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Ovarian cancer


Ovarian cancer treatment


The treatment for ovarian cancer depends on:

  • the type of ovarian cancer
  • the stage of the cancer
  • whether you wish to have children
  • whether you have a gene fault
  • your general health and fitness
  • your doctors’ recommendations.

Ovarian cancer is most often treated with surgery and chemotherapy, either on their own, or in combination. Whether you have surgery or chemotherapy first will depend on several factors.

Targeted therapy drugs may be offered if you have certain genes changes in your tumour and/or if you have advanced cancer that could not be completely removed with surgery.

Treatment options by type of ovarian cancer

  • Epithelial (stage 1) – usually treated with surgery alone. You may be offered chemotherapy after surgery if there is a high risk of the cancer coming back.
  • Epithelial (stages 2, 3 and 4) – usually treated with a combination of surgery and chemotherapy. Rarely, radiation therapy is offered. New targeted therapy drugs are being offered to people with a BRCA gene fault.
  • Stromal cell – usually treated with surgery, sometimes followed by chemotherapy or targeted therapy.
  • Germ cell – usually treated with surgery or chemotherapy or both.
  • Borderline tumour – usually treated with surgery only.

Some people with ovarian cancer may feel that they are not given as many options for treatment as there are for other types of cancer.

Currently there are several treatment options for ovarian cancer that have been proven to work and research is continuing. In some cases, you may be able to join a clinical trial to access new treatments that are being investigated.

 

Surgery

Surgery for ovarian cancer is complex. It is recommended that a gynaecological oncologist who does a lot of these operations performs the surgery. Surgery allows your gynaecological oncologist to confirm the diagnosis of ovarian cancer and work out how far the cancer has spread.

Your gynaecological oncologist will talk to you about the most suitable type of surgery, as well as the risks and side effects. These may include infertility.

If having children is important to you, talk to your doctor before surgery and ask for a referral to a fertility specialist.

How the surgery is done

You will be given a general anaesthetic and will have either a laparoscopy (with 3–4 small cuts in your abdomen) or a laparotomy (with a vertical cut from around your bellybutton to your pubic line). A laparoscopy may be used to see if a suspicious mass is cancerous. If the cancer is advanced, you will usually have a laparotomy.

You may have a biopsy during surgery if you cannot have an image-guided biopsy, or to remove and check a suspicious tumour. The results will help decide if you need debulking surgery.

If cancer is found, the surgeon will remove as much cancer as possible. This is called debulking or cytoreductive surgery. You may also have chemotherapy before or after surgery.

Debulking usually means removing the ovaries, fallopian tubes, uterus and cervix. Depending on how far the cancer has spread, other organs or tissue may also be removed during the same operation.

Types of surgery

If ovarian cancer is found, all or some of the reproductive organs will be removed. The type of surgery you have will depend on how certain the gynaecological oncologist is that cancer is present and where the cancer has spread.

  • Total hysterectomy and bilateral salpingo-oopherectomy in most cases, surgery for ovarian cancer means removing the uterus and cervix, along with both fallopian tubes and ovaries. Removing the uterus will mean you cannot carry a child.
  • Unilateral salpingo-oophorectomy – if cancer is found early and it is in one ovary, you may have only one ovary and fallopian tube removed. This is suggested for some young women who still wish to have children.

What to expect after surgery

Your recovery time will depend on the type of surgery you had, your general health, and your support at home. If you don’t have support from family, friends or neighbours, ask your nurse or the hospital social worker if it’s possible to get help at home.

In most cases, you will feel better within 1–2 weeks and should be able to fully return to your usual activities after 4–8 weeks. Ask your treatment team for more information about your particular circumstances.

  • Tubes and drips – you are likely to have several tubes in place, which will be removed as you recover.
  • Pain – as with all major surgery, you will have some discomfort or pain, but this can be controlled. 
  • Blood clot prevention – you will be encouraged to move around as soon as you can. It is common to be given a daily injection of a blood thinner or wear compression stockings for 2–3 weeks to reduce the risk of blood clots. 
  • Wound care – you can expect some light vaginal bleeding after the surgery, which should stop within two weeks. 
  • Stoma care – if you had part of the bowel removed and have a stoma, a stomal therapy nurse will explain how to manage it.
  • Length of stay – you will stay in hospital for 1–4 days. How long you stay will depend on the type of surgery you had and how quickly you recover. If you had laparoscopic surgery, you will be able to go home on the first or second day after the operation.

 

Further treatment after surgery

All tissue and fluids removed during surgery are checked for cancer cells by a pathologist. The results will help confirm the type of ovarian cancer you have, if it has spread (metastasised), and its stage, which will help determine if further treatment is needed.

If the cancer is advanced, it’s more likely to come back, so surgery will usually be followed by chemotherapy, and occasionally by targeted therapy. Radiation therapy is recommended only in particular cases.

