Treatment of ovarian cancer
Does everyone get treated in the same way?
There are 3 main types of treatment available; surgery, chemotherapy and radiotherapy, and they are usually used in combinations rather than alone. Which treatment a patient receives depends on the extent, exact type of cancer and how far it has spread as well as the general health of the patient. No treatment combination is necessarily worse than any other so you should not panic if you have received chemotherapy after surgery but someone with a similar stage and grade of cancer had it both before and after. It is important to discuss any concerns about your treatment with your oncologist who will be able to tell you everything you need to know regarding your treatment options and make recommendations based on your cancer.
Surgery
Surgery is an important treatment in ovarian cancer and almost all women with ovarian cancer will need surgery. It is used to make the diagnosis and to determine the type and stage of the disease, and also to remove as much of the cancer as possible (called debulking).
How much surgery is required depends on the extent of the disease and can range from removal of the affected ovary and its fallopian tube (especially in women of child bearing age) to a total hysterectomy (removal of the ovaries, fallopian tubes and uterus) together with nearby lymph nodes and surrounding tissue where the cancer might have spread to. This is complex surgery and, if possible, should be carried out by a gynaecological surgeon who is a specialist in the treatment of female pelvic cancers. Results of recent studies show improved prognosis when surgery is carried out by a gynaecologic oncologist.
If both ovaries and/or the uterus are removed the patient will not be able to conceive naturally and/or carry a pregnancy. Also, removal of both ovaries will cause women to enter the menopause if they have not done so already.
Most women stay in the hospital for 3 to 7 days after the operation and recovery usually takes 4 to 6 weeks. Complications from surgery may include bleeding, infection and bowel and bladder problems.
Second-Look Surgery
After completion of chemotherapy, some doctors recommend additional surgical evaluation, a second look laparotomy, to further evaluate the results of treatment. Second-look laparotomy is the most accurate method of detecting persistent cancer cells when other tests are normal.
Chemotherapy
How It Works
Chemotherapy is the use of drugs to kill cancer cells. It works because cancer cells grow and divide more rapidly than most normal cells and the drugs prevent them from multiplying. Unfortunately, some normal cells also grow and divide at a fast rate and these cells are also susceptible to the effects of chemotherapy. Typical cells affected include hair follicles, the cells which line the digestive tract, red and white blood cells and platelets (blood clotting agents). This can result in side effects such as:
Nausea
Vomiting
Diarrhoea
Hair loss
Hand and foot rashes
Loss of appetite
Kidney or nerve damage
Mouth sores
Tiredness
Anaemia
Leukopenia - decreased numbers of white blood cells which can lead to infection
Thrombocytopenia - decreased numbers of platelets, which may lead to bleeding
Women's experience of side effects vary enormously. The side effects you might experience will depend on:
Which drugs you are given
How much of each drug you are given
How you individually react
How long the treatment lasts
There are drugs available that can help to reduce some of these side effects such as antiemetic drugs which prevent or reduce nausea and vomiting. It may seem like the chemotherapy will never end, particularly if you have many side effects. However, when treatment finishes most of the effects will disappear. For example, hair will grow back although it may look differently than before treatment.
How It Is Given
Chemotherapy drugs are usually given by mouth or injected into a vein or muscle. This is called a systemic treatment because the drugs enter the bloodstream and spreads throughout the body and can kill cancer cells which have moved away from the ovary. Injections can be given in outpatients or may require a stay in hospital.
Chemotherapy can also be delivered directly into the abdomen (intraperitoneal chemotherapy) and most of the drug remains in the abdomen. This aims the drugs at the cancer cells and limits the amount which reaches the rest of the body, thus reducing some of the side effects. To read about recent developments in this area click here
Chemotherapy is usually given in cycles of treatment followed by a rest period. This allows normal cells to recover from the chemotherapy. The typical course of chemotherapy for epithelial ovarian cancer involves 3 to 6 cycles with the degree of response evaluated after each 2 courses. Different drugs have varying cycles. Which drugs are given depends on:
the patient's type of ovarian cancer
cancer stage
the body's response to and recovery from chemotherapy
health statusof the patient
For example, patients with a history of kidney problems will not be given drugs known to cause kidney toxicity.
