Treatment for ovarian cancer
On this page: Surgery | Chemotherapy | Radiotherapy | Hormone therapy | Palliative treatment | Information reviewed by
The treatment for ovarian cancer depends on what type of cancer you have, the stage of the cancer, your general health and fitness, your doctors' recommendations, and your wishes.
- Epithelial ovarian cancer: commonly treated with surgery, chemotherapy and/or radiotherapy.
- Non-epithelial ovarian cancer: usually treated with surgery and/or chemotherapy.
- Borderline tumours: usually treated with surgery.
Surgery
Your gynaecological oncologist will talk to you about the most appropriate type of surgery. A procedure called an exploratory laparotomy is usually recommended if the doctor suspects you have ovarian cancer. In this operation, the gynaecological oncologist makes a long, vertical cut from your bellybutton to your pubic bone while you're under general anaesthetic.
The surgeon will take tissue and fluid samples from the abdomen (biopsy). While still in theatre, the tissue samples are sent to a specialist called a pathologist who examines them for signs of cancer. This is called a frozen section analysis. If the pathologist confirms that cancer is present, the surgeon will continue the operation.
If there's obvious spread of cancer, the surgeon will remove as much of the cancer as is possible. This is called surgical debulking. Surgical debulking allows chemotherapy treatment to be more effective.
You may have one or more of the following procedures:
- Total abdominal hysterectomy: removal of the uterus and the cervix.
- Bilateral salpingo-oophorectomy: removal of both ovaries and fallopian tubes.
- Omentectomy: removal of the fatty protective tissue (omentum) covering the abdominal organs.
- Colectomy: removal of all or part of the bowel, where the end of the bowel may be rejoined to a new opening called a stoma (colostomy or ileostomy).
- Lymphadenectomy: removal of some lymph nodes, which are small, bean-shaped organs that help filter toxins, including cancer cells, from the bloodstream.
It may sound as if a lot of your body parts or organs will be removed in an operation. However, these organs are quite small compared with everything else in your abdomen and pelvis, and their removal won't leave an empty space.
Some women don't need extensive surgery. A young woman with early epithelial ovarian cancer, germ cell cancer or a borderline tumour usually won't have her uterus and ovaries removed.
Surgery may cause infertility. If having children is important to you, talk to your doctor before surgery. You may be able to store eggs before treatment, especially if only one ovary is affected.
'I felt great relief after the surgery, as once the tumour had been removed, the pain that I had in my lower abdomen and hip was gone.' — Ann
After the operation
After surgery, you may have several tubes in place:
- A drip inserted into a vein in your arm (intravenous drip) will give you fluid, medications and pain relief.
- A small plastic tube (catheter) may be inserted into your bladder and urine will be collected in a bag.
- A tube down your nose into your stomach (nasogastric tube) may suck out stomach fluid to prevent vomiting.
- You may have tubes in your abdomen to drain fluid from the operation site.
As you recover from the operation, the tubes will be removed gradually over a few days. You'll be in hospital for 3 to 7 days.
Some women also have calf compression devices or elastic stockings to keep the blood in their legs circulating. Once you're mobile, compression devices will be removed so you can get out of bed, but you'll still wear the stockings. It's common to receive a daily injection to decrease the risk of developing a blood clot. You may have injections for up to a month after the operation.
It's common to feel some pain after an operation, but this can be controlled. Medication may be given by an intravenous drip or through an injection in the spine called an epidural. This is similar to what may be given to women during childbirth.
Some patients have a patient controlled analgesic (PCA) system. This is a machine that allows you to get a dose of pain-killers by pressing a button.
Let your doctor or nurse know if you're in pain so they can adjust your medication. Don't wait until the pain is severe. Making sure that you're as comfortable as possible will help you recover and move more freely.
Taking care of yourself after surgery
Some women say they start to feel better within six weeks, but it may take longer. Your recovery time depends on the type of surgery you had, other treatment or medical conditions you have had, and your support at home.
- Rest: Take things easy and do only what is comfortable. You may like to try some meditation or relaxation techniques to reduce tension. You can also talk to a social worker about getting help at home.
- Sex: Penetrative sexual intercourse should be avoided for about six weeks after the operation to give your wound time to heal. Call the Helpline for more information about sexuality, intimacy and cancer.
