Ovarian cancer is usually diagnosed and staged with laparotomy or laparoscopy. Both of these procedures involve surgically removing samples of tissues to determine whether they have cancer cells. In many instances when ovarian cancer is suspected, the surgeon will attempt to remove as much of the tumor as possible—a procedure called debulking. However, further surgery is often needed. Chemotherapy and/or radiation therapy may also be necessary. Infertility is often a side effect of ovarian cancer treatment, and women who are interested in having children in the future should discuss this issue with their cancer team prior to treatment.
- Tumor Debulking
- Second-Look Surgery
- Radiation Therapy
Tumor debulking (also called cytoreduction) involves removing as much of the tumor as possible. If the cancer has spread, the procedure is typically performed to improve patient prognosis (expected outcome) and increase survival time. Tumor debulking can reduce the size of the tumor before chemotherapy or radiation therapy.
An oophorectomy is a surgical procedure to remove one or both of the ovaries. A bilateral oophorectomy, removal of both ovaries, will result in infertility and premature menopause for women who are still menstruating. A unilateral oophorectomy, removal of one ovary, may be possible for some young women with certain types of early-stage ovarian cancer. Removing only one ovary may allow women to bear children in the future.
A salpingectomy is a surgical procedure to remove one or both of the Fallopian tubes. Salpingectomy is usually combined with an oophorectomy (removal of one or both ovaries), hysterectomy (removal of the uterus), and omentectomy (removal of the omentum—see description below) to treat patients with ovarian cancer. All of these procedures are typically performed under general anesthesia. A salpingectomy alone is associated with a short recovery time.
A hysterectomy involves surgically removing the uterus through the vagina or an incision in the abdomen. The surgery may or may not include removing tissues near the uterus, such as the parametria and uterosacral ligaments, the upper portion of the vagina, and the pelvic lymph nodes. For ovarian cancer patients, a hysterectomy is often accompanied by a bilateral oophorectomy (removal of both ovaries), salpingectomy (removal of the Fallopian tubes) and many times an omentectomy (removal of the thin tissue covering the stomach and large intestine) and removal of the lymph nodes in the abdomen.
An omentectomy is a surgical procedure to remove the omentum, a fold of abdominal tissue that contains blood vessels, nerves, lymph vessels, and lymph nodes. For ovarian cancer patients, an omentectomy is usually combined with an oophorectomy (removal of one or both ovaries), hysterectomy (removal of the uterus), and salpingectomy (removal of one or both Fallopian tubes).
Chemotherapy involves using anticancer drugs to help control or prevent the growth of cancerous tumors. Chemotherapy is often used as an adjuvant (supplemental) therapy in addition to other treatments, such as surgery or radiation therapy, which are designed to achieve local control of the cancer. Normally, chemotherapy is administered through a semipermanent catheter (a flexible tube) implanted into a large vein, or by a smaller, temporary, intravenous catheter placed into the smaller veins in the arm or hand. Some chemotherapy drugs are administered orally in form of pills or liquid. Chemotherapy may also be given intramuscularly (injected in the muscle), under the skin, topically (on the skin), or injected locally into the cancer area. In the case of ovarian cancer, chemotherapy is often administered intraperitoneally—directly into the abdomen through a catheter. This can reduce the number of side effects since most of the chemotherapy drugs remain in the abdomen.
Chemotherapy may be used to:
- cure cancer
- stop cancer from spreading to other parts of the body
- slow cancer growth
- kill cancer cells
- relieve symptoms of cancer
Ovarian cancer patients who undergo chemotherapy may be given one drug or a combination of two or more drugs during treatment. Most physicians believe that combination chemotherapy (administering two or more drugs) is most effective for ovarian cancer patients because combination therapy has been shown to provide better cancer cell control with lower doses of individual drugs. With combination chemotherapy, better results may be achieved while causing fewer of the side effects associated with higher doses of an individual drug. At this time, there are over 90 chemotherapy drugs used to treat different types of cancer. Often, ovarian cancer patients are given a platinum drug (such as cisplatin or carboplatin) and a taxane (such as paclitaxel).
Chemotherapy drugs most often used to treat ovarian cancer include:
- cisplatin (brand name, Platinol)
- carboplatin (brand name, brand name, Paraplatin)
- paclitaxel (brand name, Taxol)
A variety of other chemotherapy drugs may also be used to treat ovarian cancer or a recurrence of the disease. Examples include doxorubicin (brand name, Adriamycin), cyclophosphamide (brand name, Ellence), vinorelbine (brand name, Navelbine), ifosfamide, (brand name, Ifex), etoposide (brand names VePesid, Etophophos, VP-16), fluorouracil (brand names, Fluorouracil, 5-FU, Adrucil), and docetaxel (brand name, Taxotere).
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Second-look surgery is surgery that is usually performed after chemotherapy. The goal of second-look surgery is to sample fluid or tissue from the abdomen to determine whether treatment with chemotherapy was successful. Depending on the results of the second-look surgery, additional chemotherapy or radiation therapy may be needed.
Radiation therapy (or radiotherapy) uses high-energy rays to stop cancer cells from growing and dividing. There are two main types of radiation therapy: external beam and internal beam (also called brachytherapy). External beam radiation is delivered from a source outside the body on the specific area of the body that has been affected by the cancer. Experts compare the experience of external beam radiation to having a diagnostic x-ray, except that radiation is usually administered for a longer period of time and at a higher dose. Internal beam radiation involves either placing a capsule of radioactive material into the vagina near the tumor or placing small radioactive needles directly into the tumor.
For external beam radiation, the physician will measure the correct angles for aiming the radiation beam at the specific area of the body and make ink marks on the patient’s skin. The procedure itself is pain-free. While the radiation is being administered, the technologist will leave the room and monitor the patient on a closed-circuit television. However, patients should be able to communicate with the technologist at any time over an intercom system. Some ovarian cancer patients may be given intraperitoneal radiation therapy in which radioactive liquid is administered to the abdomen through a catheter (tiny tube).
Common side effects of external radiation to the abdomen include:
- Loss of appetite
- Nausea and vomiting
- Urinary discomfort
- Skin changes on the abdomen.
Side effects of intraperitoneal radiation therapy may include abdominal pain and bowel obstruction.
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Updated: January 10, 2008