Treatment of Ovarian Cancer
The goal of treatment for ovarian cancer is to surgically remove as much of the cancer as possible (called “debulking” or “cytoreductive surgery”) and then to provide what is called adjuvant, or additional therapy, such as chemotherapy, to kill any possibly remaining cancer cells in the body. Radiation therapy, which uses high energy rays to kill cancer cells, is not typically utilized in ovarian cancer.
Before surgery, a doctor, preferably a gynecologic oncologist, will explain to a woman the nature of the operation and the extent of tissue that will be removed. During the operation, the doctor will assess how far the tumor has spread, to determine the stage of the cancer, and will give tissue samples to a pathologist, who will determine the grade of the cancer.
After the operation, the doctor will discuss the nature of the chemotherapy that will be given, which will depend on the stage of the disease and how much of the tumor was removed.
- Intraperitoneal chemotherapy is done through a tube in the peritoneum, the abdominal cavity, to destroy cancer in the abdomen or pelvis.
- Systemic chemotherapy is done by mouth or intravenously, through the vein to destroy or control cancer throughout the body.
- Dose dense chemotherapy or weekly chemotherapy is a new approach which improves a woman’s survival
Women will usually have either systemic chemotherapy or systemic chemotherapy and intraperitoneal therapy. A doctor might also offer a woman the possibility of enrolling in a clinical trial, if she meets the criteria for the research study. See Clinical Trials section.
Besides the gynecologic oncologist (or medical oncologist for those women in rural areas who don’t have access to a gynecologic oncologist) taking care of you, a chemotherapy nurse will assist in providing the drug treatment that will attempt to kill remaining cancer cells in the body. The chemotherapy nurse is a very important health care professional in a patient’s life because s/he assesses the side effects of the drugs and helps alleviate them. Side effects are common with chemotherapy and depend on the type and length of treatment. Each woman is different in her response to chemotherapy and the doctor and nurse will explain possible side effects and provide suggestions and treatments about ways to manage them. For more information, see Chemotherapy: Dealing with Side Effects.
Many women want to take an active part in understanding the types of treatment available to them. Knowing as much as possible about ovarian cancer and its treatment helps these women cope. Even if a woman does not want extensive details about treatment, it can be helpful, in any case, to get a sense of how treatment is going to affect your daily life and your normal activities. Making a list of questions before an appointment with a doctor can be useful because the shock and stress of the diagnosis can make it hard to remember things and medical care can be complicated and difficult to understand. Taking notes of the doctor’s responses or having a friend or relative with you during appointments can be helpful.
Here are some questions the National Cancer Institute suggests you might consider asking a doctor early in treatment:
- What is the stage of my disease? Has the cancer spread from the ovaries? If so, to where?
- What are my treatment choices? Do you recommend intraperitoneal chemotherapy for me? Why or why not?
- Would a clinical trial be appropriate for me?
- Will I need more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment? What can we do to control side effects? Will they go away after treatment ends?
- What can I do to prepare for treatment?
- How long will I need to stay in the hospital? Can I get chemotherapy at my local hospital since it is too far to drive to a major medical center?
- What is the treatment likely to cost? Will my insurance cover the cost?
- How will treatment affect my normal activities?
- Will treatment cause me to go through early menopause?
- Will I be able to get pregnant and have children after treatment?
- How often should I have checkups after treatment?
If a woman doesn’t feel comfortable with a doctor or wants to seek a second opinion about her care, she has the right to do so.
Recovery from surgery can take time and chemotherapy is an ordeal, so many women seek support to help them both physically and psychologically during treatment. To emotionally cope with the disease, many women join ovarian cancer support groups, or seek counseling from a social worker, members of the clergy, or from a trusted relative or friend. Many women also develop networks of friends, who bring food to the house or do errands, when she is not feeling up to her usual activities.
With a diagnosis of cancer, some women might opt to try complementary or alternative therapies to help themselves. Complementary therapies are those used along with conventional medicine, while alternative therapy is used in place of conventional care. Acupuncture, massage therapy, herbal products, vitamins, special diets and meditation are examples of these approaches. You should talk with your doctor about treatments you may use because although products, such as herbal teas, are routinely sold, they may interact with cancer drugs and change the drugs’ effectiveness. More and more healthcare facilities these days are offering integrated medical approaches that combine both conventional and complementary therapies for which there is evidence of safety and effectiveness.