How It Is Monitored
The effectiveness of the drugs is monitored during treatment in several ways:
CA125 blood tests
CT scans
ultrasound scans
'Second look' surgery
In addition, periodic blood counts will be performed to check the recovery rates of blood cells in the bone marrow (red blood cells, white blood cells, platelets).
After completion of chemotherapy if all of the tests for cancer are negative for cancer, a patient is said to be in a complete clinical remission.
Some of the chemotherapy drugs can cause a life threatening cancer of white blood cells called leukaemia. This secondary malignancy (cancer) rarely occurs and the benefits of chemotherapy for ovarian cancer outweigh the potential risk of developing leukaemia.
Radiotherapy
Radiotherapy uses radiation such as high-energy x-rays to kill cancer cells and shrink tumours. For ovarian cancer 3 types of radiotherapy are available:
External - uses a machine outside the body to focus radiation onto the cancer. It is given 5 days a week for several weeks with each session lasting only a few minutes. Patients are accurately lined up on the machine so that the radiation is aimed accurately at the cancer.
Internal - materials producing radiation (radioisotopes) are put into the affected area
Intraperitoneal - radioactive liquid is placed directly in the abdomen through a catheter
Like chemotherapy, radiotherapy works because cancer cells grow faster than most normal cells. Unfortunately, as with chemotherapy, radiotherapy has side effects because some areas of the body also multiple rapidly. These include hair, skin and the lining of the digestive tract.
Side effects from radiotherapy include:
Tiredness
Nausea
Diarrhoea
Abdominal pain
Obstruction of the small bowel
Skin irritation
Oedema (swelling)
Skin darkening at treatment site
Irritable bladder
Radiotherapy may cause long term side effects to the bladder and bowel.
Radiotherapy is rarely used to treat ovarian cancer but may be used for Stage 1c or stage 2 cancers and to give relief from the symptoms of advanced cancer.
More information regarding specific chemotherapy drugs for initial treatment or recurrent ovarian cancer can be found here shortly.
New therapies
Research into ovarian cancer is constantly ongoing. One of the aims is to improve treatment strategies and a number of these, such as gene therapy and hormone therapy, are in development. These are tested in clinical trials but whether they are better at curing ovarian cancer will not be known for several years.
Gene Therapy
Cancer is thought to result from a number of genetic mistakes in the cells. Some of these are inherited (see familial cancer) but most are caused by exposures to environmental or other factors that can damage DNA, the genetic blueprint of life. Gene therapy is looking into several possibilities:
repairing the damage by putting copies of normal genes into cancer cells
making the cells "commit suicide" in a process called apoptosis
making the cells a target for the immune system to destroy
making the cells more senstive to chemotherapy
Hormone Therapy
The ovaries are sensitive to the actions of hormones and the menstrual cycle is controlled by them. Some ovarian cancers which have become resistant to treatment may respond to hormone therapies. Currently, doctors are investigating the use of hormone treatment but responses have so far been variable and not that effective at managing cancer progression.
Many women who have been through the change of life (menopause) take hormone replacement therapy (HRT). There is currently not enough evidence to say whether HRT is risky or safe for women who have been treated for epithelial ovarian cancer.
Role of clinical trials
Unfortunately the current treatments available for ovarian cancer do not always provide a permanent solution. Scientists and doctors are trying to improve treatment and success rates by creating new drugs that work better with less side effects. Before these become "standard" treatment any potential new drugs have to go through years of testing to ensure they are both safe to take and represent a significant improvement on the current treatment. Clinical trials are the means by which drugs that have shown promise in the laboratory, or are already used to treat other diseases, can be tested. It is important to realise that at each stage of testing doctors are examining whether the new treatment is better than the old so patients will receive the very best care during a trial. Patients can opt for clinical trials as part of thir first treatment or if they have a relapse.
There are 4 types of clinical trials called phases. Before you consider any type of trial you need to understand what each phase hopes to achieve. Click here for a simple explanation of the phases.
For details of current trials, and further information on the issues you should consider before participating in a trial, we recommend you read the information on cancerbackup’s website.You can also go directly to the National Cancer Rearch Network website.