Treatment for ovarian cancer

Tuesday 1 April, 2014

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On this page: Surgery | Chemotherapy | Radiotherapy | Hormone therapy | Palliative treatment | Key points


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 and chemotherapy (in rare cases also with radiotherapy).
  • Non-epithelial  ovarian cancer: usually treated with surgery and/or chemotherapy.
  • Borderline tumours: usually treated with surgery only.

Surgery

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.

Possible surgical procedures for ovarian cancer 

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 ends of the bowel may be rejoined or a new opening called a stoma is created (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 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 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 drain your stomach fluid to prevent you vomiting.
  • You may have tubes in your abdomen to drain fluid from the operation site.

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. 

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 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.

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 wounds time to heal. Speak to your medical team, or call Cancer Council 13 11 20 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. Services are also available. It may help to support your abdomen with your hands and/or a pillow when coughing or sneezing. If you want to exercise, talk to your doctor. You should start with gentle exercise and build up to more vigorous exercise, if you want.
  • Driving: Your medical team will advise you on how long you should avoid driving.
  • Other side effects: You may have bowel problems, such as constipation or diarrhoea. Some women go through menopause if their ovaries are removed. For informaton see managing side effects of ovarian cancer treatment.

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 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.

  • Women with early stage epithelial ovarian cancer or borderline tumours may not need chemotherapy.
  •  Women with epithelial ovarian cancer that has spread outside the ovaries usually receive a combination of two chemotherapy drugs. However, a single chemotherapy drug may be prescribed for frail or elderly women, or if there are other particular medical concerns.

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.

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. 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.

Intraperitoneal chemotherapy

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.

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 are given. Talk to your medical team about what to expect.

  • Tiredness: Your red blood cell level (haemoglobin) may drop, which can cause you to feel tired and breathless. Travelling to and from treatment can also be exhausting.
  • 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.
  • 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 (loose, watery bowel movements) is another possible side effect.
  • Risk of infections: Chemotherapy drugs lower the number of white blood cells that fight infection, so you may become more susceptible to colds and the 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.
  • Temporary thinning or loss of hair: It is likely that you will lose your head and body hair, depending on the chemotherapy drug you receive. The hair will grow back after treatment is completed, however, it may look a bit different than it used to be.
  • Numbness or tingling in your hands and feet: This is called neuropathy and can be a side effect of certain chemotherapy drugs. Let your doctor know if this happens, as your dose of chemotherapy may need to be adjusted.
"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.

Ovarian cancer resource

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

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
Side effects

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:

  • fatigue and tiredness
  • diarrhoea
  • increased urination and stinging when emptying your bladder
  • slight burn to the skin around the treatment site.

More rarely, you may experience nausea or vomiting. If this occurs, you will be prescribed effective medication to control it.

For more information on radiotherapy and side effects, talk to your medical team, see our radiotherapy section or call Cancer Council 13 11 20.

Hormone therapy

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.

Palliative treatment

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.

If you would like more information see the palliative treatment, advanced cancer and coping with the side effects of cancer and its treatment sections or call Cancer Council 13 11 20.

Key points

  • Your treatment will depend on many factors, including the type of cancer, its stage and your health and fitness.
  • Ovarian cancer is usually treated with surgery. In most women with ovarian cancer, it involves a total abdominal hysterectomy, including the removal of both fallopian tubes and ovaries.
  • During the operation, the doctor will take tissue samples to check for signs of cancer. This is called a frozen section analysis or biopsy. • It will take some time to recover from an operation. Most women start to feel better within six weeks, but it may take longer.
  • After an operation, you may have further treatment. Most women have chemotherapy, but radiotherapy or hormone therapy are sometimes given.
  • Chemotherapy is the treatment of cancer with anti-cancer drugs. It is usually given soon after an operation for 5–6 months. Side effects may include tiredness, nausea and vomiting, and hair loss.
  • Radiotherapy uses x-rays to kill cancer cells or damage them and reduce their activity. You may have treatment to your pelvis, but it can also be given to other parts of the body if the cancer has spread. Side effects may include fatigue, diarrhoea and nausea. • Hormone therapy is the use of hormones or hormone- blocking drugs to fight cancer. It is only used to treat some types of ovarian cancer.
  • Pallitative treatment is given to improve your quality of life by relieving the symptoms of cancer.

Force of Life, Susan Renouf's story

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!’”

Tell your cancer story.


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.

Updated: 01 Apr, 2014