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Comparing Ovarian Cancer Treatment Options

Ovarian cancer starts when cells grow out of control in, on, or near one or both ovaries. The most commonly used treatment for ovarian cancer is surgery.

Chemotherapy, radiation, and targeted drug therapy are other therapies are used to treat ovarian cancer. These therapies may be combined with each other or with surgical treatment.

This article will discuss the treatments used for ovarian cancer and provide information about their success rates and side effects.

Does Ovarian Cancer Treatment Cure Patients?

Ovarian cancer can be challenging to cure, but full, long-term recovery is possible to achieve.

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program reports these five-survival rates:

  • Localized (confined to the primary site): 92.4%
  • Regional (spread to regional lymph nodes): 72.9%
  • Distant (cancer has metastasized—spread to other areas of the body): 31.5%

Around 20% of people with advanced-stage ovarian cancer survive for over 12 years after treatment.

One of the challenges of treatment is late-stage diagnosis. Only 18% of cases are diagnosed while the cancer is localized, and 55% of cases are already metastasized when diagnosed.

People at high risk for ovarian cancer may undergo periodic diagnostic testing that includes blood tests and sonograms. However, there is no effective early-detection screening test available for the general population.

In addition, early-stage ovarian cancer presents with vague symptoms, such as bloating, which can go unnoticed for an extended period of time. Ovarian cancer also progresses quickly. It's possible to go from an early stage to a late stage in as little as one year.

For all of these reasons, ovarian cancer often goes undetected until it has spread and is difficult to cure. Even so, there is always room for hope.

The goal of initial ovarian cancer treatment is the complete removal of all cancer cells, wherever they exist in the body. Surgical removal of tumors, chemotherapy that kills cancer cells, and other treatments are used for this purpose.

Ovarian cancer has the greatest chance of being cured if no cancer cells remain after the initial round of treatment. Cancer is more likely to recur if this goal is not met.

Ovarian Cancer Treatment Options

Your overall health and strength, along with the type of ovarian cancer you have, will be taken into account when a treatment plan is designed for you.

Every form of ovarian cancer is staged from 1 (the least amount of spread) to 4 (the most spread). Your cancer stage will have an impact on your treatment options.

Surgery

Surgery for ovarian cancer is done by a specialist, such as a gynecologic oncologist (a specialist in cancers of the female reproductive system). The main goals of surgery are staging and debulking. Surgery is used to treat ovarian cancer from stages 1 to 4.

Imaging tests may be done before or during the procedure to locate tumors in the reproductive organs and other areas of the body. The extent of the cancer's spread will be assessed during surgery. This is referred to as staging.

Surgical procedures for ovarian cancer include:

Lymph nodes in the pelvis and abdomen may be removed and biopsied (examined microscopically in the lab) to check for spread. If fluid has accumulated in these areas, it will also be removed and biopsied.

If your cancer is in an early stage and you wish to bear children, your uterus, one ovary, and one fallopian tube may be left intact, provided no tumors are found in those areas.

Any tumors found will be debulked. This means that as much tumor as possible will be surgically removed. Portions of other organs, such as the colon or bladder, may need to be removed so that your surgeon can effectively debulk the tumors.

Debulking increases survival rates and helps ensure that follow-up treatments, like chemotherapy and radiation, will be more successful.  

Surgery may need to be repeated for cancer that returns (recurrent) or is persistent (the tumor was not fully removed during the initial surgery).

Facts about surgery for ovarian cancer:

  • Success rate: Success rates vary based on the stage and type of ovarian cancer being treated. Other treatments, including chemotherapy, typically accompany surgery. Up to 70% of people treated with surgery plus chemo experience relapse after a remission period of 12 to 18 months.
  • Side effects: Pain, discomfort, or tenderness in the pelvis and abdomen are common post-surgical side effects. Removal of the reproductive organs can also cause menopausal symptoms in people who have not yet gone through menopause. These include hot flashes and vaginal dryness. If your lymph nodes are removed, you may also experience lymphedema (painful swelling from lymph fluid buildup).

