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Ovarian cancer

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Treatment of epithelial ovarian cancer

The types of treatments given for epithelial ovarian cancer are based on the stage and the unique needs of the woman.

Early stage epithelial ovarian cancer

The following are treatment options for early stage (stages I and II) epithelial ovarian cancer.

Surgery

Surgery is the primary treatment for stages I and II epithelial ovarian cancer. Surgical staging is done at the same time as the surgery to remove the tumour. The types of surgery are:

  • total hysterectomy and bilateral salpingo-oophorectomy
  • total hysterectomy and unilateral salpingo-oophorectomy
    • This surgery may be an option for some women who want to have children in the future.

Chemotherapy

Chemotherapy may be offered following surgery for stages I and II epithelial ovarian cancer. Stages IA and IB may not need to be treated with chemotherapy after surgery. Chemotherapy drugs are given intravenously (into a vein):

  • carboplatin (Paraplatin, Paraplatin AQ) and paclitaxel (Taxol)
  • carboplatin and docetaxel (Taxotere)
  • cisplatin (Platinol AQ) and paclitaxel

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Advanced stage epithelial ovarian cancer

The following are treatment options for advanced stage (stages III and IV) epithelial ovarian cancer.

Surgery

Surgery is a common treatment for stages III and IV epithelial ovarian cancer. Surgery can be offered as the first form of treatment (primary debulking) or after several treatments (cycles) of chemotherapy (delayed primary debulking or interval debulking surgery). If surgery is the first of treatment, then surgical staging is done at the same time as surgery to remove the tumour. The types of surgery are:

  • total hysterectomy and bilateral salpingo-oophorectomy
  • primary surgical debulking
  • interval debulking surgery
  • surgical procedures to reduce symptoms and relieve pain
    • paracentesis (a thin needle or tube is inserted through the skin into the abdominal cavity to remove fluid)
    • thoracentesis (a needle is inserted through the skin and between the ribs into the space between the lungs and the walls of the chest to remove fluid)
    • placement of a gastrostomy (feeding) tube into the stomach or intestines
    • placement of a tube (stent) in the large or small intestine (bowel) to relieve a blockage caused by a tumour (a colostomycolostomyA surgical procedure to create a stoma (artificial opening) from the colon to the outside of the body through the abdominal wall. may be done if the colon cannot be repaired after a blockage is removed)
    • placement of a stent in the ureter to relieve a blockage caused by a tumour (a ureterostomyureterostomyA surgical procedure to create a stoma (artificial opening) from the ureter to the outside of the body through the abdominal wall. may be done if the ureter cannot be repaired after the blockage is removed)

Chemotherapy

Chemotherapy is usually offered following surgery for stages III and IV epithelial ovarian cancer. The drugs may be given intravenously (into a vein) or as intraperitoneal (IP) chemotherapy (delivered directly into the abdomen).

The types of chemotherapy given intravenously are:

  • carboplatin (Paraplatin, Paraplatin AQ) and paclitaxel (Taxol)
  • carboplatin and docetaxel (Taxotere)
  • cisplatin (Platinol AQ) and paclitaxel

Intraperitoneal chemotherapy is given in addition to intravenous chemotherapy. It may be offered to women with stage III epithelial ovarian cancer who still have tumours smaller than 1 cm after primary surgical debulking. Cisplatin is most often used for intraperitoneal chemotherapy.

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells.

Olaparib (Lynparza) is a type of poly ADP ribose polymerase (PARP) inhibitor. PARP is a group of proteins that helps repair damage to DNA. PARP inhibitors block PARP in cancer cells, causing them to die. This treatment may be offered to women who have epithelial ovarian cancer with BRCA1 gene mutations that has responded to platinum-based chemotherapy. It is given by itself to stop or slow the cancer from recurring (called maintenance therapy).

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Recurrent or refractory epithelial ovarian cancer

The following are treatment options for recurrent or refractory (does not respond or is resistant to treatment) epithelial ovarian cancer.

Surgery

Surgery may be offered for recurrent or refractory epithelial ovarian cancer. The types of surgery are:

  • debulking surgery
  • surgical procedures to reduce symptoms and relieve pain
    • paracentesis (a thin needle or tube is inserted through the skin into the abdominal cavity to remove fluid)
    • thoracentesis (a needle is inserted through the skin and between the ribs into the space between the lungs and the walls of the chest to remove fluid)
    • placement of a gastrostomy (feeding) tube into the stomach or intestines
    • placement of a tube (stent) in the large intestine or small intestine to relieve a blockage caused by a tumour (a colostomycolostomyA surgical procedure to create a stoma (artificial opening) from the colon to the outside of the body through the abdominal wall. may be done if the colon cannot be repaired after the blockage is removed)
    • placement of a stent in the ureter to relieve a blockage caused by a tumour (a ureterostomyureterostomyA surgical procedure to create a stoma (artificial opening) from the ureter to the outside of the body through the abdominal wall. may be done if the ureter cannot be repaired after the blockage is removed)

Chemotherapy

Chemotherapy with a combination of drugs may be used to treat recurrent or refractory epithelial ovarian cancer.

  • If the cancer responded to platinum drugs (cisplatin or carboplatin) initially and the response lasted for more than 6 months after the end of treatment, it is described as platinum-sensitive. Platinum-sensitive recurrent epithelial ovarian cancer will be treated with a combination of drugs, including a platinum drug again.
  • If the cancer did not respond to platinum drugs, it is referred to as platinum-refractory. If it recurred less than 6 months after the end of the first cycle of chemotherapy, it is called platinum-resistant. The most common drugs used to treat platinum-refractory and platinum-resistant epithelial ovarian cancer are:
    • docetaxel (Taxotere)
    • paclitaxel (Taxol)
    • etoposide (Vepesid)
    • gemcitabine (Gemzar)
    • topotecan (Hycamtin)
    • vinorelbine (Navelbine)
    • pegylated liposomal doxorubicin (Caelyx)
    • trabectedin (Yondelis)
    • bevacizumab (Avastin)

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Clinical trials

Women with epithelial ovarian cancer may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.

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