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Treating advanced ovarian cancer

Women discussing ovarian cancer

This page is about treating advanced ovarian cancer and cancer that has come back. You can find the following information

 

A quick guide to what's on this page

Treating advanced ovarian cancer and cancer that has come back

If your ovarian cancer can't be cured, treatment can shrink the cancer and control it for some time.

Chemotherapy, radiotherapy and surgery are the main treatments doctors use to treat advanced ovarian cancer. If your cancer has come back, you may have some or all these treatments again. Which treatment you have will depend on where your cancer has spread and how big it is, the symptoms the cancer is causing and the treatment you have already had.

Deciding about treatment

It can be difficult to decide which treatment to try, or whether to have treatment at all when you have advanced cancer. You will need to think about how the treatment will affect you. Your doctor will talk through the options for treatment with you.

It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends, for example your cancer nurse specialist (CNS) or a counsellor. There is information about counselling in our coping with cancer section.


CR PDF Icon You can view and print the quick guides for all the pages in the treating ovarian cancer section.

 

 

What advanced ovarian cancer is

Advanced ovarian cancer means cancer from stages 2 to 4. It has spread away from the ovary to other parts of the body. Cancer that has spread to another part of the body is called secondary cancer or metastases. Unfortunately, ovarian cancer can often be quite advanced when it is first diagnosed. Women may not have any symptoms when the cancer is in its early stages. Or any symptoms may have been vague and difficult to spot or explain.

Ovarian cancer that is advanced when it is first diagnosed can sometimes be cured with surgery and chemotherapy. Though this will partly depend on what the exact stage is. Ovarian cancer that comes back after treatment (recurrence) cannot usually be cured, but treatment may control it for some time.

 

Aims of treatment

The aim of treatment for advanced cancer is usually to shrink the cancer and control it for as long as possible.

If ovarian cancer spreads, it may spread to the

  • Lining of the abdomen (the peritoneum)
  • Lining of the bowel or bladder
  • Liver
  • Lungs

Click on the links to find out more about secondary cancers.

The growing cancer can also cause pressure on the tubes that drain the kidneys (the ureters). This can block the flow of urine. 

 

The treatments used

Chemotherapy, radiotherapy and surgery can all be used to treat advanced ovarian cancer. Some women may have a type of biological therapy with chemotherapy. The best treatment for you depends on

  • Where in the body the cancer is
  • The size and number of secondary cancers you have
  • The treatment you have already had

Chemotherapy

You will probably be able to have chemotherapy even if you already had some at an earlier stage in your illness. If carboplatin chemotherapy worked well for you before, your doctor may suggest giving you some more. Other drugs your doctor may suggest include paclitaxel (Taxol), liposomal doxorubicin, gemcitabine, cisplatin or topotecan.

There is more information about chemotherapy in the section on chemotherapy for ovarian cancer. The links above for each drug take you to a page on that drug's particular side effects.

Doctors may also use other chemotherapy drugs to treat advanced ovarian cancer. If you would like information about any other drug, look at our full list of chemotherapy drugs or contact the Cancer Research UK information nurses. They would be happy to help you.

Radiotherapy

Occasionally, doctors suggest radiotherapy for advanced ovarian cancer. Radiotherapy can shrink tumours and reduce symptoms. But there is a maximum total dose of radiotherapy you can have to any part of the body. So if you had radiotherapy to your abdomen after your initial surgery, radiotherapy may not be an option for you now. Doctors also use radiotherapy to treat ovarian cancer that has spread to another organ in the body. So you may be able to have it if you haven't had radiotherapy to that part of the body before.

There is more about having radiotherapy for ovarian cancer in this section of the website. And more about radiotherapy generally in the main radiotherapy section.

Surgery

For advanced ovarian cancer, surgery may be used to

Debulking

This is the name for the operation to remove cancer from inside your abdomen before you have chemotherapy. It is done because chemotherapy tends to work better when there are no visible signs of cancer or there are only small cancer nodules left inside the abdomen. There is information about surgery for ovarian cancer in this section.

