Treating ovarian cancer

By NHS Choices 13

Surgery

The majority of women who have ovarian cancer will be considered for surgery. Sometimes, it is not possible to confirm the stage of the cancer until the surgery.

Your doctor will discuss with you what will happen during the surgery. The surgery will probably involve removing:

  • both ovaries and the fallopian tubes (called a bilateral salpingo-oophorectomy)
  • the uterus (called a total abdominal hysterectomy)
  • the omentum, a fatty layer of tissue within the abdomen (called an omentectomy)

The surgeon may also remove the lymph nodes from the pelvis and abdomen. They may also take samples of nearby tissue and send it to the laboratory to see if the cancer has spread.

If the cancer has spread, the surgeon will try to remove as much of it as possible. This is known as debulking surgery.

If the cancer is confined to one or both ovaries, you may only need to have the ovary or ovaries removed, leaving your uterus (womb) intact. This means you may still be able to carry a pregnancy. For most women, however, pregnancy is not an issue and the normal procedure is to remove both ovaries and the uterus.

You will probably be ready to go home three to seven days after your operation, but it can take many weeks to fully recover. After your operation you will be encouraged to start moving about as soon as possible. This is very important. Even if you have to stay in bed you must keep doing regular leg movements to help your circulation and prevent blood clots. A physiotherapist will show you exercises to help prevent complications.

When you go home, you will need to exercise gently to build up your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. Discuss with your doctor or physiotherapist which types of exercise would be suitable for you.

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Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) drugs to kill cancer cells. It is often given after surgery for ovarian cancer. In some cases, it can be given before surgery as it may help shrink the tumour and make it easier to remove. This is called neoadjuvant chemotherapy.

Several different drugs can be used in chemotherapy. Often, a combination is given. The choice of drug and how and when it is given depends on the stage of your cancer and how much it has spread. The most common treatment for ovarian cancer is a platinum-containing drug (carboplatin), which is used alone or in combination with another drug, paclitaxel.

Chemotherapy is usually given as a drip into the vein, but is sometimes given as tablets. Some studies have looked at giving chemotherapy directly into the abdomen, called intraperitoneal chemotherapy. This is not established routine practice in the UK at the moment, but it is being assessed in clinical trials.

Most often, you will have chemotherapy as an outpatient, but sometimes you may need a short stay in hospital. It is usually given in cycles, with a period of treatment followed by a period of rest to allow the body to recover. Most women have six cycles of chemotherapy.

How will I know if the chemotherapy is working?

Over the course of your chemotherapy, you will have tests to monitor how the ovarian cancer is responding to treatment. This can be done in a number of ways.

  • if you had higher than normal levels of the cancer chemical CA125 in your blood when diagnosed, you may have blood tests to see whether the levels are falling
  • if you had a tumour visible on a CT or ultrasound scan when diagnosed, you may have repeated scans to see whether it has shrunk
  • you may have another small operation, known as ‘second-look surgery’, which is carried out in the same way as a laparoscopy

If, after your chemotherapy treatment, all of your tests are clear of cancer, you will be in remission. This means the cancer is under control.

Side effects of chemotherapy

The main side effects of chemotherapy are caused by its influence on normal, healthy cells, such as immune cells. Side effects include:

  • infections
  • loss of appetite
  • nausea and vomiting
  • tiredness
  • hair loss
  • sore mouth

Many side effects can be prevented or controlled with medicines your doctor can prescribe.

Chemotherapy for cancer that has come back

Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This may be the same drugs again or a different combination of chemotherapy drugs. This is called second-line treatment. The choice of drugs will take into account which drugs were used in previous treatments, and the side effects and benefits of the drugs. Your doctor will discuss this with you.

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Radiotherapy

Radiotherapy uses high energy X-rays. Like chemotherapy, it works by targeting rapidly growing cancer cells. Radiotherapy is not often used to treat ovarian cancer. But occasionally, the multidisciplinary team may recommend it for ovarian cancer treatment under very specific circumstances, such as treating pain and bleeding from a localised tumour mass.

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Clinical trials

A great deal of progress has been made in ovarian cancer treatment. More women are living longer and having fewer side effects. These advances were discovered through clinical trials where new drugs and combinations of drugs are compared with standard treatment.

All cancer trials in this country are subject to careful oversight to ensure the trial is worthwhile and safely conducted. Participants in clinical trials can often do better overall than in routine care.

If you are approached about taking part in a trial, you will be offered an information sheet. If you wish to take part, you will be asked to sign your consent. You are always free to refuse or withdraw from a clinical trial without it affecting your care.

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Psychological help

Dealing with cancer can be a huge challenge for patients and their families. It can bring emotional and practical difficulties.

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support:

  • Your hospital doctor, specialist nurse or GP can refer you to a counsellor. If you are feeling depressed, talk to your GP. A course of antidepressant drugs may help, or your GP can arrange for you to see a counsellor or psychotherapist.
  • It can help to talk to someone who has been through the same thing as you. Many organisations have helplines and online forums. They can also put you in touch with other people who have had cancer treatment.

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