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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 faulty gene, your general health and fitness, and your doctors’ recommendations.
In most cases, surgery is the main treatment. Surgery for ovarian cancer is complex. It is recommended that you have it performed by a gynaecological oncologist at a hospital that does a lot of these operations (high-volume centre).
|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; in some cases, radiation therapy is offered|
|germ cell||usually treated with surgery or chemotherapy or both|
|stromal cell||usually treated with surgery, sometimes followed by chemotherapy or targeted therapy|
|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. This is because there are only a few treatment plans for ovarian cancer that have been proven to be effective. Research is continuing into ovarian cancer treatments and, in some cases, you may be able to join a clinical trial to access new treatments.
Surgery for ovarian cancer allows your gynaecological oncologist to confirm the diagnosis of ovarian cancer and work out how far the cancer has spread. They will also remove as much of the cancer as possible. This may involve several procedures during the operation.
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 bikini line). The type of surgery you have will depend on how certain the gynaecological oncologist is that cancer is present and how far they think the cancer has spread. A laparoscopy may be used to see if a suspicious mass is cancerous; if the cancer is advanced, you will usually have a laparotomy.
Taking a biopsy
The gynaecological oncologist will look inside your pelvis and abdomen for signs of cancer, and take tissue and fluid samples (biopsy). During the operation, the samples may be sent to a specialist called a pathologist, who checks them right away for signs of cancer. This is called a frozen section analysis or biopsy.
If cancer is present, the operation will continue and as much cancer as possible will be removed. This is called debulking. The surgeon usually has to remove 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 intestines 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. 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.
It may not be possible to remove all the cancerous tissue during the operation, but surgery for ovarian cancer is often followed by other treatments to shrink or destroy any remaining cancer cells.
What to expect after surgery
When you wake up from surgery, you will be in a recovery room near the operating theatre. 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 – After an operation, it is common to feel some 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)
- a local anaesthetic injection into the abdomen (a transverse abdominis plane or TAP block) or into the spine (an epidural)
- a 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 the medicine. Managing your pain will help you to recover and move around more quickly.
Injections – It is common to have daily injections of a blood thinner to reduce the risk of blood clots. These injections may continue for some time after the operation and while you’re having chemotherapy. A nurse will show you how to give this injection to yourself before you leave hospital.
Compression devices and stockings – You will need to use compression devices or wear elastic stockings to keep the blood in your legs circulating. Once you are able to move around, compression devices will be removed so you can get out of bed, but you may still wear the stockings for a couple of weeks.
Wound care – You can expect some light vaginal bleeding after the surgery, which should stop within two weeks. Your doctor will talk to you about how to keep the wound clean once you go home to prevent it becoming infected.
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 probably stay in hospital for several days after a big operation. Your hospital stay will usually be shorter after a laparoscopy or smaller 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 a social worker if it’s possible to get help at home. In most cases, you will be able to fully return to your usual activities after 4–8 weeks.
Rest – 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 or heavy work (e.g. gardening) for at least four weeks. Use a clothes horse or dryer until it’s comfortable to hang out your washing on a line.
Driving – You will most likely need to avoid driving for a few weeks after the surgery. Check with your car insurer for any conditions regarding major surgery and driving.
Work – Depending on the nature of your work, you will probably need several weeks off work.
Bowel problems – You may have constipation after the surgery and when you are taking strong painkillers. It is important to avoid straining when passing a bowel motion, so your doctor may advise you to take laxatives and drink plenty of fluids.
Nutrition – To help your body recover from surgery, focus on eating a balanced diet (including proteins such as lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds and legumes/beans).
Exercise – Your health care team will probably encourage you to start walking the day after the surgery. Exercise may help manage some side effects and speed up a return to usual activities. Start with a short walk and go a little further each day. Because of the risk of infection, avoid swimming for 4–6 weeks after surgery.
Sex – Sexual intercourse should be avoided for about six weeks after the operation to give your wounds time to heal. Ask your doctor when you can have sexual intercourse 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 of ovarian cancer, the stage of the disease and the amount of any remaining 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. Chemotherapy may be used at different times:
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 provide details about your specific schedule.
Before surgery – For stage 3 or 4 ovarian cancer, chemotherapy is sometimes given before surgery (neoadjuvant chemotherapy). The aim is to shrink the tumours to make them easier to remove. This usually involves three cycles of chemotherapy, followed by surgery, and then another three cycles.