Treating a blockage in the bowel

Sometimes ovarian cancer can grow so that it completely blocks the bowel. This is called bowel obstruction. The waste from food you have digested, and the fluids normally produced inside the gut, cannot get past the blockage. This causes symptoms such as

  • Feeling bloated and full
  • Pain
  • Feeling sick
  • Vomiting large amounts
  • Constipation

To relieve the symptoms, it is sometimes possible to operate to unblock the bowel. It may be possible to close up the bowel again. Or you may have to have a stoma. This is an opening onto the abdomen. Your bowel motions come out of the opening. They are then collected in a waterproof bag which sticks onto your skin over the stoma. There is more about bowel surgery and having a stoma in the section about surgery for bowel (colorectal) cancer.

You may want to talk over having this operation with your close family and friends as well as your doctor and nurse. No one can say how much you will benefit from it beforehand. The operation may help you feel better for a time, but the cancer may come back to block the bowel again. It is likely to be quite a big operation just when you are feeling very low.

If surgery is not an option, doctors can use a drug called octreotide to treat a blocked bowel. It can control the symptoms for a time. Octreotide works by reducing the amount of fluid produced in your stomach and digestive system.

A blockage in the urinary system

Sometimes ovarian cancer can cause pressure so that it blocks part of the urinary system. It may block one or both of your ureters. The ureters are the tubes that connect the kidneys with the bladder. If one of these tubes gets blocked, your urine cannot drain away and the kidney may swell and become damaged. Your doctor may suggest a procedure to put a tube in to drain urine from the kidney. There are 2 ways of doing this. You can have

Ureteric stent

A ureteric stent can be put in using a local anaesthetic. The doctor uses ultrasound or X-ray to put a small plastic tube into the blocked ureter. Sometimes this is done under general anaesthetic during a cystoscopy operation. A flexible telescope tube called a cystoscope is put into the bladder. This allows the doctor to see the opening of the ureter to the blocked kidney. The doctor pushes a thin tube called a stent up into the ureter from the bladder.

With a stent in place, urine can drain from the blocked kidney into your bladder. You will continue to pass urine normally after this operation.

Nephrostomy

A nephrostomy tube is a tube put into your blocked kidney. The tube comes out of your body close to the area of the kidney. A bag can be stuck over, or connected to, the tube to drain the urine. The cancer is not actually removed during this operation. The tube just bypasses the blockage by draining the urine outside the body.

Biological therapies

Biological therapies are drugs that can help the body to control the growth of cancer cells. You can find out about biological therapies in our cancer treatment section. One type of biological therapy works by stopping tumours from developing their own blood vessels, so the cancer cannot continue to grow. These are called anti angiogenic drugs. One of these drugs is called bevacizumab (Avastin). Doctors may use it alongside chemotherapy for some women with advanced ovarian cancer. 

 

Fluid in the abdomen

Ascites is the medical name for a build up of fluid in the abdomen. Many women with advanced ovarian cancer have ascites. There are a number of reasons why ascites can develop. For example, when cancer cells spread to the lining of the abdomen (peritoneum), they can irritate it and cause fluid to build up. Also, cancer can block part of the lymphatic system so the fluid can't drain out of the abdomen as usual. The swelling caused by the build up of fluid can be uncomfortable. You may have other symptoms such as

  • Loss of appetite
  • Indigestion
  • Feeling sick
  • Constipation
  • Shortness of breath 

The treatment you have for ovarian cancer, such as chemotherapy, can help with ascites. Or your doctor may drain off some of the fluid to help relieve symptoms. There is more information about ascites and treatment in the coping with cancer section.

 

Research for advanced ovarian cancer

There is always research going on into new treatments for different types of cancer. Your doctor may talk about trials of new treatments and ask whether you would like to take part.

These may be trials for new combinations of chemotherapy drugs or new types of treatment. Look at our page on ovarian cancer research for more information about research, including research into biological therapies. Our research and trials section also has a searchable database of UK clinical trials.

 

Decisions about treatment

When you have an advanced cancer, it can be difficult to decide which treatment to try, or whether to have treatment at all. Your doctor may decide to wait until you develop symptoms before offering these treatments. Treatment can control symptoms and help you to feel better. It may also help you to live longer. But you will need to think about your quality of life while you are actually having treatment. Side effects may make you feel ill and treatment may cause stresses, such as travelling back and forth to the hospital. It is very important for you to understand what can be achieved with the treatment your doctor is offering you.

Your doctor will discuss the options for treatment with you. It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends, for example your cancer nurse specialist (CNS) or a counsellor. You could contact a counselling organisation to find out more about counselling and how to find a counsellor in your area.

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Updated: 22 January 2014