In developing your treatment plan, your medical team will consider the cancer stage, as well as your age, overall health and personal preferences, which might include fertility preservation. Depending on your needs, you may work with many types of doctors:
- Gynecologists treat diseases of the female reproductive system.
- Gynecologic oncologists specialize in treating cancers of the female reproductive system with surgery, chemotherapy and radiation therapy.
- Medical oncologists use medicine (including chemotherapy) to treat cancer.
- Radiation oncologists use radiation therapy to treat cancer.
It is important for everyone to feel comfortable with their doctors, and that can be especially true for women with gynecologic cancers. You should feel free to seek a second opinion by asking another doctor to confirm your diagnosis and recommend treatment options.
Following are the most common treatment options for ovarian cancers. Surgery is the primary treatment for most ovarian cancers. Genetic testing can now help determine whether certain hormone therapies or targeted therapies might be more beneficial for certain women, so talk to your doctor to see whether these options are appropriate for you. Radiation therapy may be useful in treating metastases, but it is rarely used as the main treatment for ovarian cancer.
Surgery helps establish the stage of your cancer and removes as much of the tumor as possible. The extent of surgery will depend on how far the cancer has metastasized (spread). Determining whether the cancer has spread beyond the ovary is extremely important, as is locating any other affected tissue and organs.
Surgical treatment usually involves a hysterectomy (removal of the uterus) as well as a salpingo-oophorectomy (removal of the ovary and fallopian tube on one or both sides). Surgery to remove the uterus, ovaries or fallopian tubes can affect your fertility. Talk to your doctor about fertility options if this is a concern for you. The omentum (a layer of fatty tissue covering the abdominal contents) is also typically removed because ovarian cancer can spread to this area. Surgeons might also extract fluid, lymph nodes or other tissue samples in the abdomen and pelvis to determine whether cancer has spread.
Chemotherapy uses systemic drugs to treat cancer. Systemic drugs are ones that reach the entire body, making them useful for cancer that has spread. Chemotherapy is given in multiple ways, most commonly intravenously, as an injection or orally. It is specifically an important part of treatment for epithelial ovarian cancer and germ cell tumors of the ovary. Chemotherapy is rarely used for stromal tumors, but a combination regimen may be an option.
For ovarian cancer that has spread to the inside of the abdomen, intraperitoneal chemotherapy (an injection into the abdomen) may be given in addition to intravenous chemotherapy. This may help improve overall survival compared to intravenous chemotherapy alone. Two types of chemotherapy at once may also cause more side effects, so intraperitoneal chemotherapy may not be the best option for some women.
Targeted therapy drugs work by changing the way cancer cells grow, divide, repair themselves or interact with other cells. Angiogenesis inhibitors work by stopping the signals that cause new blood vessels to form. Without these blood vessels, tumors cannot grow. PARP inhibitors are another class of targeted therapy drugs that can be used to treat ovarian cancers.
Hormone therapy is rarely used to treat epithelial ovarian cancer, but it is sometimes used to treat stromal tumors:
- Luteinizing hormone-releasing hormone (LHRH) agonists can stop the body from producing estrogen. This can help stop the growth of stromal tumors, which are often stimulated by estrogen. LHRH agonists may also be called GnRH agonists.
- Selective estrogen-receptor modulators (SERMs) are another class of hormone therapy drugs that can be used to treat ovarian stromal tumors and, rarely, advanced epithelial ovarian cancer. They prevent estrogen from helping cancer cells grow.
- Aromatase inhibitors are drugs that are sometimes used to treat recurrent stromal tumors. They work by blocking enzymes that produce estrogen in women who have already been through menopause.
Clinical trials are research studies that determine whether new treatments are effective. Ask your doctor about any clinical trials for which you might qualify. Participating in these studies may give you access to treatments that aren’t yet available. For more about clinical trials, click here.