Treatments for epithelial ovarian cancer

Epithelial ovarian cancer is the most common type of ovarian cancer. Your healthcare team will suggest treatments for this cancer based on your needs and work with you to develop a treatment plan.

The following are treatment options for the different stages of epithelial ovarian, fallopian tube and primary peritoneal cancers. Fallopian tube and primary peritoneal cancers start in the same type of tissue as epithelial ovarian cancer, but are much rarer cancers.

The following are treatment options for stage 1 cancer. 

Surgery is the first treatment for stage 1 cancer. It's done to remove the cancer and to check if it has spread outside of the ovaries. The types of surgery that may be done are:

• removing only the ovary with cancer and the fallopian tube on the same side (called a unilateral salpingo-oophorectomy)
• removing the cervix and uterus (called a total hysterectomy) and both ovaries and both fallopian tubes (called a bilateral salpingo-oophorectomy)

During surgery, the surgeon collects abnormal-looking tissue samples from different parts of the pelvis, abdomen and lymph nodes. They will also rinse the abdomen with salt water (saline) and collect a sample (called pelvic washings). The tissue samples and pelvic washings are analyzed in a lab to find out if cancer has spread. This is called surgical staging.

Find out more about surgery for ovarian cancer.

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy is offered to destroy cancer cells left behind after surgery and reduce the risk the cancer will come back (recur). This is called adjuvant chemotherapy.

Chemotherapy for stage 1 cancer is usually given as a combination of 2 or more drugs. A platinum drug, such as carboplatin or cisplatin, is combined with a taxane drug, such as paclitaxel or docetaxel. The combination most often used is carboplatin and paclitaxel. These drugs are given by IV (intravenously).

Find out more about chemotherapy for ovarian cancer.

The following are treatment options for stage 2 cancer. 

Surgery is the first treatment given for stage 2 cancer. The cancer is staged during surgery. The types of surgery that may be done are:

• removing the uterus and cervix (called a total hysterectomy) and both ovaries and both fallopian tubes (called a bilateral salpingo-oophorectomy)
• removing as much of the tumour as possible (called surgical debulking)

Chemotherapy is usually offered after surgery. Carboplatin and paclitaxel is the drug combination that is most often used. 

The following are treatment options for stage 3 cancer. 

Surgery is the first treatment given for stage 3 cancer. The types of surgery that may be done are:

• removing the uterus and cervix (called a total hysterectomy) and both ovaries and both fallopian tubes (called a bilateral salpingo-oophorectomy)
• removing the fatty tissue from the upper abdomen (called an omentectomy)
• removing as much of the tumour as possible (called surgical debulking)

During surgical staging, the surgeon may also remove all or parts of other organs where cancer has spread, such as the intestines, liver or bladder.

Chemotherapy is sometimes given to shrink a tumour before surgical debulking (called neoadjuvant chemotherapy). Carboplatin and paclitaxel is the combination that is most often used.

You may be offered adjuvant chemotherapy after surgery. If the tumour in the abdomen is smaller than 1 cm, intraperitoneal (IP) chemotherapy may be used. IP chemotherapy is given directly into the abdomen through a small, flexible catheter.

When chemotherapy drugs are heated before putting them into the body, it's called hyperthermic intraperitoneal chemotherapy (HIPEC). This type of IP chemotherapy may be used to destroy any cancer cells left behind after surgery. Once the surgeon has removed as much of the tumour as possible, a machine heats the chemotherapy and pumps it into the abdomen.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer.

Bevacizumab (Avastin) is the targeted therapy drug that is most often used. If you have advanced cancer, bevacizumab may be given if the cancer has responded to chemotherapy with a platinum drug such as carboplatin or cisplatin. If you have recurrent cancer that did not respond to chemotherapy, bevacizumab may be combined with chemotherapy drugs to help them work better.

Olaparib (Lynparza) or niraparib (Zejula) may be offered after the cancer has responded to platinum-based chemotherapy. These drugs are given as maintenance therapy to prevent the cancer from coming back.

Find out more about targeted therapy for ovarian cancer.

The following are treatment options for stage 4 cancer.

Surgery is the main treatment for stage 4 cancer. It may be done to remove the tumour. Or, if the tumour can't be completely removed, they'll remove as much as possible (called surgical debulking). 

Surgery may also be done to reduce pain or ease symptoms (called palliative surgery). Types of palliative surgeries for stage 4 cancer include:

• paracentesis to remove fluid from the abdomen
• thoracentesis to remove fluid from around the lungs
• placing a feeding tube into the stomach or intestines
• placing a tube (stent) in the large or small intestine or ureter to relieve a blockage caused by a tumour

Chemotherapy may be offered before or after surgery. Carboplatin and paclitaxel is the combination that is most often used.

Targeted therapy may be offered on its own or with chemotherapy. The same drugs are used as stage 3.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered palliative radiation therapy to relieve pain or control the symptoms of stage 4 cancer.

Find out more about radiation therapy for ovarian cancer.

Recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer means that the cancer has come back after it has been treated.

Persistent cancer means that the cancer didn’t go away completely after treatment.

Refractory cancer means the cancer has stopped responding to treatment or continues to grow during treatment.

You may be offered the following treatments for recurrent, persistent or refractory epithelial ovarian, fallopian tube or primary peritoneal cancer.

Surgery may be offered for recurrent or persistent cancer. The types of surgery that may be done are:

• surgical debulking
• palliative surgery used in stage 4

Chemotherapy with a combination of drugs is usually used to treat recurrent, persistent or refractory cancer. The chemotherapy drugs used depends on the drugs used the first time and how long the cancer went away after finishing the last chemotherapy treatment.

If the cancer comes back (recurs) at least 6 months after your last chemotherapy treatment, you may be given the same drug combination again.

If the cancer recurs in less than 6 months or it didn’t go away, your healthcare team may try a different drug combination.

Many drugs can be combined to treat recurrent, persistent or refractory ovarian cancer. The most common combination is carboplatin and paclitaxel. Other chemotherapy combinations that may be used include:

• BEP – bleomycin, etopisode phosphate and cisplatin gemcitibine and cisplatin
• VAC – vincristine sulfate, dactinomycin and cyclophosphamide
• VeLP – vinblastine sulfate, ifosfamide and cisplatin

If the cancer is not responding to chemotherapy or continues to grow during treatment, your healthcare team may use a single non-platinum chemotherapy drug or combine chemotherapy with other treatments, such as targeted therapy. Single chemotherapy drugs that may be used include:

• docetaxel
• paclitaxel
• etoposide
• gemcitabine
• topotecan
• vinorelbine
• pegylated liposomal doxorubicin
• trabectedin

Targeted therapy may be used to treat recurrent, persistent or refractory cancer. You may be offered the same drugs as previous stages.

Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. It's rarely used to treat recurrent, persistent or refractory cancer.

The hormone therapy drugs that may be used are:

• anastrozole (Arimidex)
• letrozole (Femara)
• tamoxifen

Find out more about hormone therapy for ovarian cancer.

Talk to your doctor about clinical trials open to people with ovarian, fallopian tube and primary peritoneal cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer.

Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.