The main treatments for ovarian cancer are surgery and chemotherapy.
Occasionally other treatments are used, such as targeted therapies or radiotherapy.
The type of treatment you have is based on:
the type of ovarian cancer you have
its stage and grade
where it is
your general health
your personal preferences.
Women with borderline tumours or early-stage ovarian cancer can usually be cured with surgery to remove the cancer. Often this is the only treatment that’s needed.
However, women with early-stage (stage 1) cancer that’s clear cell, high-grade serous, or stage 1c, are usually offered chemotherapy after surgery. This is because without chemotherapy there’s a higher risk of the cancer coming back.
Advanced ovarian cancer
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Most women are treated with a combination of surgery and chemotherapy. The aim of treatment may be to cure the cancer or to keep it under control for as long as possible.
Surgery is done to remove as much of the cancer as possible. This is called ‘debulking’. It’s then followed by chemotherapy to reduce the risk of the cancer coming back, or to shrink any remaining cancer that couldn’t be removed during the operation.
If a woman has surgery but not enough of the cancer can be removed, she may then have chemotherapy followed by a second operation to remove the rest of the cancer.
Sometimes, if an operation isn’t likely to remove most or all of the cancer, chemotherapy is given first. The aim is to shrink the cancer so that surgery is more successful. After the operation, more chemotherapy is given to complete the course of treatment. This is called interval debulking.
If surgery isn’t possible because of where the cancer is, or if a woman isn’t well enough for a major operation, chemotherapy may be the main treatment used. The aim is to shrink the cancer and relieve symptoms.
Sometimes women with advanced cancer aren’t well enough for, or choose not to have, anti-cancer treatments such as surgery or chemotherapy. In this situation, treatments to control and relieve symptoms are offered. This is known as supportive or palliative care.
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Women with ovarian cancer should be treated by a specialist gynaecological cancer team. These teams are based in larger cancer centres, so you may have to travel for your treatment.
A team of specialists will meet to discuss and decide on the best treatment for you. This multidisciplinary team (MDT) will include:
a surgeon who specialises in gynaecological cancers (a gynaecological oncologist)
a medical oncologist (a chemotherapy specialist doctor who specialises in ovarian cancer)
a clinical oncologist (a radiotherapy and chemotherapy specialist doctor who specialises in gynaecological cancers)
a gynae-oncology nurse specialist
a radiologist (a doctor who analyses x-rays and scans)
pathologists (who advise on the type and extent of the cancer).
It may also include other healthcare professionals, such as a dietitian, physiotherapist, occupational therapist, radiographer, psychologist or counsellor.
Your doctor or nurse specialist will discuss with you what the best treatment is for your particular situation. If you have any questions about your treatment, don’t be afraid to ask your doctor or the nurse looking after you.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you’re asked to sign the form you should be given full information about:
the type and extent of the treatment
its benefits and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You’re also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The benefits and disadvantages of treatment
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Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending upon your individual situation.
If the cancer has spread to other parts of the body, treatment may be able to control it, improving symptoms and quality of life. However, for some people in this situation, the treatment will have no effect on the cancer and they will get the side effects without any of the benefit.
If you’ve been offered treatment that has a good chance of curing the cancer or keeping it under control, deciding whether to accept it may not be difficult. However, if the treatment has a lower chance of working, it may be more difficult to decide whether to go ahead.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have it, you can still be given supportive (palliative) care, with medicines to control any symptoms.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you.
Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or your GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.