a light and camera that is inserted into the pelvic cavity through a small incision).   A sample of the tumor is examined immediately under a microscope to confirm ovarian cancer and rule out metastasis from another site.  If the cancer is a metastasis from another organ, the surgeon searches for the primary tumor within the abdominal cavity.

Once ovarian cancer is confirmed, a total hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries on both sides), omentectomy (removal of the fatty tissue that covers the bowels), lymphadenectomy (removal of one or more lymph nodes) may be performed. Tissue removed during debulking is sent for histopathological examination.

Chemotherapy

Chemotherapy involves using drugs to destroy cancer cells. Many of these drugs destroy cancer cells by preventing them from growing and dividing rapidly. Unfortunately, many normal cells also divide rapidly and are damaged by chemotherapy as part of the process.

During treatment, damage to these cells (e.g., hair follicles, red and white blood cells, platelets [blood cells responsible for clotting], cells that line the gastrointestinal tract) may cause the following:

  • Anemia (decreased number of red blood cells, which may cause fatigue, dizziness, and shortness of breath)
  • Gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)
  • Leukopenia (decreased number of white blood cells, which may cause infection)
  • Temporary hair loss
  • Thrombocytopenia (decreased number of platelets, which may cause bleeding)

Researchers have developed some medications that may help to minimize some of these side effects and others are in the process of being tested. 

Methods
There are four ways to administer chemotherapy. The most common method is intravenous (through a vein) injection. Other methods include intraperitoneal (into the abdominal cavity) injection, oral administration (by mouth), and intramuscular (into a muscle) injection.

Many chemotherapy drugs are given by intravenous injection over a 3-week treatment period, allowing normal cells to recover from the effects of the drugs. Also, because different chemotherapy drugs affect different phases of the cancer cell cycle, combinations of the drugs may be used. Combination chemotherapy helps to increase the cancer-fighting potential of treatment and also helps to keep cancer cells from becoming resistant to individual drugs.

The frequency, dosing, and choice of chemotherapies are determined by a number of factors (e.g., the type of ovarian cancer, the patient's response to and recovery from chemotherapy, the overall health of the patient).

The intraperitoneal method for delivery has been shown to increase survival in patients with Stage III ovarian cancer who have undergone surgery. In this treatment, high doses of chemotherapy drugs are infused directly into the abdominal cavity through a catheter to destroy remaining cancer cells. These drugs eventually enter the bloodstream and may destroy any cancer cells that have spread.

Intraperitoneal chemotherapy usually is administered in 6 cycles, approximately every 3 weeks. Side effects of treatment, which can be severe and include abdominal pain, bloating, fatigue, and infection, sometimes prevent patients from completing all 6 cycles.

Intravenous injection of chemotherapy may be performed on an outpatient basis or, if it takes place over several days, the patient may be admitted to the hospital. In some cases, a catheter (flexible tube) may be placed in a vein in the chest or neck for administration of the drugs. The catheter may be implanted within the skin (e.g., Mediport catheter) or remain external (e.g., Groshong catheter).

Oral drugs may be given in pill form for first- or second-line ovarian cancer treatment.

Radiation

Radiotherapy, otherwise known as radiation therapy, is not a common treatment for ovarian cancer in the United States. This is because many American women are diagnosed with late-stage cancers that have spread widely within the abdominal cavity (see also Signs of Ovarian Cancer). To be effective, radiotherapy must include all cancer cells within the radiation field, and abdominal organs like the liver, kidneys, and small bowel may not be able to withstand the doses of radiation required to destroy all tumorous tissue. Yet if the ovarian cancer is confined to one or both ovaries without spread to abdominal organs or pelvic lymph nodes, radiotherapy may be an option.

Radiotherapy may be used to kill cancer cells from a cyst that ruptures during surgical removal of an ovary, or it may be used to treat certain patients who appear cancer-free or who have only microscopic evidence of disease at second-look surgery. It is historically the treatment of choice for germ cell tumors known as dysgerminomas. However, recently it has been found that chemotherapy can cure a percentage of such patients.

Radiotherapy uses high-energy, ionizing radiation (e.g., gamma rays) to kill cancer cells. Radiotherapy can be delivered in two ways: (1) by a radiotherapy device, which is used outside of the body in a manner similar to that of an x-ray machine, and (2) by injection of a short-lived radioactive chemical (e.g., radioactive phosphorus) into the peritoneal cavity.

Because cancer cells usually multiply faster than most bodily tissues, they are especially affected by radiation, which prevents cell division and the formation of DNA (human genetic material). Yet the bodily tissues that also divide rapidly—such as the lining of the digestive tract, hair, and skin—are particularly vulnerable to radiotherapy. The specific side effects of abdominal (injected) radiotherapy include: abdominal pain, nausea, diarrhea, inflammation of the peritoneum (tissue that lines the abdominal cavity), formation of abdominal adhesions (fibrous bands), obstruction of the small bowel, and lowered blood counts. If radiotherapy is applied externally by a radiotherapy device, side effects may include skin irritation, edema (swelling), and skin darkening at the treatment site.

 

                                                                                                                                                    *information obtained from the Mayo Clinic

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