Treatments for epithelial ovarian cancer

The following are treatment options for the stages of epithelial ovarian cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the first treatment given for stage 1 epithelial ovarian cancer. It is done to remove the cancer and to see if there is any spread outside of the ovaries. The types of surgery are:

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

During surgery, the surgeon also removes abnormal-looking tissue samples from different parts of the pelvis, abdomen and lymph nodes. These samples are then analyzed in the lab to find out if the cancer has spread. This part of surgery is called surgical staging.

Chemotherapy may be given after surgery for stage 1 epithelial ovarian cancer.

A combination of a platinum drug, such as cisplatin or carboplatin, and a taxane drug, such as paclitaxel or docetaxel, is used. Carboplatin and paclitaxel given by IV (intravenously) is the chemotherapy that is most often given for stage 1 epithelial cancer.

The grade of the cancer is important when planning treatment for stage 1A and 1B epithelial ovarian cancer.

• A grade 1 epithelial ovarian cancer may be treated with a unilateral salpingo-oophorectomy only if you want to be able to get pregnant after treatment.
• A grade 2 cancer can be watched closely after surgery without more treatment, or chemotherapy will be given.
• A grade 3 cancer is usually treated with chemotherapy after surgery.

Stage 1C treatment is surgery followed by chemotherapy.

Surgery is the first treatment given for stage 2 epithelial ovarian cancer. The types of surgery are:

• total hysterectomy and bilateral salpingo-oophorectomy
• removing as much of the cancer as possible (called surgical debulking)

During surgery, the surgeon also removes abnormal-looking tissue samples from different parts of the pelvis, abdomen and lymph nodes. These samples are then analyzed in the lab to find out if the cancer has spread. This part of surgery is called surgical staging.

Chemotherapy is usually given following surgery. Carboplatin and paclitaxel given by IV is the chemotherapy that is most often given. Some women may have intraperitoneal (IP) chemotherapy instead of IV chemotherapy. IP chemotherapy is given directly into the abdomen through an implanted temporary port, instead of IV chemotherapy.

Surgery is the first treatment given for stage 3 epithelial ovarian cancer. The types of surgery are:

• total hysterectomy and bilateral salpingo-oophorectomy
• removing the fatty tissue that covers the abdominal organs (omentectomy)
• surgical debulking

During surgery, the surgeon also removes abnormal-looking tissue samples from different parts of the pelvis, abdomen and lymph nodes. These samples are then analyzed in the lab to find out if the cancer has spread. This part of surgery is called surgical staging.

Chemotherapy is given after surgery with carboplatin or cisplatin along with paclitaxel or docetaxel. Carboplatin and paclitaxel given by IV is the chemotherapy that is most often used.

Intraperitoneal chemotherapy directly into the abdomen may be given instead of intravenous chemotherapy. You may be offered this therapy if you have stage 3 epithelial ovarian cancer with tumours smaller than 1 cm in size after primary surgical debulking.

Sometimes chemotherapy is given before debulking surgery for a few treatments. If the cancer shrinks from the chemotherapy, surgery can be done to remove as much cancer as possible. More chemotherapy is given after the surgery. This is called interval debulking surgery.

Stage 4 epithelial ovarian cancer is often treated with surgery and chemotherapy.

Surgery may be done to remove the tumour and debulk the cancer. Sometimes chemotherapy is given before surgery to shrink the tumour. More chemotherapy may be given after surgery.

During surgery, the surgeon also removes abnormal looking tissue samples from different parts of the pelvis, abdomen and lymph nodes. These samples are then analyzed in the lab to find out if the cancer has spread. This part of surgery is called surgical staging.

Surgical procedures to reduce symptoms and relieve pain 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 for stage 4 epithelial ovarian cancer is often carboplatin or cisplatin with paclitaxel or docetaxel. Carboplatin and paclitaxel is the chemotherapy combination that is most often used.

Recurrent ovarian cancer means that the cancer has come back after it has been treated. Persistent ovarian cancer never went away completely even after treatment.

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

• surgical debulking
• surgical procedures to reduce symptoms and relieve pain as used in stage 4

Chemotherapy with a combination of drugs is usually used to treat recurrent or persistent epithelial ovarian cancer.

The chemotherapy drugs used depends on the drugs used the first time and how long the cancer stayed away after finishing the last chemotherapy treatment.

If it has been at least 6 months since your last chemotherapy treatment, you may be re-treated with carboplatin and paclitaxel even if these were the drugs you had before.

If the cancer comes back in less than 6 months or it didn’t go away, your healthcare team will consider a different drug combination.

Many drugs can be used in combination to treat recurrent or persistent ovarian cancer if treatment with a platinum drug such as carboplatin or cisplatin isn’t working. Other drugs that may be used include:

• docetaxel
• paclitaxel
• etoposide (Vepesid)
• gemcitabine
• topotecan
• vinorelbine
• pegylated liposomal doxorubicin (Caelyx)
• trabectedin (Yondelis)

Targeted therapy may be used to treat advanced epithelial ovarian cancer. Sometimes a targeted therapy drug is combined with a chemotherapy drug. Targeted therapy drugs approved in Canada include:

• bevacizumab (Avastin)
• olaparib (Lynparza) for those with a BRCA1 or BRCA2 gene mutation
• niraparib (Zejula)

Olaparib or niraparib may be given as maintenance therapy for recurrent epithelial ovarian cancer that has responded to chemotherapy with a platinum drug such as carboplatin or cisplatin.

Hormone therapy may be given in addition to chemotherapy to treat advanced epithelial ovarian cancer. Hormonal therapy includes drugs such as:

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

Radiation therapy is sometimes given to treat advanced epithelial ovarian cancer.

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.

Some clinical trials in Canada are open to women with ovarian cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.