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Types of treatment for ovarian cancer

Women discussing ovarian cancer

This page gives an overview of treatments for ovarian cancer. You can find the following information

 

A quick guide to what's on this page

Types of treatment for ovarian cancer

Your specialist team will plan your treatment according to the type of ovarian cancer you have, the stage, the grade and your general health.

Almost all women with ovarian cancer will need surgery. The amount of surgery will depend on the stage and type of cancer. Most women with epithelial ovarian cancer are diagnosed with advanced disease and have a combination of surgery and chemotherapy. You may have chemotherapy after surgery, or both before and after surgery.

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. Radiotherapy is sometimes used to relieve symptoms depending on where in the body the cancer has spread.
 

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

 

 

The main treatments

The main treatments for ovarian cancer are surgery and chemotherapy.

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. The information in this section is about treating epithelial ovarian cancer. For some women with very early stage ovarian cancer, surgery is the only treatment you need.

Most women with ovarian cancer are diagnosed with advanced disease and have a combination of both surgery and chemotherapy. You may have chemotherapy after surgery, or both before and after 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.

 

Planning treatment

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.

National guidelines recommend that women with ovarian cancer have their treatment in a specialist gynaecology cancer centre, 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 looking after you will plan your treatment according to a number of factors, including

  • 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 type or stage your cancer is until after your surgery. During the operation, your surgeon will examine the inside of your abdomen. They will take tissue samples (biopsies) to check whether the cancer has spread.

 

Very early ovarian cancer

If you have a borderline ovarian tumour or a very early cancer (stage 1a) that is low grade, you may only need to have the affected ovary and fallopian tube removed. As the unaffected ovary and your womb are left behind, you may still be able to have children in the future. Your surgeon will take biopsies from several areas within your abdomen and pelvis during surgery to fully stage your cancer. If there are cancer cells in any of these samples, you may need another operation to remove the rest of the cancer.

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 taken out. Women with a borderline tumour or very early cancer may not need any other treatment after surgery.

 

Early stage ovarian cancer

The aim of surgery for early stage ovarian cancer (stage 1) is to remove the cancer and fully stage the disease. Knowing the stage helps your doctor decide if you need treatment after surgery.

For most women with stage 1 ovarian cancer, you will have surgery to remove your

  • Ovaries
  • Fallopian tubes
  • Womb (including the cervix)

There is more information about surgery for early ovarian cancer in this section. 

After surgery, your doctor may suggest you have chemotherapy if there is a high risk of the cancer coming back. For example if you have stage 1c or a high grade (grade 3) cancer. This is known as adjuvant chemotherapy.

 

Advanced ovarian cancer

Stage 2, 3 and 4 ovarian cancers are classed as advanced. This means the cancer has spread away from the ovary. Some advanced cancers may be cured with surgery and chemotherapy. If your cancer cannot be cured, the aim of treatment is to control the cancer for as long as possible.

You may have surgery as the first treatment for your cancer. The surgeon removes as much of the cancer as possible. This is called debulking. Whether you have surgery or not will depend on a number of factors, including

  • Where the cancer has spread to
  • Your general health
  • How quickly the cancer is growing

There is more information about surgery for advanced ovarian cancer in this section.

After you have recovered from surgery, you will have chemotherapy. If the surgeon was able to remove all your cancer, the aim of chemotherapy is to reduce the risk of the cancer coming back. If the surgeon could not take out all the cancer, then the aim of chemotherapy is to shrink the cancer that has been left behind. Some women may then have further surgery.

From looking at the scans you had at diagnosis, your surgeon may decide in advance that it would not be possible to remove all the cancer. In this case, you may have chemotherapy before surgery. This is to shrink the cancer and make it easier to remove. Chemotherapy before surgery is called neo adjuvant (pronounced nee-oh-ad-joo-vent) or primary chemotherapy.

With this, you have a scan halfway through your course of chemotherapy. If the cancer is shrinking, you will then have surgery. You may hear your surgeon call this interval debulking surgery or IDS. After the surgery, you have the rest of the course of chemotherapy.

For some advanced cancers, you may have a type of biological therapy called bevacizumab with chemotherapy.

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. You may have radiotherapy to relieve symptoms, depending on where in the body the cancer has spread.

Your doctor may suggest having treatment as part of a clinical trial. You can read about taking part in trials and how to find a clinical trial in our trials and research section.

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 page about treating advanced ovarian cancer.

 

Getting a second opinion

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 women's 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.

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Updated: 20 January 2014