Speak to a qualified cancer nurse
Call us on 13 11 20
Avg. connection time: 25 secs
Treatment for ovarian cancer
The treatment for ovarian cancer depends on the type of ovarian cancer you have, the stage of the cancer, whether you wish to have children, whether you have a gene fault, your general health and fitness, and your doctors’ recommendations.
Ovarian cancer is most often treated with surgery and chemotherapy, either on their own, or in combination. Whether you have surgery or chemotherapy first will depend on several factors. Targeted therapy drugs may be offered if you have certain genes changes in your tumour and/or if you have advanced cancer that could not be completely removed with surgery.
|epithelial – stage 1||usually treated with surgery alone; may be offered chemotherapy after surgery if there is a high risk of the cancer coming back|
|epithelial – stages 2, 3 and 4||usually treated with a combination of surgery and chemotherapy; new targeted therapy drugs are being offered to people with a BRCA gene fault; rarely, radiation therapy is offered|
|stromal cell||usually treated with surgery, sometimes followed by chemotherapy or targeted therapy|
|germ cell||usually treated with surgery or chemotherapy or both|
|borderline tumour||usually treated with surgery only|
Other treatment options
Some women with ovarian cancer may feel that they are not given as many options for treatment as there are for other types of cancer. Currently there are several treatment options for ovarian cancer that have been proven to work. Research is continuing into treatments for ovarian cancer.
In some cases, you may be able to join a clinical trial to access new treatments that are being investigated.
Surgery for ovarian cancer is complex. It is recommended that a gynaecological oncologist who is at a hospital that does a lot of these operations (high-volume centre) performs the surgery. Visit the Australian Society of Gynaecologic Oncologists Inc. to find a gynaecological oncologist near you.
Surgery allows your gynaecological oncologist to confirm the diagnosis of ovarian cancer and work out how far the cancer has spread.
Your gynaecological oncologist will talk to you about the most suitable type of surgery, as well as the risks and side effects. These may include infertility. If having children is important to you, talk to your doctor before surgery and ask for a referral to a fertility specialist.
How the surgery is done
You will be given a general anaesthetic and will have either a laparoscopy (with 3–4 small cuts in your abdomen) or a laparotomy (with a vertical cut from around your bellybutton to your pubic line). A laparoscopy may be used to see if a suspicious mass is cancerous; if the cancer is advanced, you will usually have a laparotomy.
Having a surgical biopsy
You may have a biopsy during surgery if you cannot have an image-guided biopsy, or to remove and check a suspicious tumour. The tissue samples are sent to a pathologist, who checks them for signs of cancer. The results will help decide if you need debulking surgery.
If cancer is found, the surgeon will remove as much cancer as possible. This is called debulking or cytoreductive surgery. You may also have chemotherapy before or after surgery.
Debulking usually means removing the ovaries, fallopian tubes, uterus and cervix. Depending on how far the cancer has spread, other organs or tissue may also be removed during the same operation.
Omentectomy – The omentum is a sheet of fatty tissue that hangs down in front of the large bowel like an apron. If the cancer has spread to the omentum, it will need to be removed.
Lymphadenectomy – Cancer cells can spread from your ovaries to nearby lymph nodes. Your doctor may suggest removing some in a lymphadenectomy (also called lymph node dissection).
Colectomy – If cancer has spread to the bowel, some of the bowel may need to be removed. Rarely, a new opening called a stoma might be created (colostomy or ileostomy).
Removal of other organs – Ovarian cancer can spread to many organs in the abdomen. In some cases, parts of the liver, diaphragm, bladder and spleen may be removed if it is safe to do so.
Types of surgery
If ovarian cancer is found, all or some of the reproductive organs will be removed. The type of surgery you have will depend on how certain the gynaecological oncologist is that cancer is present and where the cancer has spread.
Total hysterectomy and bilateral salpingo-oopherectomy
In most cases, surgery for ovarian cancer means removing the uterus and cervix, along with both fallopian tubes and ovaries.
Removing the uterus will mean you cannot carry a child.
If cancer is found early and it is in one ovary, you may have only one ovary and fallopian tube removed.
This is suggested for some young women who still wish to have children.
What to expect after surgery
When you wake up after the operation, you will be in a recovery room near the operating theatre or in the intensive care unit. Once you are fully conscious, you will be taken back to your bed on the hospital ward. The surgeon will visit you as soon as possible to explain the results of the operation.
Tubes and drips – You are likely to have several tubes in place, which will be removed as you recover:
- a drip inserted into a vein in your arm (intravenous drip) will give you fluid, medicines and pain relief
- a small plastic tube (catheter) may be inserted into your bladder to collect urine in a bag
- a tube may be inserted down your nose into your stomach (nasogastric tube) to drain stomach fluid and prevent vomiting
- tubes may be inserted in your abdomen to drain fluid from the site of the operation.
