Treating advanced ovarian cancer

• A quick guide to what's on this page
• What advanced ovarian cancer is
• Aims of treatment
• The treatments used
• Decisions about treatment

Advanced ovarian cancer means the cancer is stage 3 or 4. It has spread away from the ovary to other parts of the body. Unfortunately, ovarian cancer can be quite advanced when it is first diagnosed. This is because women often don't know that they have the cancer at first. You may not have had any symptoms when the cancer was in its early stages. Or your symptoms may have been vague and difficult to spot or explain. Ovarian cancer that is advanced when it is first diagnosed can sometimes be cured with surgery and chemotherapy. Ovarian cancer that comes back after treatment cannot usually be cured.

It is not usually possible to cure advanced ovarian cancer. But treatment can shrink the cancer and control it for some time for most women.

If ovarian cancer spreads, it may spread to the

• Lining of the abdomen (the peritoneum)
• Lining of the bowel or bladder
• Liver
• Lungs
• Ureters or kidneys - this is rare but the tumour can block the flow of urine by pressing on the ureters

Chemotherapy, radiotherapy and surgery can all be used to treat advanced ovarian cancer. Sometimes a drug called octreotide may be used. The best treatment for you depends on

• The size and number of secondary cancers you have
• Where in the body the cancer is
• The treatment you have already had

There may also be trials of experimental treatments going on that you could take part in. These may be trials for new chemotherapy drugs or new types of treatment. Look in the what's new in ovarian cancer section of CancerHelp UK for more information about taking part in clinical trials.

Chemotherapy

You will probably be able to have chemotherapy even if you already had some at an earlier stage in your illness. If carboplatin chemotherapy worked well for you before, your doctor may suggest giving you some more. Other drugs you may be offered include paclitaxel (Taxol), liposomal doxorubicin, gemcitabine, topotecan or cisplatin.

There is more information about chemotherapy in the CancerHelp UK section on chemotherapy for ovarian cancer. The links above for each drug take you to a page on the drug's specific side effects.

Other chemotherapy drugs are also used to treat advanced ovarian cancer. If you would like information about any other drug, look at our full list of chemotherapy drugs or contact the Cancer Research UK information nurses. They would be happy to help you.

Radiotherapy

You may be offered radiotherapy for advanced ovarian cancer. Radiotherapy can shrink down tumours and reduce symptoms. But there is a maximum total dose of radiotherapy you can have to any part of the body. So if you had radiotherapy to your abdomen after your initial surgery, radiotherapy may not be an option for you. Radiotherapy may be used to treat ovarian cancer that has spread to another organ in the body.

There is more about having radiotherapy for ovarian cancer in this section of CancerHelp UK. And more about radiotherapy generally in the main radiotherapy section.

Octreotide

Sometimes advanced ovarian cancer can press on the bowel and block it. A drug called octreotide can control the symptoms of a blocked bowel for a time. Octreotide works by reducing the amount of fluid produced in your stomach and digestive system.

Surgery

For advanced ovarian cancer, surgery may be used to

• Remove as much of the cancer as possible from inside your abdomen before chemotherapy - this is called debulking
• Treat cancer that has caused a blockage of your bowel
• Treat cancer that has caused a blockage of your urinary system

Debulking

This is the name for the operation to remove cancer from inside your abdomen before you have chemotherapy. It is done because chemotherapy tends to work better when there are only small cancer nodules (less than 0.5 cm across) inside the abdomen. The preparation and recovery from this type of surgery are much the same as for an abdominal hysterectomy. There is information about this in the CancerHelp UK section on surgery for ovarian cancer.

Treating a blockage in the bowel

Sometimes ovarian cancer can grow so that it completely blocks the bowel. This is called a bowel obstruction. The waste from food you have digested cannot get past the blockage. This causes symptoms such as

• Feeling bloated and full
• Pain
• Feeling sick
• Vomiting large amounts
• Constipation

To relieve the symptoms, it is sometimes possible to operate to unblock the bowel. It may be possible to close up the bowel again. Or you may have to have a stoma. This is an opening onto the abdomen. Your bowel motions come out of the opening. They are then collected in a waterproof bag which sticks onto your skin over the stoma opening. There is more about bowel surgery and having a stoma in the CancerHelp UK section about surgery for colorectal cancer.

You may want to talk over having this operation with your close family and friends as well as your doctor and nurse. No one can say how much you will benefit from the operation. The operation may help you feel better for a time, but the cancer may come back to block the bowel again. It is likely to be quite a big operation just when you are feeling very low.

A blockage in the urinary system

Sometimes ovarian cancer can grow so that it blocks part of the urinary system. It may block one of your ureters. The ureters are the tubes that connect the kidneys with the bladder. If one of these tubes gets blocked, your urine cannot drain away and the kidney may swell and become damaged. Your doctor may suggest a procedure to put a tube in to drain urine from the kidney. There are two ways of doing this. You can have

• An internal tube, called a ureteric stent
• An external tube called a nephrostomy tube.

Ureteric stent

A ureteric stent can be put in using a local anaesthetic. The doctor uses ultrasound or X-ray to put a small plastic tube into the blocked ureter. Sometimes this is done under general anaesthetic during a cystoscopy operation. A flexible tube called a cystoscope is put into the bladder. This allows the doctor to see the opening of the ureter to the blocked kidney. The doctor pushes the tube up into the ureter from the bladder.

With a stent in place, urine can drain from the blocked kidney into your bladder. You will continue to pass urine normally after this operation.

Nephrostomy

A nephrostomy tube is a tube put into your blocked kidney. The tube comes out of your body close to the area of the kidney. A bag can be stuck over, or connected to, the tube to drain the urine. The cancer is not actually removed during this operation. The tube just bypasses the blockage by draining the urine outside the body.

When you have an advanced cancer, it can be difficult to decide which treatment to try, or whether to have treatment at all. Treatment can control symptoms and help you to feel better. It may also help you to live longer. But you will need to consider your quality of life while you are having the treatment. Side effects of treatment may make you feel ill and treatment may cause stresses, such as travelling back and forth to the hospital. It is very important for you to understand what can be achieved with the treatment you are being offered.

Your doctor will discuss the options for treatment with you. You will also be able to talk to a gynaecological cancer specialist nurse. There may be a counsellor you could chat to. You may also want to talk things over with a close relative or friend.

It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends.Contact a counselling organisation to find out more about counselling and how to find a counsellor in your area.