The treatment for ovarian cancer depends on the type of ovarian cancer you have, the stage of the cancer, your general health and fitness, your doctors' recommendations, and whether you wish to have children.
Treatment options by type of ovarian cancer
Surgery is the main treatment for all stages of epithelial ovarian cancer. The aim is to remove as much of the cancer as possible. Sometimes, additional treatment is needed.
- Stage I ovarian cancer is usually treated with surgery alone. Some women will be offered chemotherapy after surgery if there is a high risk of the cancer coming back.
- Stages II, III and IV are usually treated with a combination of surgery and chemotherapy. New targeted therapy drugs are being offered to women with a BRCA mutation. In some cases, radiation therapy is offered.
This is usually treated with surgery and/or chemotherapy.
This is usually treated with surgery, sometimes followed by chemotherapy or targeted therapy.
This is usually treated with surgery only.
Your gynaecological oncologist will talk to you about the most suitable type of surgery, as well as the risks and any possible complications. 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.
Ovarian cancer is staged surgically. This means that the surgery will help the doctor work out how far the tumour has spread within the pelvic cavity.
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 long, vertical cut from your bellybutton to your bikini line). The type of surgery you have will depend on how certain the gynaecological oncologist is that cancer is present and how far they think the cancer has spread. A laparoscopy may be used to see if a suspicious mass is cancerous; however, most women with advanced cancer will have a laparotomy.
The gynaecological oncologist will look inside your pelvis and abdomen for signs of cancer, and take tissue and fluid samples (biopsy). During the operation, the samples are usually sent to a specialist called a pathologist, who immediately examines them for signs of cancer. This is called a frozen section analysis or biopsy.
If cancer is present, the gynaecological oncologist will continue the operation and remove as much of the cancer as possible. This is called surgical debulking.
Types of surgery
Depending on how far the cancer has spread, you may have one or more of the procedures listed below.
Total hysterectomy and bilateral salpingo-oophorectomy
Most women with ovarian cancer will have an operation to remove the uterus and cervix, along with both fallopian tubes and ovaries.
If the cancer is found early and it is only in one ovary, some young women who still wish to have children may have only one ovary and fallopian tube removed.
The omentum is a sheet of fatty tissue attached to the stomach and bowel. It hangs down in front of the intestines. Ovarian cancer often spreads to the omentum and it may need to be removed.
The pelvis contains large groups of lymph nodes. Cancer cells can spread from your ovaries to nearby lymph nodes. Your doctor may suggest removing some in a lymphadenectomy (also called lymph node dissection).
If cancer spreads to the bowel, some of the bowel may be removed. A new opening called a stoma may be created (colostomy or ileostomy). This is usually temporary.
Removal of other organs
Ovarian cancer can spread to many organs in the abdomen. In some cases, parts of the liver, diaphragm, bladder and spleen may be removed if it is safe to do.
Surgery for ovarian cancer is complex. To ensure the best result, it is recommended that you are treated by a gynaecological oncologist at a specialist centre for gynaecological cancer. Call Cancer Council 13 11 20 for information about specialist centres in your area or see Understanding Surgery.
All tissue and fluids removed during surgery are examined 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. It may not be possible to remove all the cancerous tissue. Surgery is often followed by chemotherapy, which will shrink or destroy any remaining cancer cells.
What to expect after surgery
When you wake up from surgery, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be taken back to your bed on the hospital ward.
Tubes and drips
You will have several tubes in place, which will be removed as you recover:
- a drip inserted into a vein in your arm (intravenous drip) will give you fluid, medicines and pain relief
- a small plastic tube (catheter) may be inserted into your bladder to collect urine in a bag
- a tube may be inserted down your nose into your stomach (nasogastric tube) to drain stomach fluid and prevent vomiting
- tubes may be inserted in your abdomen to drain fluid from the site of the operation.
