Surgery and chemotherapy are key ovarian cancer treatments, as with other cancers. Early surgery can keep more than 90 percent of women from dying of the cancer.
The treatment plan for you will depend on the stage of your ovarian cancer and how quickly it seems to be growing. For cancers caught at stage 1, surgery alone may be the solution, preventing from 90 to 95 percent of patients from dying of the cancer.
First-line ovarian cancer treatment begins with surgery, followed by a chemotherapy regimen. About 80 percent of patients emerge with normal blood tests and no visible evidence of disease on imaging scans.
If your cancer returns after six months, you may repeat the process. For cancer that progresses or recurs (comes back) within six months, surgeons will look for other forms of chemotherapy. Another possibility is immunotherapy, using your own immune system.
The main ovarian cancer treatment is surgery. It is appropriate in the early and later stages and for cancers that have returned.
Laparatomy and laparoscopy
If the tumor hasn’t spread beyond the ovary, your surgeon can remove in using a traditional type of surgery with a large incision in the abdomen — a laparotomy.
A laparoscopy requires only smaller incisions. Your surgeons insert a small video camera into the abdominal area through an endoscope (it has a light at the end), and guide the camera within your body. Through another incision, your surgeons use small tools to remove the ovary.
You may recover faster and have less scarring with this approach.
This procedure may be used to remove one of the fallopian tubes and ovaries along with the omentum, a thin fold of abdominal tissue that encases the stomach, large intestine, and other abdominal organs. Your lymph nodes may also be removed.
In a laparoscopy procedure, your surgeons can explore the abdomen to determine how far the tumor has spread, drain any fluid buildup, take samples for a biopsy, and see if you might benefit from other surgery. If your team suspects fluid in your chest, possibly because cancer has spread, you may also have a scope there to explore and drain fluid.
Sometimes surgical instruments are mounted on three robotic arms, which the surgeon can operate by finger or foot. A fourth arm carries a camera, creating magnified, three-dimensional images on a computer monitor, so the surgeon can see what is going on.
This approach also requires smaller incisions than a laparotomy, so it may produce less scarring.
Also called cytoreduction, in this procedure your surgeons aim to leave no visible tumor behind and may remove the uterus, cervix, fallopian tubes, and any other areas containing diseased tissue.
If your cancer has spread beyond your pelvis, the surgeon may remove part of the omentum, the diaphragm (the thin muscle below your lungs and heart that separates the chest from the abdomen), and segments of the bowel, the spleen, and parts of the liver.
If your cancer comes back, a second debulking procedure may be helpful.
If you hope to bear children and your cancer is in an early stage, surgeons may remove only the affected ovary (called unilateral oophorectomy) and fallopian tube, omentum, and lymph nodes. This procedure may preserve your fertility.
Surgery for ovarian cancer can cause some pain at the surgical site that usually can be managed with medication. You may also experience hot flashes or vaginal dryness, which also can be treated.
Tumor cells can remain after surgery even with the most skilled surgeon. So first-line treatment for advanced cancer includes chemotherapy as well. These drugs are designed to interrupt the growth of those cells. You may take your medication by mouth, through an injection called intraperitoneal chemotherapy, when the medication is inserted into the lining of your abdominal area (the peritoneum) following surgery.
If you have a BRCA1 or BRCA2 mutation, you may receive a drug that inhibits PARP-1, an enzyme involved in cell death. The Food and Drug Administration (FDA) has approved the PARP inhibitor olaparib (Lynparza) for women with BRCA mutations who have experienced a recurrence of ovarian cancer.
Other possibilities are bevacizumab (Avastin), which targets the blood vessels that supply the tumor and pazopanib (Votrient), which helps stop new blood vessels from forming and has shown early promise for ovarian cancer treatment.
Drugs that build on your own immune system are at the forefront of cancer research. Ask your doctor about immunotherapy clinical trials. For example, the drug pembrolizumab (Keytruda) has FDA approval to treat melanoma, non-small cell lung cancer, and other cancers, and is in trials for ovarian cancer treatment, recurrent or metastatic head and neck cancer, classical Hodgkin lymphoma, and urothelial carcinoma.
Your ovarian cancer treatment should include follow-up care. You’ll need checkups to catch any recurrences quickly and identify and treat late effects of your cancer and treatment. Eventually you can shift to receiving care from your gynecologist rather than an ovarian cancer specialist.
September 26, 2019
Janet O’Dell RN