Pain – As with all major surgery, you will have some discomfort or pain, but this can be controlled. For the first day or two, you may be given pain medicine through a:
- drip into a vein (intravenous drip)
- local anaesthetic injection into the abdominal wall (a transverse abdominis plane or TAP block) or into the spine (an epidural)
- patient-controlled analgesia (PCA) system – you press a button to give yourself a measured dose of pain relief.
Let your doctor or nurse know if you are in pain so they can adjust your medicines to make you as comfortable as possible. Pain that is treated early is better managed. After you go home, you can continue taking pain medicines as needed.
Pain in the shoulder – During a laparoscopy, carbon dioxide gas is used to inflate the abdomen. The gas can irritate nearby nerves. This can cause pain in the lower chest and up into the shoulder area, which is known as “referred pain”. This type of pain can be quite uncomfortable and may last several days. Walking and mild pain medicines can help ease the pain in the shoulder. Applying heat to the area may also help.
Blood clot prevention – You will be encouraged to move around as soon as you can. It is common to be given a daily injection of a blood thinner to reduce the risk of blood clots. Depending on your risk of clotting, you may be taught to give this injection to yourself so you can continue it for a few weeks at home. You may also be advised to wear compression stockings for 2–3 weeks to help the blood in your legs to circulate and avoid clots.
Wound care – You can expect some light vaginal bleeding after the surgery, which should stop within two weeks. Your treatment team will talk to you about how you can keep the wound clean to prevent infection once you go home. If you had part of the bowel removed and have a stoma, a stomal therapy nurse will explain how to manage it.
Length of stay – You will stay in hospital for 1–4 days. How long you stay will depend on the type of surgery you had and how quickly you recover. If you had laparoscopic surgery, you will be able to go home on the first or second day after the operation.
Taking care of yourself at home after surgery
Your recovery time will depend on the type of surgery you had, your general health, and your support at home. If you don’t have support from family, friends or neighbours, ask your nurse or the hospital social worker if it’s possible to get help at home. In most cases, you will feel better within 1–2 weeks and should be able to fully return to your usual activities after 4–8 weeks. Ask your treatment team for more information about your particular circumstances.
Rest up – When you get home from hospital, take things easy and do only what is comfortable. You may like to try meditation or some relaxation techniques to reduce anxiety or tension.
Lifting – Avoid heavy lifting (more than 3–4 kg) or heavy work (e.g. gardening) for at least 4 weeks. This will depend on the method of the surgery.
Work – Depending on the type of work you do, you will probably need time off work. Ask your treatment team how long this might be.
Driving – You will need to avoid driving after the surgery until pain in no way limits your ability to move freely. Discuss this issue with your doctor. Check with your car insurer for any exclusions regarding major surgery and driving.
Eat well – To help your body recover from surgery, eat a well-balanced diet that includes a variety of foods. Include proteins such as lean meat, fish, eggs, milk, yoghurt, nuts, and legumes/beans.
Bowel problems – You may have constipation after having a hysterectomy and taking strong pain medicines. You will probably be offered stool softeners while you’re taking pain medicines and until your bowel movements return to normal.
Exercise – Your treatment team will probably encourage you to walk the day of the surgery. Research suggests that exercise helps manage some treatment side effects and speed up a return to usual activities. Speak to your doctor about suitable exercise and ask for a referral to an exercise physiologist. To avoid infection, it’s best to avoid swimming for 4–5 weeks after surgery.
Sex – Sexual intercourse should be avoided for up to 8 weeks after a hysterectomy. Ask your doctor or nurse when you can have sex again, and explore other ways you and your partner can be intimate, such as massage.
Will I need further treatment after surgery?
All tissue and fluids removed during surgery are checked for cancer cells by a pathologist. The results will help confirm the type of ovarian cancer you have, if it has spread (metastasised), and its stage.
Your doctor should have all the test results within two weeks of surgery. Further treatment will depend on the type, stage and grade of the cancer.
If the cancer is advanced, it’s more likely to come back, so surgery will usually be followed by chemotherapy, and occasionally by targeted therapy. Radiation therapy is recommended only in particular cases.
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim is to destroy cancer cells while causing the least possible damage to normal, healthy cells.
When you have chemotherapy depends on the stage of the cancer. It may be used at different times:
Before surgery – For stage 3 or 4 ovarian cancer, chemotherapy is sometimes given before surgery. This is known as neoadjuvant chemotherapy. The aim is to shrink the tumours to make them easier to remove.