Chemotherapy

Chemotherapy uses one or more drugs to kill cancer cells. It is used to treat ovarian cancer in stages 2 to 4. People with stage 1 cancer may also get chemotherapy if they have high-grade tumors. (High-grade cancer cells grow and spread rapidly compared to low-grade cancer cells.)

Chemo is used to treat cancer that has spread (metastasized) to other areas of the body.

Chemotherapy may be done before surgery to shrink existing tumors. This may make the surgical procedure easier and more successful. Chemotherapy may also be done after surgery to kill off any remaining cancer cells in the reproductive organs.

Chemo may be given intravenously or orally. In some instances, chemotherapy for ovarian cancer may be administered directly into the abdomen through a catheter (intraperitoneal chemotherapy).

Facts about chemotherapy for ovarian cancer include:

  • Success rate: Chemotherapy is beneficial for increasing the efficacy of surgery. The success rate for this treatment is determined significantly by multiple factors, including cancer stage and the extent of metastasis. Ask your treatment team how it may be expected to benefit you given the characteristics of your case.
  • Side effects: Side effects of chemotherapy include hair loss, mouth sores, nausea, bruising, rashes, and an increased risk of infection.

Radiatio

Radiation therapy kills cancer cells and shrinks tumors with high-energy beams. Recurrent or persistent ovarian cancer may be treated with external beam radiation therapy. Ovarian cancer that has metastasized to other parts of the body, such as the brain or spinal cord, may also be treated with radiation therapy.

Radiation is less commonly used to treat ovarian cancer than other treatments, such as surgery and chemotherapy.

Facts about radiation therapy for ovarian cancer include:

  • Success rate: Radiation is less effective than aggressive chemotherapy for treating ovarian cancer.
  •  Side effects: Side effects include skin irritation at the radiation site, nausea, vomiting, and fatigue.

Targeted Drug Therapy

Targeted therapy uses drugs to alter the way cancer cells divide, grow, or interact with other cells. It is used to treat stage 3 and stage 4 ovarian cancer.

Several different types of targeted therapy drugs are used for ovarian cancer. Common types include antiangiogenic agents such as Avastin (bevacizumab) and poly (ADP-ribose) polymerase (PARP) inhibitors such as Lynparza (olaparib).

Some targeted drugs are given orally. Others are administered via infusion into a vein.

Targeted therapy may be used along with chemotherapy in people with advanced ovarian cancer.

Facts about targeted therapy for ovarian cancer include:

  • Success rate: Many targeted drug treatments are beneficial for shrinking or stopping the growth of tumors. Data are lacking on their ability to prolong life expectancy.
  • Side effects: Side effects vary based on the drug given. Nausea, vomiting, stomach pain, and diarrhea are common.

Hormone Therapy

Hormone therapy adds, alters, or blocks the production of hormones, such as estrogen, that stimulate tumor growth. This type of treatment is usually reserved for treating ovarian stromal tumors. It is not a common treatment for other types of ovarian cancer. However, it may be used instead of chemotherapy in some instances.

Hormone-blocking medications include Nolvadex (tamoxifen), aromatase inhibitors such as Femara (letrozole), and luteinizing hormone-releasing hormone (LHRH) agonists such as Lupron (leuprolide). These medications may be given orally or via injection.

Facts about hormone therapy for ovarian cancer include:

  • Success rate: Certain forms of hormone therapy may be helpful for improving survival rates when it is used in combination with treatments like surgery and chemotherapy.
  • Side effects: Side effects of hormone-blocking treatment include bone thinning, joint pain, muscle pain, and hot flashes.

Clinical Trial Enrollment

Clinical trials are research studies used to determine the efficacy of new treatments and combinations of treatments. This type of research is vital for increasing medical knowledge about combating disease.

Participating in a clinical trial is voluntary. You and your healthcare provider can discuss which trials you may be eligible for and whether they may be beneficial for you.

Many people experience highly positive outcomes and gain hope from their participation in a clinical trial.

Approximately 350 National Cancer Institute (NCI)–supported ovarian cancer clinical trials are currently recruiting, being planned, or taking place. The list is available online.

