If you have been diagnosed with ovarian cancer, the first line of treatment is almost always surgery. Surgery may be an unilateral salpingo-oophorectomy (surgery to remove one of the ovaries and the fallopian tube, the tube that connects the ovary to the uterus) or a combination of a hysterectomy (surgery to remove the uterus), a bilateral salpingo-oophorectomy (surgery remove both of the ovaries and fallopian tubes), and an omentectomy (partial removal of the fatty lining of the abdominal cavity, where the cancer tends to spread). The lymph nodes (small organs that fight infection and disease) may also be removed to check for signs of disease.
An aggressive approach to tumor debulking (taking out as much of the cancer as possible) is important in ovarian cancer, since removal of the maximum amount of tumor is associated with improved survival. A qualified gynecologic oncologist, who is a gynecologic surgeon with specialized training in pelvic cancers, best performs the procedure. Call the Gynecologic Cancer Foundation at 1-800-444-4441 for a referral list.
If the disease has spread beyond the ovaries, chemotherapy is used.
Radiation therapy, which is also used on occasion, may be given internally by placing a radioactive solution into the pelvis and abdomen through a thin tube, coating the organs and all abdominal contents. Or, your doctor may recommend external radiation.
Once the ovarian cancer diagnosis is certain
Once the diagnosis is certain, more tests will be performed to find out if the cancer has spread to other parts of your body, a process that is called staging. An operation called a laparotomy is performed for most women to determine the stage of the disease. A small incision is made in your abdomen and a laparoscope is used to allow your health care professional to look at all your organs to see if they contain cancer.
During the operation the surgeon will cut out small pieces of tissue (biopsy) so they can be examined under a microscope to see whether they contain cancer. This will help determine to which stage the disease has progressed so your health care professional can plan further treatment. The following stages are used to define how far ovarian cancer has spread in the body:
- Stage I: Cancer is found in one or both of the ovaries.
- Stage II: Cancer is found in one or both ovaries and/or has spread to the uterus, and/or the fallopian tubes (the pathway used by the egg to get from the ovary to the uterus), and/or other body parts within the pelvis.
- Stage III: Cancer is found in one or both ovaries and has spread to lymph nodes or to other body parts inside the abdomen, such as the surface of the liver or intestine. (Lymph nodes, which produce and store infection-fighting cells, are found throughout the body.)
- Stage IV: Cancer is found in one or both ovaries and has spread outside the abdomen or has spread to the inside of the liver.
- Recurrent or refractory: Recurrent disease means that the cancer has come back after it has been treated. Refractory disease means the cancer is no longer responding to treatment.
Once your health care professional has identified the stage of disease, surgery is typically the primary therapy. The extent of surgery depends on the stage of disease and your health. There is a good chance you will receive chemotherapy and/or radiation therapy as a follow-up, depending on the stage of your disease.