Which treatment for ovarian cancer
This page gives an overview of treatments for ovarian cancer. There is information on
Which treatment for ovarian cancer?
Your specialist team will plan your treatment according to the type of ovarian cancer you have, the stage, the grade and your general health.
Almost all women with ovarian cancer will need surgery. The amount of surgery will depend on the stage and type of cancer. Below we present detailed information about surgery for the different stages of ovarian cancer.
After surgery, your specialist may offer you chemotherapy or, more rarely, radiotherapy. This is to help stop the cancer coming back or to kill of any remaining cancer cells.
For stage 4 ovarian cancer, some doctors try giving chemotherapy first to shrink the cancer so that less surgery is necessary. Or if you cannot have surgery, you can have chemotherapy to shrink the cancer as much as possible. Radiotherapy is sometimes used to relieve symptoms
depending on where in the body the cancer has spread.
Almost all women with ovarian cancer will need surgery. The amount and type of surgery you have will depend on your stage and type of cancer. Women with borderline tumours or low grade stage 1 tumours may need no further treatment, although some may have radiotherapy to the pelvic area. Most other women have chemotherapy after their surgery.
You may find that other women you meet with ovarian cancer are having different treatment from you. This may be because they have a different type of ovarian cancer. Or it may be that their cancer is a different stage. Don't be afraid to ask your doctor or nurse any questions you may have about your treatment. It often helps to write down a list of questions you want to ask. You could also take a close friend or relative with you when you go to see the doctor - they can help you remember what was said.
You are most likely to be treated by a team of specialist doctors working together, known as a gynaecology oncology team. This will include a surgeon (gynaecologist) and a cancer specialist (oncologist). It should also include a gynaecological oncology specialist nurse, who can give you information about treatment and any support you may need. These gynaecology oncology teams are usually based in specialist cancer hospitals and so you may need to travel some distance to hospital for your treatment.
If you have only seen a surgeon, you should ask to be seen by an oncologist before your treatment plan is finalised. The team will plan your treatment according to
- The type of ovarian cancer you have
- Whether the cancer has spread (the stage)
- What the cells look like under the microscope (the grade)
- Your general health
Your doctor may not be able to tell you exactly what stage your cancer is until after your surgery. During the operation, your surgeon will examine the inside of your abdomen. And they will take biopsies to check whether the cancer has spread.
If you are young and have a very early cancer that is borderline or low grade, you may only need to have the affected ovary and its fallopian tube removed. Borderline ovarian cancers are unlikely to come back and so your unaffected ovary can be left behind. You will still be able to have children in the future. If you have had your menopause, or do not want to have any more children, your surgeon may advise that you have both ovaries and your womb removed. Women with borderline or low grade tumours may need no further treatment as the cancer is unlikely to come back.
If you have a medium or high grade cancer or stage 1b or 1c, you are most likely to have surgery to remove both ovaries and your womb. This is because there is a risk of cancer cells being left behind if the other ovary and womb are not removed.
Your surgeon will also put fluid into your abdomen, then remove it and send a sample to the laboratory to see if it contains cancer cells. And they will take samples of tissue (biopsies) from areas where the cancer could have spread. You may have biopsies of the
- Lymph nodes in your pelvis and abdomen
- Sheet of muscle under your lungs (your diaphragm)
- Tissue lining your abdomen and pelvis
You may have the omentum removed. This is called omentectomy. The omentum is a sheet of fatty tissue inside the abdomen. Surgeons usually remove it along with the womb because ovarian cancer can sometimes spread into the omentum.
After surgery, women with borderline or low grade cancer usually need no further treatment. But if you have a medium or high grade tumour or stage 1b or 1c, you are likely to be offered chemotherapy to help stop the cancer coming back. This is known as adjuvant chemotherapy.
If you have a stage 2 or 3 ovarian cancer, you will have surgery followed by chemotherapy. During the surgery, your surgeon removes your
- Ovaries
- Womb
- Omentum - a sheet of fatty tissue in the abdomen
- As much of the tumour elsewhere as it is possible to remove
As much of the tumour as possible is removed, because if tumours are very small chemotherapy works better. Your surgeon will try to take out all the tumours and leave no area of cancer cells bigger than 0.5 cm.
Your surgeon will also put fluid into your abdomen, then remove it and send a sample to the laboratory to see if it contains cancer cells. And they may take biopsies of all the places where the cancer is most likely to have spread. This could include biopsies of
- Your diaphragm (the sheet of muscle under the lungs)
- The lining of your pelvic and abdominal cavities
- The lymph nodes in your pelvis and abdomen
After you have recovered from your surgery, you will be given chemotherapy to reduce the chance of the cancer coming back.
The treatment you have for stage 4 ovarian cancer will depend on
- How far your cancer has spread
- Your general health
- How quickly the cancer is growing
You may be offered surgery to remove as much of the cancer as possible. This is sometimes called 'debulking'. You may have chemotherapy to try to shrink the tumours before the operation and make the surgery easier. After the surgery you may have chemotherapy to try to shrink any remaining tumours.
If you have a very advanced cancer, it may not be possible for a surgeon to remove it. You may also not be well enough for a big operation. You can have chemotherapy to shrink the cancer as much as possible and to slow it down. Radiotherapy is sometimes used to relieve symptoms, depending on where in the body the cancer has spread.
You will need time to think about your options for treatment. And you will need support from your family as well as your doctor in making your decision. There is more about your treatment options on the treating advanced ovarian cancer page.
Some people feel they would like to get an opinion from a second doctor before they decide about their treatment. If a surgeon (gynaecologist) is treating you, you should get an opinion from a cancer specialist (oncologist) about whether you need chemotherapy or radiotherapy. Most doctors are happy to refer you to another NHS specialist for a second opinion if you would find this helpful.
Note: A second opinion means just that. It does not mean that the second doctor will take over your care. Your treatment will usually still be managed by your original specialist.
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