Ovarian cancer - Treating ovarian cancer

Surgery

Most women with ovarian cancer will be considered for surgery. It sometimes isn't possible to confirm the stage of the cancer until surgery is carried out.

Your doctor will discuss what will happen during surgery. It will probably involve removing:

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

The surgeon may also remove the lymph nodes from your pelvis and abdomen, and samples of nearby tissue, to find out whether the cancer has spread.

If it 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 womb intact. This means you may still be able to carry a pregnancy.

You will probably be ready to go home three to seven days after your operation, but it can take many weeks to fully recover.

When you go home, you'll 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 the types of exercise that are suitable for you with your doctor or physiotherapist.

Want to know more?

Chemotherapy

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

Several different medicines can be used in chemotherapy. A combination is often given. The choice of medicine and how and when it's 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 medicine (carboplatin), which is used alone or in combination with another medicine called 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". It is not currently established routine practice in the UK, but it's being assessed in clinical trials.

You will usually have chemotherapy as an outpatient, but you may sometimes need a short stay in hospital. It's 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.

Is chemotherapy working?

Over the course of your chemotherapy, you'll have tests to monitor how the cancer is responding to treatment. This can be done in a number of ways. For example:

if you had higher than normal levels of the protein 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 scan 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

After your chemotherapy treatment, if all of your tests are clear of cancer, you'll be in remission. This means the cancer is under control.

Side effects of chemotherapy

Side effects of chemotherapy 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 recurring cancer

Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This is called "second-line treatment".

Want to know more?

Radiotherapy

Radiotherapy uses high energy X-rays. Like chemotherapy, it works by targeting rapidly growing cancer cells.

Radiotherapy isn't usually used to treat ovarian cancer. However, the multidisciplinary team may occasionally recommend it to treat ovarian cancer under very specific circumstances, such as treating pain and bleeding from a localised tumour mass.

Want to know more?

Clinical trials

In recent years, much progress has been made in ovarian cancer treatment. More women are living longer and experiencing fewer side effects. These advances were discovered through clinical trials, where new medicines and combinations of medicines are compared with standard treatment.

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

If you're asked about taking part in a trial, you'll be offered an information sheet. If you wish to take part, you'll be asked to give your consent (permission) by signing a form. You're always free to refuse or withdraw from a clinical trial without it affecting your care.

Want to know more?

Cancer Research: ovarian cancer research.

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. For example:

your hospital doctor, specialist nurse or GP can refer you to a counsellor; talk to your GP if you're feeling depressed; a course of antidepressants may help, or your GP can arrange for you to see a counsellor or psychotherapist
it can help to talk to someone who's 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