Learn more about cancer treatments

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. When you have chemotherapy depends on the stage of ovarian cancer. It may be used at different times.

Chemotherapy before surgery

For stage 3 or 4 ovarian cancer, chemotherapy is sometimes given before surgery (neoadjuvant chemotherapy). The aim is to shrink the tumours to make them easier to remove.

After three cycles of chemotherapy, you will have a CT scan to check how the tumour has responded. Your doctor will then decide about having an operation. If you have surgery, you will have another three cycles of chemotherapy afterward. If you do not have surgery, you will continue with a further three cycles of chemotherapy.

Chemotherapy after surgery

Chemotherapy is usually given 2–4 weeks after the surgery (adjuvant chemotherapy) as there may be some cancer cells still in the body. For ovarian cancer, the drugs are usually given in repeating cycles spread over 4–5 months, but this can vary. Some people may have chemotherapy with a targeted therapy drug.

Chemotherapy as the main treatment

Chemotherapy may be recommended as the main treatment if you are not well enough for a major operation or when the cancer cannot be surgically removed.

Blood tests during chemotherapy

You will have blood tests before each chemotherapy cycle, to check your body’s healthy cells have had time to recover. If your blood count has not recovered, which can be common, there may be a delay before your next treatment.

In some cases, you may also have blood tests during treatment to check for the CA125 tumour marker.

 

Immunotherapy for ovarian cancer

In Australia, immunotherapy drugs are currently available as treatment options for some types of cancer, such as melanoma and lung cancer. At present, immunotherapy has not been proven to help treat ovarian cancer.

International clinical trials are continuing to test immunotherapy drugs for treating ovarian cancer. You can ask your treatment team for the latest updates. 

More about immunotherapy

Targeted therapy

Targeted therapy is used to treat ovarian cancer that has come back or advanced ovarian cancer. Whether you are offered targeted therapy drugs will depend on:

  • the type of ovarian cancer you have
  • other treatments you’ve already had and if they’ve worked
  • whether you have a particular gene change (fault) that may respond to targeted therapy drugs.

Types of targeted therapy drugs

Olaparib

This targeted therapy drug blocks poly (ADP-ribose) polymerase (PARP), a protein that targets cancer cells that have a BRCA1 or BRCA2 gene fault.

You may be offered olaparib after chemotherapy to treat a high-grade epithelial ovarian cancer. This is known as maintenance treatment. Or you may have olaparib if the cancer has come back (recurred) after initial chemotherapy.

Olaparib is taken as a tablet twice a day for as long as the drug appears to be helping control the cancer.

The most common side effects of olaparib include nausea, fatigue, diarrhoea and low blood cell counts. More serious side effects include bone marrow or lung problems.

Bevacizumab

This targeted therapy drug is sometimes used to treat advanced epithelial tumours. It is given with chemotherapy every three weeks as a drip into a vein (intravenous infusion). Treatment will continue for 12 months for women first diagnosed with ovarian cancer, or for as long as it’s working if it is used for cancer that has come back.

The most common side effects of bevacizumab include bleeding, skin rash, high blood pressure and kidney problems. In very rare cases, small tears (perforations) may develop in the bowel or stomach wall.

 

Radiation therapy

Radiation therapy is occasionally used to treat ovarian cancer that has spread to the pelvis or to other parts of the body. It may be used after chemotherapy or surgery to help reduce the symptoms of advanced cancer, or on its own as a palliative treatment.

How many radiation therapy sessions you have will depend on the type and size of the cancer and where it is located. You may have a few treatments or daily treatments for a number of weeks.

The side effects of radiation therapy vary. Most are temporary and disappear a few weeks or months after treatment. Radiation therapy for ovarian cancer is usually given over the abdominal area, which can irritate the bowel and bladder. It can also cause infertility.

Palliative treatment

Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease.

Many people think that palliative treatment is only for people at the end of their life, but it can help people at any stage of advanced ovarian cancer, even if they are still having active treatment for the cancer. 

As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. It is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, social and spiritual needs. The team also supports families and carers.

Learn more about palliative care

Learn more about advanced cancer

Understanding Ovarian Cancer

Download our Understanding Ovarian Cancer booklet to learn more

Download now

 

Expert content reviewers:

Dr Nisha Jagasia, Gynaecological Oncologist, Mater Hospital Brisbane, QLD; Sue Hayes, Consumer; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Health, QLD; Dr Andrew Lee, Radiation Oncologist, Canberra Region Cancer Centre and Canberra Hospital, ACT; A/Prof Tarek Meniawy, Medical Oncologist, Sir Charles Gairdner Hospital, WA; Caitriona Nienaber, Cancer Council WA; Jane Power, Consumer; A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW.

Page last updated:

The information on this webpage was adapted from Understanding Ovarian Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in April 2022. 

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