Where Do Patients Receive Ovarian Cancer Treatment?

Cancer treatment, including clinical trials, take place in cancer centers and hospitals, including some specific to veterans and the military. Treatment for ovarian cancer takes place in every U.S. state and around the world.

Choosing the right cancer center to treat your or a loved one's condition can be daunting. In some instances, you may learn that your health insurance is not accepted at the facility you wish to go to.

Even with insurance, the cost of treatment may be a significant factor. Your cancer team will include a social worker. Talk to them about ways to obtain financial help and resources that can make paying for treatment easier.

If you live in a remote area, you may also need to build travel plans or temporarily relocate to get the best level of care. The American Cancer Society runs a Hope Lodge community program that provides free lodging for people undergoing cancer treatment.

To start, talk to your diagnosing physician. They may have input as to the best nearby place that treats ovarian cancer.

The Association of Community Cancer Centers publishes a list of providers and a search tool which may also be helpful. The National Cancer Institute also has a list of NCI-designated cancer centers.

Advancements in Ovarian Cancer Treatment

Ovarian cancer research is constantly ongoing. This includes research into cancer stem cell (CSC) theory.

CSC is an analysis of the potential role of cancer stem cells in ovarian cancer tumor development and progression. Cancer stem cells may cause disease relapse and metastasis. It may also be responsible for making ovarian cancer tumors resistant to chemotherapy. Research into the role of cancer stem cells is ongoing and needed.

Immunotherapy is a treatment that utilizes the body's own immune system to fight, prevent, or control cancer. Immunotherapy for ovarian cancer is a promising field that is being explored in clinical trials. Several are also available via prescription. Food and Drug Administration (FDA)–approved immunotherapy treatments for ovarian cancer include:

  • Targeted antibodies that inhibit tumor blood vessel growth: Avastin (bevacizumab)
  • Immunomodulators that target immune checkpoint proteins that regulate the immune system's response to threats: Jemperli (dostarlimab) and Keytruda (pembrolizumab)

Ovarian Cancer Treatment Without Surgery

Surgical treatment for ovarian cancer can be extensive. In premenopausal people, it can also result in infertility. The prospect of surgery can be upsetting, overwhelming, or scary. However, it's important to weigh your treatment options realistically.

Ovarian cancer is a devastating disease with a high mortality rate once it has spread. If you choose to forgo surgery as a treatment, discuss your remaining options with your oncologist.

Sometimes, it may be decided that you are not physically strong enough to withstand surgery. Palliative care, which addresses symptom control rather than the possibility of a cure, may also be an option. In these instances, radiation may be used to shrink or control your tumors.

Complementary and alternative (CAM) therapies such as acupuncturereflexology, and yoga may also alleviate symptoms, reduce stress, or improve quality of life.24 These treatments are not cures and should not be pursued as cures.

Self-Care During Ovarian Cancer Treatment

Ovarian cancer is a life-altering disease, but you are still you. Self-care is essential, no matter where you are in treatment.

Self-care is not one-size-fits-all. For some people, simply pursuing daily hygiene is enough to maintain good spirits. Putting on makeup and favorite items of clothing can be a mood booster. You may wish to indulge in massages or manicures.

Stress relievers like yoga and meditation can be very beneficial. Taking walks in natural surroundings, reading absorbing books, and watching funny movies can all be helpful.

Maintaining relationships, or starting new ones, is an important aspect of self-care. Keeping in touch with good friends and close family members can help provide you with shoulders to lean on, kind words, and practical support like transportation to appointments.

Joining a support group of people with ovarian cancer can also provide a unique form of camaraderie.To find a support group near you, contact any of these organizations:

Summary

Ovarian cancer is a challenging condition that is often diagnosed during its later stages. Treatment for ovarian cancer typically includes surgery and chemotherapy. Other treatments, such as targeted drug therapy and radiation may also be used.

The type of ovarian cancer you have, as well as the stage it is in, will determine the treatment options that are best for you. Even though ovarian cancer is hard to treat, hope and long-term survival are possible.


https://www.verywellhealth.com/ovarian-cancer-treatment-7508775

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