• 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.

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.

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.

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.

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 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 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.

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.

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.