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.
Ovarian Cancer Treatment (<i>cont'd</i>)
Anticancer drugs — chemotherapy — travel through the bloodstream to almost every area of the body. Drugs used to treat cancer may be given in different ways: some are given by mouth; others are injected into a muscle, a vein or an artery. Chemotherapy is most often given in cycles: a treatment period, followed by a rest period, then another treatment period, and so on.
Many of the side effects of chemotherapy have been reduced over the years because the drugs have been refined or drugs for the side effects are better used. The side effects of chemotherapy depend on the drugs given and the individual response of the patient. Chemotherapy commonly affects hair cells, blood-forming cells and cells lining the digestive tract. As a result, patients may have side effects such as hair loss, lowered blood counts, nausea or vomiting. Most side effects end after treatment is stopped.
To help quickly restore lowered white blood cell counts to normal levels (a condition known as neutropenia), a relatively new product, called Neupogen® may be administered to patients between chemotherapy cycles. A cautionary note: Amgen Inc., the maker of Neupogen®, recently became aware of the existence in the U.S. of a counterfeit drug product labeled as Neupogen® 300 mcg vials in ten- pack boxes. In cooperation with the U.S. Food and Drug Administration (FDA), Amgen is informing patients, physicians, pharmacies and wholesalers about this serious health risk.
Loss of appetite can be a serious problem for women receiving radiation therapy or chemotherapy. Women who eat well are better able to withstand the side effects of treatment. So, nutrition is an important part of the treatment plan. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles and organs. Many women say that eating several small meals throughout the day is easier than eating three large meals.
The side effects that patients have during all of these cancer therapies vary from person to person and may even be different from one treatment to the next. Your health care professional will try to plan treatment to keep problems to a minimum, and fortunately, most side effects are temporary. It's important to tell your health care professional about your reactions and side effects because he or she may be able to adjust treatments to help you feel better.
The drugs used most commonly to treat ovarian cancer are carboplatin and paclitaxol:
Taxol was approved in 1998 as a first-line treatment for advanced ovarian cancer. Taken from the bark of the Pacific yew tree, Taxol is usually given in combination with other anticancer drugs by way of intravenous infusion. Like most cancer drugs, Taxol has side effects that can be serious. Its most serious effect is damage to the bone marrow; the soft, sponge-like tissue in the center of large bones that produces the blood cells that fight infection. So, you may get infections more easily while taking this medicine. Stay away from crowds and people with colds, flu, or other infections. It is best to avoid drinking alcohol and taking any product that has aspirin in it while using this drug. In addition, you should talk to your doctor before having any vaccines (such as flu shot). You may also experience the following side effects with the use of this drug:
- loss of hair
- bleeding gums
- blood in stool or urine
- burning or tingling in hands or feet
- nausea and vomiting
- pain in joints or muscles
- skin rash or itching
- unusual bleeding or bruising
Ovarian Cancer Treatment (<i>cont'd</i>)
This chemotherapy medication is administered by infusion too, usually in combination with Taxol. It has replaced other drugs because it is said to be less toxic. Nausea and vomiting may be severe in about one-third of all patients but usually subsides within 24 hours of treatment. Medication may be given prior to therapy to help reduce this effect. Other side effects include:
- change in taste
- hair loss
Today, first-line standard therapy includes tumor debulking surgery (removal of all visible tumors), followed by six cycles of combination paxitaxol/carboplatin administered intravenously every three weeks.
In addition to the standard chemotherapy drugs, there are other drugs available:
is used for metastatic (cancer that has spread) ovarian cancer after failure of initial or subsequent chemotherapy. This is one of the first of a new kind of drugs that kills cancer cells by inhibiting an enzyme essential to the replication of human DNA. It is injected by a health care professional who is experienced in administering anticancer (chemotherapeutic) drugs. Serious side effects that may require medical attention can include:
- difficulty breathing
- fever or chills, cough or sore throat
- mouth sores
- nausea, vomiting
- pain, swelling, redness or irritation at the injection site
- stomach pain
- unusual bleeding or bruising, pinpoint red spots on the skin
- unusual tiredness or weakness
Side effects that usually do not require medical attention include:
- hair loss
- joint pain
- loss of appetite
- tingling, or numbness in the hands and feet
- skin rash, itching
After your treatment is finished, your health care professional should discuss follow-up care, an important part of the plan. You will likely have to undergo regular blood tests, x-rays, ultrasound studies or a second-look surgery to make sure the cancer has not returned.
Copyright 2003 National Women's Health Resource Center Inc. (NWHRC).