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.
Your gynaecological oncologist will talk to you about the most appropriate type of surgery. An exploratory laparotomy is usually recommended if ovarian cancer is suspected. In this operation, the doctor makes a long, vertical cut from your bellybutton to your pubic bone hairline while you are under a general anaesthetic.
The surgeon will take tissue (biopsy) and fluid samples from the abdomen. 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 is 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:
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 will not leave an empty space.
Some women do not need extensive surgery. A woman with early epithelial ovarian cancer, germ cell cancer or a borderline tumour usually will not have her uterus and both ovaries removed.
Your treating doctor will explain the risks and possible complications of surgery. This may include infertility. If having children is important to you, talk to your doctor before surgery. You may be referred to a fertility specialist to discuss the possibility of storing eggs before treatment, especially if only one ovary is affected. For more information, see managing side effects.
After the operation After surgery, you may have several tubes in place:
The tubes will be removed over a few days as you recover from the operation. You will be in hospital for 3–7 days. Some women also have compression devices or elastic stockings to keep the blood in their legs circulating. Once you are mobile, compression devices will be removed so you can get out of bed, but you can still wear the stockings.
It is 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. These can be painful, so ask your doctor or nurse if it is possible to take pain medication beforehand.
After an operation it is common to feel some pain, 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 self-administer pain-relief by pressing a button.
Let your doctor or nurse know if you are in pain so they can adjust your medication. Do not wait until the pain is severe. Everyone’s pain tolerance is different and medication may be used to make you as comfortable as possible. Managing your pain will help you to recover and move around more quickly.
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 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, but radiotherapy is sometimes recommended. Hormone therapy may occasionally be recommended.
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.
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 surgery may have removed most of the ovarian cancer, there may still be some cancer cells in the body. For this reason, chemotherapy is usually given soon after an operation.
Chemotherapy is usually given through an intravenous drip. Some people have a small medical appliance called a port-a-cath or catheter placed beneath their skin through which they receive chemotherapy.
Current standard treatment after surgery (adjuvant chemotherapy) is six treatments, given every 3–4 weeks over 5–6 months. Each chemotherapy treatment is called a cycle. However, some centres give chemotherapy in weekly doses and treatment varies for different women. Ask your doctor about the treatment plan recommended for you.
You will probably be treated as an outpatient (also called a day patient), but some women need to stay in hospital overnight.
Let your medical oncologist know if you are taking nutritional or herbal supplements as these can interact with chemotherapy drugs and may be harmful.
Before each chemotherapy session, blood tests will be taken to ensure your body’s healthy cells have had time to recover. If your blood count has not recovered, your doctor may delay treatment.
Some women also have blood tests during treatment to check their tumour markers, such as CA-125 (see diagnosis). Some women have high CA-125 levels before or after surgery. If the CA-125 level was higher before treatment it can be monitored to see if the chemotherapy treatment is working.
Some types of chemotherapy can be delivered directly into the abdominal cavity through a tube. This is called intraperitoneal chemotherapy. It is only used in specialised units in Australia, but it may be offered to women on a clinical trial.
Whether intraperitoneal chemotherapy treatment is suitable will depend on the outcome of surgery. The treating doctor can describe the treatment and the advantages and disadvantages of this approach.
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 are given. Talk to your medical team about what to expect.
"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
Most of these side effects are usually temporary and there are ways to prevent or reduce them. See managing side effects. Let your medical team know about the symptoms and side effects that you experience. To learn more see the chemotherapy section or call Cancer Council 13 11 20.
Resilience is a free information pack for women with ovarian cancer by Ovarian Cancer Australia. It includes information on diagnosis, treatment, living well, support for you and your loved ones. The pack is free and can be ordered by calling 1300 660 334 or online.
Radiotherapy uses x-rays to kill or damage cancer cells and reduce their activity. It is used less often than chemotherapy. The main use for radiotherapy is to ease symptoms or problems which are not responding to chemotherapy or when chemotherapy can no longer be given (palliative treatment).
If the cancer has spread, you will usually receive radiotherapy to the pelvis, or other parts of your body.
During radiotherapy you will be in a room and lie on an examination couch or table. A radiotherapy machine will be moved around you depending on the body part being treated. The radiation therapist will position you and the machine and then leave the room during treatment.
You will not feel anything during treatment, which will only take a few minutes each time. You may be in the room for a total of about 10–20 minutes for each appointment.
The number of radiotherapy sessions you have will depend on the type and size of the cancer. You may have treatment for a week or daily outpatient treatment for several weeks. Your doctor will explain the treatment schedule and the possible side effects.