After three cycles of chemotherapy, you will have a CT scan to check how the tumour has responded to the chemotherapy. Your doctor will then decide about having an operation. If you have surgery, you will have another three cycles of chemotherapy afterward. If you do not have surgery, you will continue with a further three cycles of chemotherapy.
After surgery – Chemotherapy is usually given 2–4 weeks after the surgery (adjuvant chemotherapy) as there may be some cancer cells still in the body. For ovarian cancer, the drugs are usually given in repeating cycles spread over 4–5 months, but this can vary depending on the stage of the cancer and your general health. Your treatment team will talk to you about your specific schedule. Some people may have chemotherapy with a targeted therapy drug.
Main treatment – Chemotherapy may be recommended as the main treatment if you are not well enough for a major operation or when the cancer cannot be surgically removed.
Chemotherapy is usually given as a combination of two or more drugs, or sometimes as a single drug.
In most cases, the drugs are injected into a vein (intravenously). To reduce the need for repeated needles, you may receive chemotherapy through a small medical appliance or tube inserted beneath your skin. This may be called a port-a-cath or a peripherally inserted central catheter (PICC), or it may have another name.
You will usually have chemotherapy as an outpatient (also called a day patient), but some people need to stay in hospital overnight.
Occasionally, chemotherapy is given directly into the abdominal cavity – the space between the organs in the abdomen and the walls of the abdomen. This is known as intraperitoneal chemotherapy.
In this method, the drugs are delivered through a tube (catheter) that is put in place during surgery and removed once the course of chemotherapy is over.
Intraperitoneal chemotherapy is used only in specialised units in Australia. It may be offered for stage 3 cancer with less than 1 cm of tumour remaining after surgery. Some studies have shown it may be more effective than giving chemotherapy through an intravenous drip.
Ask your medical oncologist for more information about this type of chemotherapy and the benefits and risks. Some studies are looking at giving heated intraperitoneal chemotherapy (HIPEC) immediately after surgery. This is thought to make the chemotherapy work better.
Blood tests during chemotherapy
You will have blood tests before each chemotherapy cycle, to check your body’s healthy cells have had time to recover. If your blood count has not recovered, which can be common, there maybe a delay before your next treatment.
In some cases, you may also have blood tests during treatment to check for the CA125 tumour marker:
- If your CA125 level was high before chemotherapy, it will be expected to fall as chemotherapy destroys the cancer cells.
- If the CA125 level stays the same or rises during chemotherapy, it may mean the cancer is not responding to treatment.
- If you did not have raised CA125 when you were diagnosed, this blood test won’t be used to monitor if the treatment is working.
Side effects of chemotherapy
Chemotherapy can affect healthy cells in the body, which may cause side effects. Not everyone will have side effects, and they will vary according to the drugs you are given. Your treatment team will talk to you about what to expect and how to manage any side effects.
Fatigue – Fatigue is very common during and after treatment for cancer, but can also be caused by other factors. Your red blood cell level may drop (anaemia), which can cause you to feel tired and short of breath.
Nausea and vomiting – Some types of chemotherapy drugs may make you feel sick (nauseous) or vomit. You will probably be given anti-nausea medicines with each chemotherapy session to help prevent or reduce nausea and vomiting. Whether or not you feel sick is not a sign of how well the treatment is working.
Changed bowel habits – Some chemotherapy drugs, pain medicines and anti-nausea drugs can cause constipation or diarrhoea. Tell your doctor or nurse if your bowel habits have changed.
Joint and muscle pain – This may occur after your treatment session. It may feel like you have the flu, but the symptoms should disappear within a few days. Ask your doctor if taking a mild pain medicine such as paracetamol may help.
Risk of infections – Chemotherapy reduces your white blood cell level, making it harder for your body to fight infections. Colds, flu and viruses may be easier to catch and harder to shake off, and scratches or cuts may get infected more easily. You may also be more likely to catch a serious infection and need to be admitted to hospital. Contact your doctor or go to the nearest hospital immediately if you have one or more symptoms of an infection, such as:
- a temperature of 38°C or above
- chills or shivering
- burning or stinging feeling when urinating
- a severe cough or sore throat
- severe abdominal pain, constipation or diarrhoea
- any sudden decline in your health.
Hair loss – Depending on the chemotherapy drug you receive, you will probably lose your head and body hair. Some treatment centres offer cold caps, which can sometimes reduce the amount of hair loss.
The hair will grow back after treatment ends, but the colour and texture may be different for a while. If you choose to wear a wig until your hair grows back, call Cancer Council 13 11 20 to find out about wig services in your area. If you have private health insurance, check whether they’ll cover the cost of a wig because of hair loss related to chemotherapy.
Numbness or tingling in your hands and feet – This is known as peripheral neuropathy, and it can be a side effect of certain chemotherapy drugs. Let your doctor know if this happens, as your dose of chemotherapy may need to be adjusted.
