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Treatments for ovarian cancer

Treatments for ovarian cancer

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options, please talk to a member of your healthcare team.

The tests described in 'What to expect when you see a gynaecologist' will give your specialist a good idea of whether you have ovarian cancer. Sometimes, however, it may not be possible to confirm a diagnosis of ovarian cancer until you have had surgery.

The tests may also provide some information about the 'stage' of the cancer – that is, how far it has spread. The stage of the cancer will affect the types of treatment you will be offered.

There are four stages of ovarian cancer, which are described in the box below. Stage I cancer is also called 'early' ovarian cancer, and stages II to IV are called 'advanced' ovarian cancer. Often the stage of the cancer can only be confirmed by surgery.

Stages of ovarian cancer

  • Stage I: the cancer is affecting only the ovaries.

  • Stage II: the cancer is also outside the ovaries, but still within the pelvic area.

  • Stage III: the cancer is also outside the pelvic area – in the lining of the abdomen and/or in abdominal organs such as lymph nodes.

  • Stage IV: the cancer is also in other parts of the body, such as the liver or lungs.

Treatments for suspected early (stage I) ovarian cancer

Surgery

Virtually all women with early ovarian cancer will be offered surgery as their main treatment. The aim of surgery is to remove all signs of ovarian cancer. The NICE guideline does not make recommendations about all aspects of surgery for ovarian cancer. Members of your specialist care team should explain what is involved, and talk with you about the various treatment options. You can also get more information from the organisations listed in 'More information'.

The NICE guideline does say that if you appear to have stage I ovarian cancer, the lymph nodes in your abdomen should be checked to make sure that the cancer hasn't spread to them. But a procedure called systematic retroperitoneal lymphadenectomy (removal of all of the lymph nodes from the abdomen) should not be carried out as part of standard surgery for women who appear to have stage I cancer.

Chemotherapy

The cancer cells that are removed during surgery will be checked to assess the risk of the cancer coming back. Your specialist should talk with you about whether chemotherapy is suitable for you (depending on your level of risk).

You should not be offered chemotherapy after surgery if you had stage I cancer that has a low risk of coming back.

If you had stage I cancer that has a high risk of returning, you should be offered chemotherapy with a drug called carboplatin.

If there is uncertainty about the risk of your cancer returning, your specialist should talk with you about the possible benefits and side effects of chemotherapy, to help you make a decision about whether to try this treatment.

Treatments for advanced (stages II to IV) ovarian cancer

Most women with advanced ovarian cancer will be offered surgery followed by chemotherapy. Sometimes, however, you may be offered chemotherapy before surgery to shrink the tumour, or surgery might not be suitable if the cancer is very advanced. Members of your care team should talk with you about the treatment options available, taking account of your goals and preferences.

Confirming the diagnosis

If you are being offered chemotherapy before or instead of surgery, your specialist should first confirm the diagnosis of ovarian cancer by checking a small amount of tissue taken from your abdomen. This is called a tissue diagnosis. The tissue should usually be obtained by a procedure called percutaneous image-guided biopsy. Another procedure called laparoscopic biopsy may be used instead if it is more suitable for you. Occasionally, a technique called cytology (which involves checking cells taken from the abdominal fluid) may be used for tissue diagnosis.

Very rarely, you may be offered chemotherapy without a tissue diagnosis. Your specialist should talk with you about the benefits and risks of starting chemotherapy without having a tissue diagnosis.

Surgery and chemotherapy

The aim of surgery is to remove all signs of ovarian cancer, whether the surgery takes place before or after chemotherapy.

You should not be offered intraperitoneal chemotherapy – where the chemotherapy is given directly into the abdomen rather than into a vein – unless you are asked to take part in a clinical trial of this type of treatment.

The NICE guideline does not include full details about surgery and chemotherapy for women with advanced ovarian cancer. Members of your care team should talk with you about what the treatments involve, including the benefits and risks associated with them.


Questions you might like to ask about surgery

  • Why are you recommending surgery?

  • What will it involve?

  • What are the possible benefits and risks?

  • How long will I be in hospital for?

  • Will the surgery get rid of all of my cancer? If not, what other treatments might I have?

  • What will happen if I choose not to have surgery?

Questions you might like to ask about chemotherapy

  • Please tell me more about chemotherapy for ovarian cancer.

  • Why are you recommending chemotherapy?

  • What is a cycle of treatment? How many treatment cycles will I have?

  • What are the possible side effects of chemotherapy?

  • What can you offer me to help me to cope with the side effects?

  • Might there be any lasting harm resulting from chemotherapy?

  • Are there other drugs I can try if my cancer comes back after the first course of chemotherapy?

  • Do you think I should have chemotherapy before surgery?

  • What if I choose not to have chemotherapy?

  • Information Standard