Primary 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. Let your oncologist know if you are taking nutritional or herbal supplements as these can interact with chemotherapy and may lessen the effect.
In most cases, the drugs are delivered into a vein (intravenous drip). 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 disease 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.
Blood tests during chemotherapy
Before each chemotherapy session, you will have blood tests to ensure your body’s healthy cells have had time to recover. If your blood count has not recovered, your doctor may delay treatment.
In some cases, you may also have blood tests during treatment to check your tumour markers, such as CA125. If the CA125 level was high before chemotherapy, it can be monitored to see 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 – Your red blood cell level may drop (anaemia), which can cause you to feel tired and short of breath. Fatigue is very common during and after cancer treatment, and can also be caused by many other factors.
Nausea and vomiting – Some types of chemotherapy drugs may make you feel sick (nauseous) or vomit. You will generally 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. If you are constipated, they may recommend taking laxatives.
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 painkiller 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 and flu 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. The hair will grow back after treatment is completed, but the colour and texture may change for a while. If you choose to wear a wig until your hair grows back, you can call Cancer Council 13 11 20 to ask about wig services in your area. If you have private health insurance, check whether your provider offers a rebate if you buy 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 get inside cancer cells and block specific particles (molecules) that tell the cancer cells to grow. These drugs are used to treat some types of ovarian cancer. They may also be used in certain situations (e.g. if chemotherapy has not been successful). Genetic testing will help show if you have a particular faulty gene that may respond to targeted therapy drugs.
Bevacizumab is a targeted therapy drug sometimes used to treat advanced epithelial tumours. It is given with chemotherapy every three weeks as a drip into a vein (intravenous infusion).
Olaparib is a targeted therapy drug occasionally used for ovarian cancer. You may be offered this if you have a high-grade epithelial ovarian cancer that has come back after initial treatment and has a BRCA1 or BRCA2 gene mutation. This drug is usually given after chemotherapy to help stop the cancer growing. It is taken as a tablet twice a day for as long as it appears to be helping control the cancer. This is known as maintenance treatment.
Other targeted therapy drugs may be available on clinical trials. Talk with your doctor about the latest developments and whether you are a suitable candidate.
Side effects of targeted therapy
Although targeted therapy minimises harm to healthy cells, it can still have side effects. It is important to discuss any side effects with your doctor right away. If left untreated, some can become life-threatening. Your doctor will monitor you throughout treatment.
The most common side effects of bevacizumab include bleeding, wound-healing problems, high blood pressure and kidney problems. In very rare cases, small tears (perforations) may develop in the bowel wall.
The most common side effects of olaparib include nausea, fatigue, vomiting and low blood cell counts. More serious side effects include bone marrow or lung problems.
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 be an effective treatment for ovarian cancer.
International clinical trials are continuing to test immunotherapy drugs for 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, or on its own as a palliative treatment.
Before treatment starts, the radiation oncology team will explain the treatment schedule and the possible side effects. For each radiation therapy session, you will lie on a treatment table under a 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.
The number of radiation therapy sessions you have will depend on the type and size of the cancer. You may have a few treatments or daily treatment 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.
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 of 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 chemotherapy and radiation therapy. If you have swelling and are uncomfortable, you may have a procedure called paracentesis or 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 provides support to families and carers.
This information is reviewed by
This information was last reviewed April 2020 by the following expert content reviewers: A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecologic Oncologists, TAS; Dr Robyn Cheuk, Senior Radiation Oncologist, Royal Brisbane and Women’s Hospital, QLD; Kim Hobbs, Clinical Specialist Social Worker, Gynaecological Cancer, Westmead Hospital, NSW; Sonja Kingston, Consumer; Clinical A/Prof Judy Kirk, Head, Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, and Sydney Medical School, The University of Sydney, NSW; Prof Linda Mileshkin, Medical Oncologist and Clinical Researcher, Peter MacCallum Cancer Centre, VIC; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Support Team, Ovarian Cancer Australia; Emily Stevens, Gynaecology Oncology Nurse Coordinator, Department of Obstetrics and Gynaecology, Flinders Medical Centre, SA; Dr Amy Vassallo, Fussell Family Foundation Research Fellow, Cancer Research Division, Cancer Council NSW; Merran Williams, Consumer.