"My GP has been amazing during treatment. She cares, follows up after radio to make sure I’m okay, researches trials I can go on and more. This reassures me." — Holly
The side effects of radiotherapy depend on the strength of the dose and the part of your body that is treated. You may experience the following:
More rarely, you may experience nausea or vomiting. If this occurs, you will be prescribed effective medication to control it.
Hormone therapy is the use of man-made hormones or hormone- blocking drugs to fight cancer. It is only used to treat certain types of ovarian cancer, such as recurrent epithelial tumours or stromal tumours, or under special circumstances (for example, when chemotherapy has failed). It is sometimes given to women participating in a clinical trial.
For more information about this type of treatment, talk to your medical team.
If your cancer is more advanced and a cure is not possible, your doctor may still recommend treatment to control symptoms. This is called palliative treatment and helps to maintain quality of life.
Palliative treatment is not just for end-of-life care – it can be used during different stages of ovarian cancer. 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.
Extract from the Good Weekend, 16 November 2013. Author: Jane Cadzow
Lady Susan Renouf was home alone, dozing on the sofa, when her GP rang with the results of her scans. The way she remembers it, “He said, ‘It’s the doctor here. You’ve got cancer. Masses. Everywhere in your body.’” The news was difficult to absorb. “I put the phone down and I think I went back to sleep for a while,” she says. “I woke up and I thought, ‘This is a terrible dream. I dreamt the doctor rang and told me I had cancer!’”
When Renouf thinks about it, she realises that for much of last year she lacked some of her usual oomph. “It was my 70th birthday, so I thought, ‘I’ve got to make a special effort’, because a lot of friends were planning a few little festivities. But I just wasn’t feeling great. Very listless. If I didn’t have to get out of bed in the morning, I didn’t.”
When she returned to Australia after three months in the UK and Europe, “a couple of girlfriends said to me, ‘Gosh, you’ve got a funny colour.’ I said, Well, I’ve been in the English summer.’”
By last November, she had become accustomed to an odd sensation in her abdomen: “Funny little jabbing pains.” She went to her doctor, but for one reason or another it was January before the scans were done. The cancer had spread. “The prognosis was less than five months to live,” she says with a tight, bright smile.
She had three months of chemotherapy, followed by surgery to remove as much of the cancer as possible. “When I went under, I thought, ‘Well, I don’t know if I’m coming out of it,’” she says. In the event, she was on the table longer than expected: “It had invaded the lower part of my bowel and wrapped itself around my appendix. So that was another 2½ hours under anaesthetic. It was an 11-hour operation.” Then she had a second course of chemotherapy. “Luckily, I didn’t find the chemo as traumatic as I thought it would be,” she says. “I didn’t have the nausea or the vomiting. I lost my hair, of course.”
Wigs felt hot and itchy, and scarves kept slipping out of place, so she preferred to go bare-headed most of the time. When two of her grandsons arrived to visit her, her skull was as smooth as a billiard ball. “Totally bald,” she says cheerfully, remembering their gasps when she opened the front door. “I said, ‘It’s a long story, boys. Come in.’”
Susan’s mother, Joan Rossiter, died in 1979 at 64. She had a brain tumour, which Renouf has only recently learned was metastatic.
“It turns out that my mother had ovarian cancer,” she says. Tests have shown that Renouf has inherited faults in one of the two genes – BRCA 1 and 2. Her daughters and a niece have subsequently undergone genetic testing, and to her great relief all the results so far have been normal.
She hasn’t forgotten that she briefly considered refusing treatment for her cancer. She sees now that quietly putting an end to it all would have been wildly out of character. “If I’m going,” she says, “I’m going with a bang.”
But she hopes to be around for a long time yet. She says she was touched by a get-well message from her youngest grandson, Woody, then aged 10. “He said, ‘I know you will get better, Granny, because for me you are irreplaceable. ‘I’m reading this. ‘Irreplaceable? Woody! I’ve got to live for you!’”
Reviewed by: A/Prof Martin K Oehler, Department of Gynaecological Oncology, Royal Adelaide Hospital, SA; Lucinda Hossack, Cancer Genetic Counsellor, Peter MacCallum Cancer Centre, VIC; Dr Kevin Palumbo, Radiation Oncologist, Adelaide Radiotherapy Centre, Flinders Private Hospital, SA; Nicole Wilton, Support Programs Manager, Ovarian Cancer Australia, VIC; Ilka Carapina, Consumer; and Cancer Council Queensland Helpline Operators.