Treatment options

Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health professionals, called a multidisciplinary team. 

If you’re suspected of having ovarian cancer, you should be referred to a gynaecological oncologist. Research shows survival for women with ovarian cancer is improved when a gynaecological oncologist looks after their treatments. 

Treatment for ovarian cancer depends on: 

• the stage of the disease 
• the location of the cancer 
• the severity of symptoms 
• your general health and wishes. 

Many women have advanced disease when they are diagnosed. This is because there is no screening test to detect ovarian cancer, and because early-stage ovarian cancer may not show any obvious symptoms.^[6] 

In advanced (metastatic) ovarian cancer, cancer cells have spread in the bloodstream or lymphatic system to other areas of the pelvis, or to tissues and organs outside the pelvis. Stages II, III and IV of ovarian cancer are treated as advanced cancers. 

Treatment may involve the following. 

Surgery

Surgery is usually the initial treatment for ovarian cancer. Depending on the stage of the cancer, surgery may remove: 

• one ovary and attached fallopian tube (unilateral salpingo-oophorectomy) 
• both ovaries and both fallopian tubes if the cancer is in both ovaries (bilateral salpingo-oophorectomy) 
• the uterus, called a hysterectomy 
• the omentum (fatty tissue around the organs in the abdomen)  
• lymph nodes.  

In advanced cases, surgery aims to reduce the bulk (size) of the tumours, so no visible cancer remains. This is called maximal tumour resection or cytoreductive/debulking surgery. Women have a better prognosis and survival when there is no visible cancer and the surgery is followed by chemotherapy.  

If the cancer has spread to other organs, these will probably need to be surgically removed as well. Other organs and tissues include: 

• intestines and stomach 
• bladder 
• diaphragm 
• liver, spleen, gall bladder, appendix and pancreas  
• peritoneum (the membrane lining the walls of the abdomen and pelvis).  

If the cancer is very advanced, maximal resection will not be possible. Other conditions (comorbidities) such as pre-existing heart, lung or other medical conditions may mean that anaesthetic and surgery is not a good option. Chemotherapy may be needed to shrink the tumours. 

If both ovaries are removed during surgery, you will go through menopause (i.e. your menstrual periods will permanently stop) and may experience symptoms associated with it. These can include hot flushes, night sweats, vaginal dryness and mood swings. 

Chemotherapy

Most women with ovarian cancer will have post-operative (adjuvant) chemotherapy to eliminate any cancer that remains after surgery. 

For some women with stage III or IV ovarian cancer, chemotherapy before surgery (neoadjuvant chemotherapy) may be used to shrink the tumours before surgery to allow a successful resection.  

Chemotherapy is prescribed by a medical oncologist, and it is usually administered intravenously. In women with advanced or stage IV ovarian cancer, chemotherapy is the main treatment used to slow the growth of the cancer and improve the survival. 

Radiation therapy

Along with surgery, some people may receive radiation therapy. 

This treatment is not commonly used to treat ovarian cancer, but it can be used to help relieve symptoms caused by the cancer or when it has come back after treatment (recurred). 

Targeted therapy

Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells.  

Some women with advanced ovarian cancer might get offered treatment with bevacizumab and PARP-inhibitors such as olaparib and niraparib. 

Bevacizumab is a monoclonal antibody that belongs to a class of medicines known as angiogenesis inhibitors. These medicines prevent the formation of new blood vessels that are needed for the cancer to grow and spread. 

PARP inhibitors are a type of targeted treatment that is used to treat some cancers in people with mutations in BRCA genes. BRCA genes are involved in repairing damaged DNA and normally work to slow tumour growth. PARP-inhibitors, act by preventing tumour cells with a mutation in a BRCA gene from repairing themselves. 

Bevacizumab and PARP-inhibitors both shrink or slow the growth of advanced epithelial ovarian cancers. 

Hormone therapy

Hormone therapy, which uses hormones or medicines that block the action of hormones, is more likely to be used for ovarian stromal tumours than for epithelial ovarian cancer. 

Hormone therapies for ovarian cancer include: 

• luteinising-hormone-releasing hormone (LHRH) agonists 
• tamoxifen  
• aromatase inhibitors.  

These therapies prevent oestrogen from stimulating cancer cell growth – that is, they either reduce the levels of oestrogen or act as anti-oestrogens. 

Follow-up

Follow-up after treatment for ovarian cancer: 

• checks whether the treatment worked 
• helps to manage side effects of treatment  
• identifies whether the cancer has come back (recurred 
• gives you an opportunity to talk about psychological and emotional issues.  

The type and timing of follow-up will be determined by the woman and her doctor, and may include a physical examination of the pelvic area, blood tests and imaging. 

Recurrent cancer

Ovarian cancer can recur (come back) after treatment. The cancer can recur in the pelvis or somewhere else in the body. 

You may have signs and symptoms of recurrence of the cancer, or the recurrence might be detected during blood tests without producing any symptoms. 

Treatment options for recurrent ovarian cancer include surgery, chemotherapy and targeted therapy. The type of treatment that is used will depend on: 

• the type of recurrence 
• the time since the first treatment  
• whether you have previously had chemotherapy. 

Supportive Care

Supportive care forms an important component of managing advanced ovarian cancer. The aim of supportive care is to improve the quality of life of patients, by either preventing or treating symptoms caused by the cancer or it’s treatment.  Supportive care includes physical, psychological, social, and spiritual support for patients and their families. Symptoms arising from the cancer and its treatment may include pain, nausea, abdominal bloating, bowel obstruction and weight loss. These  can be managed by the treatment team, together with a pain specialist or palliative care specialist to improve quality of life.