Types of treatment for ovarian cancer

Almost all women with ovarian cancer will need surgery. The amount and type of surgery you have will depend on your stage and type of cancer. Women with borderline tumours or low grade stage 1 cancer may need no further treatment, although some may have radiotherapy to the pelvic area. Most other women have chemotherapy after their surgery.

You may find that other women you meet with ovarian cancer are having different treatment from you. This may be because they have a different type of ovarian cancer. Or it may be that their cancer is a different stage. Don't be afraid to ask your doctor or nurse any questions you may have about your treatment. It often helps to write down a list of questions you want to ask. You could also take a close friend or relative with you when you go to see the doctor - they can help you remember what was said.

You are most likely to be treated by a team of specialist doctors working together, known as a gynaecology oncology team. This will include a surgeon who specialises in treating women's cancers (a gynaecological oncologist) and a medical cancer specialist (an oncologist). It should also include a gynaecological cancer specialist nurse, who can give you information about treatment and any support you may need.

There are national guidelines that recommend that women with ovarian cancer have their treatment in a specialist gynaecology cancer unit, where these specialist gynaecology oncology teams are usually based.  So you may not be able to go to your local hospital and might need to travel to your nearest cancer centre for your treatment.  

If you have only seen a surgeon, you should ask to see a cancer specialist (oncologist) before your treatment plan is finalised. The team will plan your treatment according to

• The type of ovarian cancer you have
• Whether the cancer has spread (the stage)
• What the cells look like under the microscope (the grade)
• Your general health

Your doctor may not be able to tell you exactly what stage your cancer is until after your surgery. During the operation, your surgeon will examine the inside of your abdomen. And they will take tissue samples (biopsies) to check whether the cancer has spread.

If you are young and have a very early cancer (stage 1a or 1b) that is low grade or a borderline tumour, you may only need to have the affected ovary and its fallopian tube removed. Borderline ovarian tumours are unlikely to come back and so your unaffected ovary can be left behind. You will still be able to have children in the future. If you have had your menopause, or do not want to have any more children, your surgeon may advise that you have both ovaries and your womb removed. Women with borderline tumours or low grade cancer may need no further treatment as it is unlikely to come back.

If you have a stage 1 ovarian cancer NICE guidelines recommend that you have surgery to remove both ovaries and your womb. This is because there is a risk of cancer cells being left behind if the other ovary and womb are not removed.

You will also have the omentum removed. This is called omentectomy. The omentum is a sheet of fatty tissue inside the abdomen. Surgeons now remove this along with the womb because ovarian cancer often spreads into the omentum.

Your surgeon will also put some sterile salt solution inside your abdomen and then remove it. The surgeon sends this fluid to the laboratory to see if it contains cancer cells. And they will take biopsies from areas where the cancer could have spread. You may have biopsies of the

• Lymph nodes in your pelvis and abdomen
• Sheet of muscle under your lungs (your diaphragm)
• Tissue lining your abdomen and pelvis

After surgery, your doctor may suggest you have chemotherapy if you have stage 1c or a high grade (grade 3) cancer to help stop the cancer coming back. This is known as adjuvant chemotherapy.

Stage 2, 3 or 4 cancers are more advanced and usually need more treatment.

You may have surgery as the first treatment for your cancer.  Whether you have surgery or not will depend on a number of factors, including

• Whether your cancer has spread to another part of your body, and how far it has spread
• Your general health
• How quickly the cancer is growing

NICE guidelines issued in April 2011 recommend that women should have an operation to remove all of the cancer whenever possible. Doctors call this a complete resection.

After you have recovered from your surgery, you will have chemotherapy to try and kill off any remaining cancer cells.  Doctors call chemotherapy after surgery adjuvant chemotherapy.  (This is pronounced ad-joo-vent.)

If your surgeon thinks it may not be possible to remove all of the cancer, you may have chemotherapy before surgery. The aim of this treatment is to try and shrink the cancer and make it easier to remove. Chemotherapy before surgery is called neoadjuvant treatment. (This is pronounced nee-oh-ad-joo-vent.)

You will have a scan halfway through your course of treatment. If the cancer is shrinking, you will then have surgery. You may hear your surgeon call this interval debulking surgery. After the surgery, you will have more chemotherapy to try and kill off any cancer that was left behind.

During the surgery, your surgeon removes your

• Ovaries
• Womb
• Omentum - a sheet of fatty tissue in the abdomen
• As much of the tumour elsewhere as is possible

As much of the tumour as possible is removed, because chemotherapy works better if tumours are very small. Your surgeon will try to take out all the tumours and leave no area of cancer bigger than half a centimetre across (about a quarter of an inch).

Your surgeon will take a sample of fluid from your abdomen and send it to the laboratory to see if it contains cancer cells. The surgeon will also take biopsies of all the places where the cancer is most likely to have spread. This could include biopsies of

• Your diaphragm (the sheet of muscle under the lungs)
• The lining of your pelvic and abdominal cavities
• The lymph nodes in your pelvis and abdomen

If you have a very advanced cancer, it may not be possible for a surgeon to remove it. You may also not be well enough for a big operation. You can have chemotherapy to shrink the cancer as much as possible and to slow it down. Clinical trials are looking at adding biological therapies to chemotherapy to see if that works better than chemotherapy alone. You can read about this on the ovarian cancer research page. You may have radiotherapy to relieve symptoms, depending on where in the body the cancer has spread.

You will need time to think about your options for treatment. And you will need support from your family as well as your doctor in making your decision. There is more about your treatment options on the treating advanced ovarian cancer page.

Some people feel they would like to get an opinion from a second doctor before they decide about their treatment. If a surgeon who specialises in cancer (gynaecological oncologist) is treating you, you should also get an opinion from a cancer specialist (oncologist) about whether you need chemotherapy. Most doctors are happy to refer you to another NHS specialist for a second opinion if you would find this helpful.

Note: A second opinion means just that. It does not mean that the second doctor will take over your care. Your treatment will usually still be managed by your original specialist.  And if you want a second surgical opinion, you need to make sure that it is from someone who specialises in ovarian cancer surgery, and not a general gynaecologist.