- Lifting and exercise: Avoid heavy lifting for at least six weeks. If you have a partner or children, ask them to help you around the house. If you want to exercise, talk to your doctor. You should start with gentle exercise and build up to more vigorous exercise. Other services are also available such as home nursing care. Ask your hospital social worker for more information.
- Driving: Your medical team will advise you to avoid driving for about four weeks after surgery.
- Other side effects: You may also have bowel problems. Some women go through menopause if their ovaries are removed. For informaton see managing side effects of ovarian cancer treatment.
Further treatment
A few days after the operation, your doctor should have all the test results and will discuss any further treatment options with you.
It can help to have a close friend or relative with you when you talk to your medical team. This person can listen or participate in the conversation.
Further treatment will depend on the type of cancer, the stage of the disease and the amount of any remaining cancer. Most women have chemotherapy treatment but radiotherapy is sometimes recommended. Hormone therapy may occasionally be recommended.
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim is to destroy cancer cells while causing the least possible damage to normal, healthy cells.
Although most of the ovarian cancer may have been removed during surgery, there may still be some cancer cells in the body. For this reason, chemotherapy is usually given soon after an operation.
Women with low-grade stage 1 epithelial ovarian cancer or a borderline tumour may not need chemotherapy.
Women with epithelial ovarian cancer that has spread outside the ovaries usually receive a combination of 2 to 3 chemotherapy drugs. However, a single chemotherapy drug may be prescribed for frail or elderly women or if there are other particular concerns.
Chemotherapy is usually given through an intravenous drip. Current standard treatment is six treatments, given every 3 to 4 weeks over 5 to 6 months. However, some centres give chemotherapy in weekly doses and treatment varies for different women. Talk to your doctor about your treatment plan.
'I kept a notebook to record my chemotherapy symptoms and any questions I had so that I wouldn't forget anything I wanted to tell or ask my oncologist at each appointment.' — Ann
You'll probably be treated as an outpatient, but some women need to stay in hospital overnight.
Let your medical oncologist know if you're taking nutritional or herbal supplements as these can interact with chemotherapy drugs and may be harmful.
Blood tests during chemotherapy
Before each chemotherapy session, blood tests will be taken to ensure your body's healthy cells have had time to recover.
Some women also have blood tests during treatment to check their tumour markers, such as CA-125. Some women have high CA-125 levels before or after surgery. If the CA-125 level was high before the operation, the level may drop if chemotherapy treatment has worked.
Intraperitoneal chemotherapy
Some types of chemotherapy can be delivered directly into the abdominal cavity through a tube. This is called intraperitoneal chemotherapy.
This is only used within specialised units in Australia, but it may be offered to women on a clinical trial.
Whether or not intraperitoneal chemotherapy treatment is suitable will depend on the outcome of surgery. The doctor can describe the treatment and the advantages and disadvantages of this approach.
Side effects
Chemotherapy can affect healthy cells in the body, which may cause side effects. Not all women will experience side effects, and the side effects will vary according to the drugs you're given. Talk to your medical team about what to expect.
- Tiredness: Your red blood cell level may drop, which can cause you to feel tired and breathless. Travelling to and from treatment can also be exhausting.
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Nausea: Some chemotherapy drugs may make you feel sick or vomit. Whether or not you feel sick is not a sign of how well the treatment is working. Anti-sickness drugs can prevent or reduce nausea and vomiting.
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Changed bowel habits: Many women become constipated while on chemotherapy. This may be caused by anti-nausea drugs. Your doctor will talk to you about taking laxatives. Diarrhoea is another possible side effect.
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Risk of infections: Chemotherapy drugs lower the number of white blood cells that fight infection, so you'll be more susceptible to colds and flu. Let your doctor know if you have any signs of infection, which can be treated with antibiotics.
- Joint and muscle pain: This pain may occur after your treatment session. It may feel like you have the flu, but the symptoms should disappear within a few days. Pain medication like paracetamol may help.
'I tried two wigs but they weren't for me so I wore scarves. I was afraid of what other people might think but they accepted me for who I am, not what I look like.' — Holly
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Temporary thinning or loss of hair: You're likely to lose your head and body hair. It will grow back after treatment is completed, however it may look a bit different than it used to.
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Numbness or tingling in your hands and feet: This can be a side effect of some types of chemotherapy treatment. Let your doctor know if this happens as your dose of chemotherapy may need to be adjusted.
