Ovarian Cancer - Treatment

Treatment Options: Surgical management for most women in this stage is total hysterectomy, bilateral salpingo-oophorectomy, and removal of as much cancer in the pelvic area as possible (tumor debulking). Surgical staging should be performed.

After the operation, treatment with chemotherapy (e.g., paclitaxel and carboplatin) is usually necessary in an attempt to eradicate residual cancer and decrease the chance for relapse.

Stage III

In stage III, one or both of the following are present: (1) The cancer has spread beyond the pelvis to the omentum (the fatty layer that covers and pads organs in the abdomen) and other areas within the abdomen, such as the surface of the liver or intestine. (2) The cancer has spread to the lymph nodes. The average five-year survival rate for this stage is 20%.

Click the icon to see an image of the lymph system located near the ovaries.

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Treatment Options: Surgical management for most women in this stage is total hysterectomy and bilateral salpingo-oophorectomy and removal of as much cancer as possible (tumor debulking).

Following surgery, chemotherapy (e.g., paclitaxel plus carboplatin) is usually necessary in an attempt to eradicate residual cancer. A number of approaches are under investigation for reducing high rates of recurrence (about 80%), including the following: experimental chemotherapy agents, anti-angiogenic therapies, gene and biological therapies, intraperitoneally administered high-dose chemotherapy, neoadjuvant therapy (chemotherapy before surgery), high-dose chemotherapy and peripheral blood stem cell transplantation (to date this approach has proven to be very toxic with no convincing improvement in survival).

Stage IV

Stage IV is the most advanced. The cancer may have spread to the inside of the liver or spleen. There may be distant metastases, such as ovarian cancer cells in the fluid around the lungs. The average five-year survival rate for this stage is less than 10%.

Treatment Options: Tumor debulking may be performed before chemotherapy.

Although not standard practice in the United States, a surgical procedure called retroperitoneal lymphadenectomy is sometimes performed. This procedure involves removal of aortic and pelvic lymph nodes from the rear of the abdomen. Results from a 2005 randomized controlled trial suggest that while retroperitoneal lymphadenectomy does help reduce cancer progression, it does not prolong survival.

Recurrent Ovarian Cancer

Treatment Options: If ovarian cancer returns, chemotherapy is the mainstay of treatment, although it is not generally curative in the setting of relapsed disease.