Treatment for Ovarian Cancer: Surgery Options, Chemotherapy, Targeted Therapy, Immunotherapy, and More

The type of ovarian cancer, the extent of the disease, and factors like the patient’s age and overall health determine treatment decisions.

In treating ovarian cancer, surgery is typically the first plan of attack, both to help doctorsstagethe cancer — that is, to assess how advanced it is — and to remove as much of the tumor as possible.

Unless ovarian cancer is caught early (and fewer than 2 in 10 cases are), surgery is generally followed by chemotherapy. The goal of chemotherapy, which is usually administered orally or intravenously (IV), is to kill any cancer cells remaining in the body after surgery.

Doctors also sometimes use chemotherapy before surgery to shrink very large tumors so that they are easier to remove.

Doctors sometimes treat advanced ovarian cancer by using next-generation medicines called targeted drugs. These fight the disease by homing in on traits that distinguish malignant ovarian cells from normal, healthy ones.

While radiation plays a role in the treatment of many cancers, it is not typically used for ovarian cancer. Doctors might use radiation to kill cancer cells that have spread beyond the ovaries to areas such as the brain or spinal cord.

Hormone therapy, a treatment for some breast cancers, is not generally part of the strategy for fighting ovarian cancer. The exception is a rare type of ovarian cancer called ovarian stromal tumors. (1)

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Ovarian Cancer Surgery: Removing as Much Tumor as Possible

No matter how early doctorsdiagnose ovarian cancer,手术通常是治疗计划的一部分。

年代urgery can be extensive if the cancer is advanced and doctors feel the patient is healthy enough in general to withstand the operation.

This is true for epithelial ovarian cancer, the most common type of ovarian cancer, as well as for uncommon forms called ovarian germ cell tumors and stromal tumors.

One major goal of surgery is staging the cancer to see if it has spread beyond the ovaries. Staging the cancer is essential for helping doctors decide on the best treatment and make a prognosis (a prediction of the course of the disease).

Depending on how advanced the cancer is, the surgeon may remove both ovaries and fallopian tubes (a procedure called a bilateral salpingo-oophorectomy) as well as the uterus (an operation called ahysterectomy).

年代ome patients who want to preserve theirfertilitymay have the choice of having an initial surgery that removes only the ovary with the cancer and its adjacent fallopian tube.

If a patient has more advanced cancer, surgery will also probably involve removing the omentum, a layer offatty tissuewithin the abdomen, as well as lymph nodes in the pelvis and abdomen.

Any fluid present in the pelvis or abdominal cavity also has the potential to contain cancer cells, so the surgeon will remove a sample for testing.

The doctor might also “wash” the abdomen with salt water and send that liquid to the lab for analysis.

In addition to staging, surgery to remove as much of an epithelial ovarian tumor as possible — a process called debulking — is a key part of treatment.

In order to debulk an ovarian tumor, surgeons may also need to remove a piece of a nearby organ, such as the colon, small intestine, or bladder.

Removal of the spleen orgallbladder, as well as parts of the stomach, liver, orpancreas, might also be necessary.

Research has shown that surgery that leaves behind no visible cancer or reduces tumor size to 1 centimeter or less has the best outcome. (2)

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Chemotherapy Is Usually Part of the Plan

When found very early, ovarian cancer is usually very treatable and sometimes curable. (3PDF)

Women with stage 1 cancers that are deemed low-grade (meaning a tumor sample contains mainly healthy-looking cells) generally don’t receive chemotherapy after surgery.

But, because ovarian cancer is often detected at later stages, these patients are in the minority.

Patients who have more-advanced disease, and those whose disease falls into the most common variety of ovarian cancer, epithelial ovarian cancer, usually receive two different chemotherapy drugs in combination.

Typically one drug is a type called a platinum-based compound, usuallyPlatinol (cisplatin)orcarboplatin, while the other is a category of drug called a taxane, such asTaxol (paclitaxel)orTaxotere (docetaxel).

These drugs are generally administered in three to six cycles.

Other common drugs used to treat ovarian cancer include:

• Abraxane (albumin-boundpaclitaxel or nab-paclitaxel)
• Hexalen (altretamine)
• Xeloda (capecitabine)
• Cytoxan (cyclophosphamide)
• Etoposide or VP-16
• Gemzar (gemcitabine)
• Ifex (ifosfamide)
• Camptosar (irinotecan or CPT-11)
• Doxil (liposomal doxorubicin)
• Melphalan
• Alimta (pemetrexed)
• Topotecan
• Navelbine (vinorelbine)

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Intraperitoneal Chemotherapy (IP) for Advanced Ovarian Cancer

年代ome women with advanced ovarian cancer may be candidates for intraperitoneal (IP) chemotherapy, in which Platinol and Taxol are injected into the abdominal cavity through a catheter (thin tube).

Patients who might benefit from this treatment are those who have been diagnosed with stage 3 (the cancer has not spread beyond the abdomen) cancer, with tumors that have been “optimally” debulked (meaning they are no larger than 1 centimeter after surgery).

IP chemotherapy directs a concentrated dose of drugs to the tumor site. Medication is also absorbed into the bloodstream and can attack cancer cells elsewhere in the body.

IP treatment seems to help some patients live longer. But it can also cause more extreme side effects than IV medication, such asabdominal pain, nausea, and vomiting.

Researchers are investigating the effectiveness of giving IP chemotherapy during surgery using heated drugs, known as heated intraperitoneal chemotherapy (HIPEC), or “hot” chemotherapy.

In this procedure, surgeons remove all visible tumors, then pump chemotherapy medication, which has been heated to 103 degrees Fahrenheit, through the abdominal cavity. Surgeons physically rock the patient on the operating table to make sure the drug reaches all areas of the abdomen. (4)

年代ome research, including one study published in the January 2018 issue of theNew England Journal of Medicine, has shown that HIPEC can extend some patients' lives. (5,6) Women who received HIPEC plus surgery had an overall survival rate of about one year longer than those who only underwent surgery. (7)

Targeted Therapy: Next-Gen Ovarian Cancer Treatment

Researchers have developed a relatively new type of treatment called targeted therapy that attacks cancer by focusing on traits that the cancer cells need to survive.

Instead of killing cancer cells outright, as standard chemotherapy does, targeted drugs interfere with the way these cells function, which can ultimately cause them to die.

By zeroing in on cancer cells, targeted drugs avoid harming healthy cells.

Patients with advanced epithelial ovarian cancer may be treated with chemotherapy as well as with the targeted drugAvastin (bevacizumab).Avastinattaches to a protein that allows a cancer to develop the new blood vessels it needs to grow.

Other targeted drugs, called PARP inhibitors (PARP is an enzyme in cells that helps repair damaged DNA), may be used to treat the small percentage of ovarian cancers linked to mutations in theBRCAgene.

These medications may also be used as maintenance therapy (toprevent cancerfrom recurring after treatment) for patients with or without BRCA gene mutations.

PARP inhibitors includeLynparza (olaparib),Rubraca (rucaparib), andZejula (niraparib). (8)

Immunotherapy: A Promising Approach?

Immunotherapy is a newer approach in treating ovarian cancer. It involves stimulating a person’s immune system so it can better identify and attack cancer cells.

年代ome studies have suggested that combining immunotherapy medication with chemotherapy could offer survival benefits forwomen with ovarian cancer. (9)

Right now, researchers are still studying the effectiveness of this treatment, but it may hold potential down the road.

Additional reporting byJulie Marks.