These side effects are usually temporary and there are ways to prevent or reduce them. Let your medical team know about the symptoms and side effects that you experience. To learn more, call Cancer Council Helpline 13 11 20 for a free copy of the booklet Understanding Chemotherapy.
Radiotherapy
Radiotherapy uses x-rays to kill cancer cells or damage them and reduce their activity. It's used less often than chemotherapy, and it may be used to shrink the cancer or to ease your symptoms (palliative treatment).
You'll usually receive radiotherapy to the pelvis, or other parts of your body if the cancer has spread. You'll be in a room and lie on an examination couch or table. A radiotherapy machine will be located above you. The radiation therapist will position you and the machine, then leave the room during treatment.
You won't feel anything during treatment, which will only take a few minutes each time. You may be in the room for a total of about 15 to 20 minutes for each appointment.
The number of radiotherapy treatments that the doctor recommends will depend on your situation. You may have treatment for a week, or daily outpatient treatment for several weeks. Your doctor will explain how often you need to have treatment, and the possible side effects.
Side effects
The side effects of radiotherapy depend on the strength of the dose and the part of your body that's treated. You may have:
- fatigue and tiredness
- loose bowels (diarrhoea)
- frequency and stinging when emptying your bladder
- nausea
- vomiting.
Some women who have a higher dose of radiotherapy have long-term side effects, such as changes in their bowel habits.
For more information on radiotherapy and side effects, talk to your medical team or call Cancer Council Helpline for a free copy of Understanding Radiotherapy.
Cheryl's story
Looking back, I had symptoms of ovarian cancer but I didn't realise they were symptoms. I was violently ill one day, and I noticed that my toilet habits changed and my tummy felt firm. I would sit on the lounge and become uncomfortable due to the pressure in my abdomen, so I would have to get up and move around.
I went to my GP who started to rule things out. The GP thought it was an infection and gave me antibiotics. I had an enema to check if there was a blockage in the bowel, even though I was able to go to the toilet.
My GP ended up doing a scan to look at my tummy. When he looked at the results, he said that he believed that it was ovarian cancer and I was referred to a specialist.
The gynaecological oncologist recommended I have a radical hysterectomy. They cut from the bottom of my breasts to my pubic line. During the operation, they saw that there was cancer around my stomach lining and they were able to remove it.
I was in hospital for 10 days after the operation. I joined a clinical trial for chemotherapy drugs and I had my first chemo session two days after I returned home. My hair started falling out a week later, so I decided to shave it off.
Treatment also made me very weak, and I threw up a lot. Nausea and vomiting were the biggest problems but they gave me medication to reduce it.
I follow up regularly with my gynaecological oncologist and medical oncologist, and continue to have blood tests for the clinical trial. It's been more than eight years since my diagnosis, and they said I'm more or less in the clear. There's no guarantee it won't come back, but the longer it's gone, the better off I am.
Hormone therapy
Hormone therapy is the use of man-made hormones or hormone- blocking drugs to fight cancer. It's only used to treat some types of ovarian cancer, such as recurrent epithelial tumours or stromal tumours. It may be given to women participating in a clinical trial.
For more information about this type of treatment, talk to your medical team.
Palliative treatment
If your cancer has spread and a cure isn't possible, your doctor may still recommend treatment. This is called palliative treatment and helps to improve quality of life by relieving symptoms of cancer.
Palliative treatment is not just for end-of-life care and it can be used during different stages. Often treatment is concerned with pain relief, but it also involves the management of other physical and emotional symptoms.
Treatment may include chemotherapy, radiotherapy or other procedures such as ascitic taps to drain extra fluid from the abdomen. For example, some women have radiotherapy to their whole abdomen.
Call the Helpline for more information on palliative treatment or advanced cancer.
Information reviewed by: Dr Deborah Neesham, Gynaecological Oncologist, Royal Women's Hospital, Melbourne, VIC; Carole Arbuckle, Cancer Nurse, Cancer Council Helpline, VIC; Dr Scott Carruthers, Radiation Oncologist, Royal Adelaide Hospital, SA; Dr Serene Foo, Medical Oncologist, Mercy Hospital for Women, VIC; Jayne Maidens, Cancer Nurse Coordinator, Gynaecological Oncology, Royal North Shore Hospital, NSW; and Patricia Parker and Cheryl Waller, Consumers.