Targeted therapy drugs can target specific features of cancer cells to stop the cancer growing and spreading. These drugs are used to treat ovarian cancer that has come back or advanced ovarian cancer. Whether you are offered targeted therapy drugs will depend on:
- the type of ovarian cancer you have other treatments you’ve already had and if they’ve worked
- whether you have a particular gene change (fault) that may respond to targeted therapy drugs.
Types of targeted therapy drugs
Olaparib – This targeted therapy drug blocks poly (ADP-ribose) polymerase (PARP), a protein that targets cancer cells that have a BRCA1 or BRCA2 gene fault.
You may be offered olaparib after chemotherapy to treat a high-grade epithelial ovarian cancer. This is known as maintenance treatment. Or you may have olaparib if the cancer has come back (recurred) after initial chemotherapy. Olaparib is taken as a tablet twice a day for as long as the drug appears to be helping control the cancer.
Bevacizumab – This targeted therapy drug is sometimes used to treat advanced epithelial tumours. It is given with chemotherapy every three weeks as a drip into a vein (intravenous infusion). Treatment will continue for 12 months for women first diagnosed with ovarian cancer, or for as long as it’s working if it is used for cancer that has come back.
Other targeted therapy drugs may be available on clinical trials. Talk with your doctor about what new drugs are available and whether you are a suitable candidate.
Side effects of targeted therapy
Although targeted therapy drugs limit damage to healthy cells, they can still have side effects. These vary for each person depending on the drug you are given and how your body responds. It is important to tell your doctor about any new or worsening side effects. If left untreated, some can become life-threatening. Your doctor will monitor you throughout your treatment.
The most common side effects of olaparib include nausea, fatigue, diarrhoea and low blood cell counts. More serious side effects include bone marrow or lung problems.
The most common side effects of bevacizumab include bleeding, skin rash, high blood pressure and kidney problems. In very rare cases, small tears (perforations) may develop in the bowel or stomach wall.
Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer.
In Australia, immunotherapy drugs are currently available as treatment options for some types of cancer, such as melanoma and lung cancer.
At present, immunotherapy has not been proven to help treat ovarian cancer.
International clinical trials are continuing to test immunotherapy drugs for treating ovarian cancer.
You can ask your treatment team for the latest updates.
Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. The radiation is usually in the form of x-ray beams.
Radiation therapy is occasionally used to treat ovarian cancer that has spread to the pelvis or to other parts of the body. It may be used after chemotherapy or surgery to help reduce the symptoms of advanced cancer, or on its own as a palliative treatment.
For each radiation therapy session, you will lie on a treatment table under a large machine that delivers radiation to the affected parts of the body. You will not feel anything during the treatment, which will take only a few minutes each time. You may be in the room for a total of 10–20 minutes for each appointment.
How many radiation therapy sessions you have will depend on the type and size of the cancer and where it is located. You may have a few treatments or daily treatments for a number of weeks.
Side effects of radiation therapy
The side effects of radiation therapy vary. Most are temporary and disappear a few weeks or months after treatment. Radiation therapy for ovarian cancer is usually given over the abdominal area, which can irritate the bowel and bladder. It can also cause infertility.
Common side effects include feeling tired, diarrhoea, needing to pass urine more often and a burning feeling when passing urine (cystitis), and a slight reddening of the skin around the treatment site. More rarely, you may have some nausea or vomiting. If this occurs, you will be prescribed medicine to control it.
Radiation therapy can also have long-term side effects that occur months or years after therapy. This includes scarring of the bladder, vagina and bowel, as well as a very small increase in the risk of cancers in the decades after therapy.
Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. It is best thought of as supportive care.
Many people think that palliative treatment is only for people at the end of their life, but it can help people at any stage of advanced ovarian cancer, even if they are still having active treatment for the cancer. It is about living for as long as possible in the most satisfying way you can.
As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include palliative forms of chemotherapy and radiation therapy. If you have swelling and are uncomfortable, you may have a procedure called paracentesis or an ascitic tap to drain the extra fluid from your abdomen.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, social and spiritual needs. The team also supports families and carers.
This information is reviewed by
This information was last reviewed April 2022 by the following expert content reviewers: Dr Nisha Jagasia, Gynaecological Oncologist, Mater Hospital Brisbane, QLD; Sue Hayes, Consumer; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Health, QLD; Dr Andrew Lee, Radiation Oncologist, Canberra Region Cancer Centre and Canberra Hospital, ACT; A/Prof Tarek Meniawy, Medical Oncologist, Sir Charles Gairdner Hospital, WA; Caitriona Nienaber, Cancer Council WA; Jane Power, Consumer; A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW.