Ovarian Cancer Screening- Obstetrics and Gynecology

Ovarian Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.

KEY POINTS

• There are different types of treatment for patients with ovarian epithelial cancer.

• Three kinds of standard treatment are used.

  • Surgery

  • Chemotherapy

  • Targeted therapy

• New types of treatment are being tested in clinical trials.

  • Radiation therapy

  • Immunotherapy

• Treatment for ovarian epithelial, fallopian tube, and primary peritoneal cancer may cause side effects.

• Patients may want to think about taking part in a clinical trial.

• Patients can enter clinical trials before, during, or after starting their cancer treatment.

• Follow-up tests may be needed.

There are different types of treatment for patients with ovarian epithelial cancer.

Different types of treatment are available for patients with ovarian epithelial cancer. Some treatments are standard, and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the treatment currently used as standard treatment, the new treatment may become the standard treatment. Patients with any stage of ovarian cancer may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three kinds of standard treatment are used.

Surgery

Most patients have surgery to remove as much of the tumor as possible. Different types of surgery may include:

• Hysterectomy: Surgery to remove the uterus and, sometimes, the cervix. When only the uterus is removed, it is called a partial hysterectomy. When both the uterus and the cervix are removed, it is called a total hysterectomy. If the uterus and cervix are taken out through the vagina, the operation is called a vaginalhysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

• Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.

• Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.

• Omentectomy: A surgical procedure to remove the omentum (tissue in the peritoneum that contains blood vessels, nerves, lymph vessels, and lymph nodes).

• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavitysuch as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

A type of regional chemotherapy used to treat ovarian cancer is intraperitoneal (IP) chemotherapy. In IP chemotherapy, the anticancer drugs are carried directly into the peritoneal cavity (the space that contains the abdominal organs) through a thin tube.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment used during surgery that is being studied for ovarian cancer. After the surgeon has removed as much tumor tissue as possible, warmed chemotherapy is sent directly into the peritoneal cavity.

Treatment with more than one anticancer drug is called combination chemotherapy.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody that may be used with chemotherapy to treat ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer that has recurred (come back).

Poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) are targeted therapy drugs that block DNA repair and may cause cancer cells to die. Olaparib, rucaparib, and niraparib are PARP inhibitors that may be used to treat advanced ovarian cancer. Rucaparib may also be used to as maintenance therapy to treat ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer that has recurred. Veliparib is a PARP inhibitor that is being studied to treat advanced ovarian cancer.

Angiogenesis inhibitors are targeted therapy drugs that may prevent the growth of new blood vessels that tumors need to grow and may kill cancer cells. Cediranib is an angiogenesis inhibitor being studied in the treatment of recurrent ovarian cancer.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Some women receive a treatment called intraperitoneal radiation therapy, in which radioactive liquid is put directly in the abdomen through a catheter. Intraperitoneal radiation therapy is being studied to treat advanced ovarian cancer.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Vaccine therapy uses a substance to stimulate the immune system to destroy a tumor. Vaccine therapy is being studied to treat advanced ovarian cancer.

Treatment for ovarian epithelial, fallopian tube, and primary peritoneal cancer may cause side effects.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

• Early Ovarian Epithelial and Fallopian Tube Cancer

• Advanced Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer

For information about the treatments listed below, see the Treatment Option Overviewsection.

Early Ovarian Epithelial and Fallopian Tube Cancer

Treatment of early ovarian epithelial cancer or fallopian tube cancer may include the following:

• Hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Lymph nodesand other tissues in the pelvis and abdomen are removed and checked under a microscope for cancer cells. Chemotherapy may be given after surgery.

• Unilateral salpingo-oophorectomy may be done in certain women who wish to have children. Chemotherapy may be given after surgery.=

Advanced Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer

Treatment of advanced ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer may include the following:

• Hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are removed and checked under a microscope to look for cancer cells. Surgery is followed by one of the following:

  • Intravenous chemotherapy.

  • Intraperitoneal chemotherapy.

  • Chemotherapy and targeted therapy (bevacizumab).

• Chemotherapy followed by hysterectomy, bilateral salpingo-oophorectomy, and omentectomy.

• Chemotherapy alone for patients who cannot have surgery.

• A clinical trial with targeted therapy (olaparib, rucaparib, niraparib, or veliparib).

• A clinical trial of hyperthermic intraperitoneal chemotherapy (HIPEC) during surgery.

Treatment Options for Recurrent or Persistent Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer

Treatment of recurrent ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer may include the following:

• Chemotherapy using one or more anticancer drugs.

• Targeted therapy (bevacizumab, olaparib, rucaparib, niraparib, or cediranib) with or without chemotherapy.

• Chemotherapy and/or targeted therapy with bevacizumab.

• A clinical trial of hyperthermic intraperitoneal chemotherapy (HIPEC) during surgery.

• A clinical trial of a new treatment.

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