After an operation, it is common to feel some pain, but this can be controlled. For the first day or two, you may be given pain medicine through a drip or via a local anaesthetic injection into the abdomen (a transverse abdominis plane or TAP block) or spine (an epidural). Some patients have a patient-controlled analgesia (PCA) system. This machine allows you to self-administer a measured dose of pain relief by pressing a button. Let your doctor or nurse know if you are in pain so they can adjust the medicine. Managing your pain will help you to recover and move around more quickly.
It is common to have daily injections of a blood thinner to reduce the risk of blood clots. These injections may continue for some time after the operation and while you're having chemotherapy. A nurse will show you how to give this injection to yourself before you leave hospital.
Compression devices and stockings
Some women have to use compression devices or wear elastic stockings to keep the blood in their legs circulating. Once you are moving around, compression devices will be removed so you can get out of bed, but you may still wear the stockings for a couple of weeks.
You can expect some light vaginal bleeding after the surgery, which should stop within two weeks. Your doctor will talk to you about how to keep the wound clean once you go home to prevent it becoming infected.
Length of stay
You will probably stay in hospital for 4–7 days for a big operation, less for a laparoscopy or smaller operation.
Taking care of yourself at home after surgery
Your recovery time will depend on the type of surgery you had, your general health, and your support at home. Most women are able to fully return to their usual activities after 4–8 weeks.
Take things easy and do only what is comfortable. You may like to try meditation or some relaxation techniques to reduce tension.
Avoid heavy lifting (more than 3–4 kg), hanging out the washing, or vacuuming for at least six weeks. Use a clothes horse or dryer instead of hanging the washing on a line. If you have a partner or children, ask them to help around the house. You can also check with a social worker if it's possible to get help at home.
You will most likely need to avoid driving for a few weeks after the surgery. Check with your car insurer for any conditions regarding major surgery and driving.
Depending on the nature of your work, you will probably need 4–6 weeks leave from work.
You may have constipation following the surgery. It is important to avoid straining when passing a bowel motion, so you may need to take laxatives.
To help your body recover from surgery, focus on eating a balanced diet (including proteins such as lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds and legumes/beans).
Sexual intercourse should be avoided for about six weeks after the operation to give your wounds time to heal. Ask your doctor when you can resume sexual intercourse and explore other ways you and your partner can be intimate, such as massage.
Your health care team will probably encourage you to start walking the day after the surgery. Exercise has been shown to help people manage some of the common side effects of treatment, speed up a return to usual activities and improve overall quality of life. Start with a short walk and go a little further each day. Speak to your doctor if you would like to try more vigorous exercise.
Take showers instead of baths, and avoid swimming for 4–6 weeks after surgery.
Your doctor should have all the test results within two weeks of surgery. Further treatment will depend on the type of ovarian cancer, the stage of the disease and the amount of any remaining cancer. 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 not often recommended.
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. Chemotherapy may be used at different times:
Most women will have chemotherapy after surgery (adjuvant chemotherapy) as there may be some cancer cells still in the body. Chemotherapy usually starts 2–4 weeks after surgery. The drugs you receive will depend on the stage of the cancer and your general health. For ovarian cancer, a combination of several drugs is usually given in repeating cycles spread over 4–5 months. Your treatment team will provide details about your specific schedule.
Some women with stage III or stage IV ovarian cancer have chemotherapy before surgery (neoadjuvant chemotherapy). The aim is to shrink the tumours to make them easier to remove. This usually involves three cycles of chemotherapy, followed by surgery, and then another three cycles.
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.
Chemotherapy is usually given as a combination of two drugs, or sometimes as a single drug. It's delivered as a liquid drip into a vein (intravenous drip). To reduce the need for repeated needles, some women have a small medical appliance or tube placed beneath their skin through which they receive chemotherapy. This may be a port-a-cath, a peripherally inserted central catheter (PICC), or another type of catheter.
You will usually have chemotherapy as an outpatient (also called a day patient), but some women need to stay in hospital overnight.
Let your oncologist know if you are taking nutritional or herbal supplements as these can interact with chemotherapy and may lessen the effect.
For more information, see Understanding Chemotherapy or call Cancer Council 13 11 20.
Each chemotherapy treatment is called a cycle and is followed by a rest period to give your body time to recover. Ask your doctor about the treatment plan recommended for you.
