Treatment for ovarian cancer usually involves a combination of surgery and chemotherapy. Less often, treatment may include radiotherapy. The type of treatment women receive depends on the type and stage of their ovarian cancer and their general health.
Treatment is best managed by a gynaecological oncologist.
A gynaecological oncologist specialises in treating cancers of the reproductive tract and has very specialised surgical skills.
Ovarian Cancer Australia strongly recommends that women are treated by a gynaecological oncologist. Ideally, they will be part of a multidisciplinary health care team — where each member of the team specialises in a different area of care and that care is coordinated between each member. For more information you can download the multidisciplinary care information sheet. The Directory of Gynaecological Oncology Services provides a listing of treatment centres in each state and territory. The directory shows what types of services are available at each centre (such as specialist nurses, psychosocial care and the opportunity to participate in clinical trials) and includes contact details.
To find the names of individual gynaecological oncologists (many of whom work in multidisciplinary treatment centres), visit the Australian Society of Gynaecologic Oncologists website.
The first treatment for ovarian cancer is usually an operation called a laparotomy. This operation is also the main way that a diagnosis of ovarian cancer is confirmed.
During a laparotomy, a long vertical cut is made in your abdomen, which allows the surgeon to find and remove as much of the tumour as possible. In many cases, the surgeon will do a biopsy of the tumour at the beginning of the operation to confirm that it is cancer. This is called a frozen section. If the frozen section confirms that the tumour is cancer, the operation will continue.
For most women, the operation will involve removal of the ovaries, Fallopian tubes, the uterus, the omentum (the fat pad around the organs in your abdomen), the appendix and some of the lymph glands in the area. Sometimes it may be necessary to remove some of the bowel.
After your operation, samples of the tissue removed are sent to a laboratory for further examination. The results of these biopsies will provide more information about the type and extent of your cancer and enables the gynaecological oncologist to make decisions about further treatment.
If you were still having menstrual periods before you were diagnosed with ovarian cancer and you have both your ovaries removed, this surgery will result in menopause. As well as learning that you have ovarian cancer, this surgically-induced menopause creates all kinds of extra challenges to live with.
To learn more, you can download this Ovarian Cancer Australia information sheet: Early menopause from ovarian cancer treatment.
Most women with ovarian cancer will require chemotherapy, usually referred to as ‘chemo’. The purpose of chemo is to attack cancer cells and to slow or stop their growth while causing the least possible damage to normal cells.
Chemotherapy works best when the tumour is small and the cancer cells are actively growing. Even though most of the cancer may have been removed during surgery, there may be some cancer cells left. For this reason, chemotherapy works best if started soon after surgery.
Chemotherapy treatment is given under the guidance of a medical oncologist, who will usually come to see you after your operation to discuss your chemo treatment plan.
Chemotherapy for ovarian cancer is usually given through an intravenous (IV) drip in an outpatient clinic at your treatment hospital. Most women will receive six rounds or cycles of treatment with three or four weeks in-between each. This means the total treatment time usually continues over several months. Before each treatment, you will have a blood test to make sure your body’s normal cells have had time to recover. You will also have blood tests and may have a CT scan to measure your response to the treatment.
If your cancer does not respond completely to the initial treatment, you may need further chemotherapy. You may also need further treatment if your ovarian cancer comes back in the future (this is called ‘second line chemo’). The drugs used in further treatments will depend on the chemo drugs initially used, the time between treatments and the aims of the treatment.
Because chemotherapy can also damage some healthy cells in your body it can cause a range of side effects. Side effects are usually temporary and there are many things you can do to prevent or reduce them.
To learn more, download this Ovarian Cancer Australia information sheet: Coping with chemotherapy.
Radiotherapy is occasionally used as a treatment option for ovarian cancer. Radiotherapy may be used where cancer is confined to the pelvic cavity. It may also be used in advanced ovarian cancer to reduce the size of the cancer and help to relieve symptoms. Radiotherapy is treatment with special x-rays that are aimed at the specific site of the cancer. The x-ray damages the DNA or genetic code in the cancer cells and this damage kills the cancer cells when they try to grow. Treatment can be external or internal and is given daily over a number of weeks.
Radiotherapy also has side effects and many of the ideas in the Coping with chemotherapy information sheet can help you to reduce or manage these side effects.
Many women with ovarian cancer are interested in trying complementary therapies — natural therapies that are used together with mainstream medicine to help manage symptoms and side effects, reduce pain, relieve stress and encourage a feeling of wellbeing.
Ovarian Cancer Australia’s information sheet on complementary therapies explains more about the different types of therapies available and how they may help. The information sheet also explains why it is important to talk to your doctor about all types of therapy that you are thinking about using.
Optimal Care Pathway
In 2015 the Victorian Department of Health and Human services commissioned the Cancer Council Victoria to conduct a review of the optimal care pathway for women undergoing ovarian cancer treatment. The purpose of this pathway is to improve patient outcomes by providing consistent, safe, high quality and evidence based practices to all women undergoing treatment. While treatment for women may vary, the expected standards of care should not differ, regardless of treatment being provided in the public or private service. This pathway should be used to inform and empower women with a greater understanding of the expectations of care they should receive. For more information on the Optimal Care Pathway click here.
Our Ovarian Cancer Australia Connect online forum gives you access to a community of compassionate and supportive women who have been affected by ovarian cancer. The forum includes lots of discussions about treatment; click here to explore further.