Ovarian Cancer Treatment

Ovarian Cancer Treatment: Once a woman has been diagnosed with ovarian cancer, the gynaeconcologist will work with the patient to decide the appropriate treatment for her. A combination of treatments or several treatments can be recommended to the patient depending on her stage of cancer.

Whom should you consult for ovarian cancer treatment?

A gynaecologic oncologist is a doctor who possesses expertise to treat ovarian cancer by surgery. They use other treatment modalities such as chemotherapy and also prescribe medicines to treat ovarian cancer. Depending on the patient condition, location of cancer and extent of its spread, other specialists are also involved in the treatment process – including medical and radiation oncologists.

The modality of treatment and a comprehensive plan pertaining to the treatment of ovarian cancer depend on several factors – such as the personal preferences of the patient – for instance – whether the patient is planning to have children and also on the age of the patient and overall health.

First, let us have a look at the main treatments:

01. Surgery:

The main treatment option for most of the ovarian cancers is surgery. How much surgery a woman requires depends on the extent of cancer spread to the surrounding tissues and overall health of the patient. If the cancer is localized and restricted to a specific area – and if it is in the early stage, then the possibility of treating it becomes high. If such a cancer is detected in a woman of childbearing age, then it can be treated by surgery without removing ovaries and the uterus. However, in some cases, ovaries, uterus, cervix or fallopian tubes may need to be removed.

Ovarian Cancer Treatment | Dr. Geetha Nagasree Expert Oncologist

Epithelial cell cancer is treated by surgery after properly staging and debulking the cancer. It is therefore important to stage and debulk the cancer to prevent more surgeries later. It is a very common observation by surgical oncologists that patients whose ovarian cancers have been removed extensively (debulked optimally), their prognosis is far better than those left with tumours after surgery (debulked sub-optimally).

Germ cell and stromal cell tumours are also treated by surgery – and the main objective of the surgery is to remove the cancer. If the cancer is confined to just one ovary, then that ovary is removed. However, women who have finished child bearing age, surgery is recommended to remove both the ovaries, fallopian tubes and the uterus for both stromal and germ cell tumours. In general surgery is done to remove one ovary, both the ovaries and also both ovaries and uterus – depending on the stage and extent of spread of cancer.

02. Chemotherapy:

Chemotherapy drugs are injected into a vein or taken by mouth. The drugs can also be injected directly into the abdomen (intraperitoneal chemotherapy). The treatment is mostly used after surgery to kill cancer cells that might remain active.

03. Radiation Therapy:

Radiation therapy is not the first line of treatment for ovarian cancer. This type of therapy uses high-energy X-rays to kill and shrink ovarian cancer cells. Radiation therapy may be used after surgery to kill left-over cancer cells or to shrink ovarian tumours. Occasionally, it can be an option for treating small, localized recurrent cancer.

04. HIPEC [Hyperthermic Intraperitoneal Chemotherapy]:

The patients who are suffering from advanced stage ovarian cancer or recurrent ovarian cancer undergo a complete cytoreductive surgery by which the entire visible disease is resected. In other words, optimal cytoreductive surgery is performed. At the end of the surgery, the temperature of the abdomen is raised to 41 to 43 degrees Celsius by insufflation of warm fluid, and the abdominal cavity is then treated with the infusion of chemotherapy agents like cisplatin for over one and a half hour.

There is a recent evidence in the form of multicentric trial to support this treatment modality. This type of cytoreductive surgery – which is combined with HIPEC, increases the life span of the patient, the disease-free interval, and this can be achieved without unduly affecting the overall morbidity and mortality associated with the procedure.

Ovarian Cancer Treatment | Dr. Geetha Nagasree Expert Oncologist

As far as HIPEC is concerned, it is a fact that the procedure is a specialized one, as the patients need to be selected carefully to achieve the best result.

HIPEC requires specialized equipment which raises the intra-abdominal chemotherapy temperature from 41 to 43 degrees Celsius, a temperature at which the most optimal effective dose can be achieved without compromising safety.

As far as the treatment of ovarian cancer is concerned, you should discuss all the possible treatment options, their objectives and the possible side-effects with your doctor. Next, ask as many questions as you have pertaining to ovarian cancer and its treatment if you are not sure about the outcomes. It is good if you and your doctor can make a decision that satisfies your needs.

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Dr Geetha Nagasree