This is a way of giving chemotherapy directly into the abdominal cavity – the space between the abdominal organs and the abdominal wall.
The drugs are given through a tube (catheter) that is put in place during surgery and removed once the course of chemotherapy ends.
Intraperitoneal chemotherapy is used only in specialised units in Australia. It may be offered to women with stage III disease with less than 1 cm of tumour remaining after surgery.
Some studies have shown it may be more effective than giving chemotherapy through an intravenous drip.
Ask your doctor for more information about this type of treatment and the advantages and side effects.
Blood tests during chemotherapy
Before each chemotherapy session, you will have blood tests 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 CA125. If the CA125 level was high before chemotherapy, it can be monitored to see if the treatment is working.
"I kept a notebook to record my chemotherapy symptoms and any questions I had." – Ann
Side effects of chemotherapy
Chemotherapy can affect healthy cells in the body, which may cause side effects. Not all women will have side effects, and they will vary according to the drugs you are given. Your health care team will talk to you about what to expect and how to manage any side effects (see also managing side effects).
Your red blood cell level (haemoglobin) may drop, which can cause you to feel tired and short of breath. Travelling to and from treatment can also be exhausting.
Some chemotherapy drugs may make you feel sick or vomit. You will generally be given anti-nausea medicines with each chemotherapy session to help prevent or reduce nausea and vomiting. Whether or not you feel sick is not a sign of how well the treatment is working.
Changed bowel habits
Many women become constipated while on chemotherapy. This may be caused by anti-nausea drugs or because what you can eat changes. Your doctor will talk to you about taking laxatives. Diarrhoea (loose, watery bowel movements) is another possible side effect.
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, but the colour and texture may change. For more details, see Hair Loss or call Cancer Council 13 11 20 to ask about wig services in your area. If you have private health insurance, check with your provider whether you are entitled to a rebate on a wig purchased because of hair loss associated with chemotherapy.
Risk of infections
Chemotherapy reduces your white blood cell level, making it harder for your body to fight infection. Colds and flu may be easier to catch and harder to shake off, and scratches or cuts may get infected more easily. You may also be more likely to catch a more serious infection and need to be admitted to hospital. Contact your doctor or go the nearest hospital if you have a temperature of 38°C or over or other signs of infection.
Joint and muscle pain
This may occur after your treatment session. It may feel like you have the flu, but the symptoms should disappear within a few days. Taking paracetamol may help.
Numbness or tingling in your hands and feet
This is called peripheral neuropathy, and it 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.
Targeted therapy drugs can get inside cancer cells and block particular proteins (enzymes) that tell the cancer cells to grow. These drugs are used to treat some types of ovarian cancer. They may also be used in certain situations (e.g. if chemotherapy has not been successful). Genetic testing will help determine if you have a particular faulty gene that may respond to targeted therapy drugs.
Bevacizumab is a targeted therapy drug used to treat advanced epithelial tumours. It works by stopping the cancer developing new blood vessels and growing. Bevacizumab is given with chemotherapy every three weeks as a drip into a vein (infusion). It is commonly given in repeating cycles.
Olaparib is a new treatment for women with high-grade epithelial ovarian cancer who have the BRCA1 or BRCA2 gene mutation. This drug is usually given after chemotherapy to help stop the cancer growing. It is taken as a tablet twice a day.
Other targeted therapy drugs may be available on clinical trials. Talk with your doctor about the latest developments and whether you are a suitable candidate.
Side effects of targeted therapy
Although targeted therapy minimises harm to healthy cells, it can still have side effects. It is important to discuss any side effects with your doctor immediately. If left untreated, some can become lifethreatening. Your doctor will monitor you throughout treatment.
The most common side effects experienced by women taking bevacizumab include wound-healing problems, bleeding, high blood pressure and kidney problems. In very rare cases, small tears (perforations) may develop in the bowel wall.
The most common side effects experienced by women taking olaparib include nausea, fatigue, vomiting, and low blood cell counts. More serious side effects include bone marrow or lung problems.
Radiation therapy (also known as radiotherapy) uses x-rays to damage cancer cells. The radiation is targeted at cancer sites in your body, with the aim of reducing the cancer's growth and improving symptoms.
Radiation therapy for ovarian cancer may be used to treat the pelvis or other sites of cancer that have spread further away. It may be used after chemotherapy or on its own as a palliative treatment.
Before treatment starts, the radiation oncology team will explain the treatment schedule and the possible side effects. You will lie on a table under a machine that delivers radiation to the affected parts of the body. You will not feel anything during the treatment, which will take only a few minutes each time. You may be in the room for a total of 10–20 minutes for each appointment.
The number of radiation therapy sessions you have will depend on the type and size of the cancer. You may have a few treatments or daily treatment for several weeks.
Side effects of radiation therapy
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.
Common side effects include feeling tired, diarrhoea, needing to pass urine more often and burning when you pass urine (cystitis), and a slight burn to the skin around the treatment site. More rarely, you may have some nausea or vomiting. If this occurs, you will be prescribed medicine to control it. For more information, see Understanding Radiation Therapy or call Cancer Council 13 11 20.
Palliative treatment helps to improve people's quality of life by managing the symptoms of cancer without trying to cure the disease. It is best thought of as supportive care.
Many people think that palliative treatment is for people at the end of their life, but it may be beneficial for people at any stage of advanced ovarian cancer. It is about living for as long as possible in the most satisfying way you can.
As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. The treatment may include chemotherapy and radiation therapy. If you are experiencing swelling and are uncomfortable, you may have a procedure called paracentesis or ascitic tap to drain the extra fluid from your abdomen.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, practical, emotional, spiritual and social needs. For more information, see Understanding Palliative Care and Living with Advanced Cancer or call Cancer Council 13 11 20.
- Your treatment will depend on many factors, including the type of ovarian cancer, its stage, whether you wish to have children, whether you have a faulty gene, and your overall health and fitness.
- Ovarian cancer is usually treated with surgery. In most women with ovarian cancer, surgery involves a total hysterectomy, as well as the removal of both fallopian tubes and ovaries, and the omentum (fatty tissue).
- During the operation, the doctor may take tissue samples to check for signs of cancer. This is called a biopsy.
- It will take time to recover from an operation. Recovery times vary depending on the type of surgery you have. You will need to take things easy when you first get home from hospital.
- After surgery, you may have further treatment. Most women have chemotherapy, but they may also have radiation therapy or targeted therapy.
- Chemotherapy is usually given soon after an operation for 4–5 months. Side effects may include tiredness, nausea and vomiting, and hair loss.
- Newer treatments for ovarian cancer include targeted therapy drugs, which can help stop the cancer growing. You may need a genetic test to see if you are likely to respond to these drugs.
- Radiation therapy uses x-rays to damage cancer cells. You may have treatment to your pelvis, but it can also be given to other parts of the body if the cancer has spread.
- Palliative treatment aims to improve your quality of life by relieving the symptoms of cancer.
Expert content reviewers:
A/Prof Alison Brand, Director, Gynaecological Oncology, Westmead Hospital, and Chair, Australia New Zealand Gynaecological Oncology Group, NSW; Dr Scott Carruthers, Director, Radiation Oncology, Lyell McEwin Hospital, and Deputy Director, Radiation Oncology, Royal Adelaide Hospital, SA; Elizabeth Cooch, Cancer Support Nurse, Ovarian Cancer Australia; Dr Serene Foo, Medical Oncologist, Austin Hospital, Epworth Eastern Hospital, and Mercy Hospital for Women, VIC; Keely Gordon-King, Psychologist, Cancer Council Queensland; Carol Lynch, Consumer; A/Prof Gillian Mitchell, Honorary Medical Oncologist, Familial Cancer Centre, Peter MacCallum Cancer Centre, and The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC; Claire Quenby, Social Worker, King Edward Memorial Hospital for Women, WA; Jan Priaulx, 13 11 20 Consultant, Cancer Council NSW; Hayley Russell, Support Coordinator, Ovarian Cancer Australia.