Surgery is the primary treatment for ovarian cancer. The first step is a surgical biopsy to take a sample of the suspicious tissue. Once cancer is confirmed, the surgeon determines the stage of the cancer based on how far it has spread from the ovaries. If the disease appears to be limited to one or both ovaries, the surgeon will take samples of nearby tissues from the pelvis and abdomen to determine whether the cancer has spread.
If there is obvious spread, the surgeon will attempt to remove as much of the tumor as possible during the biopsy. This procedure is called debulking or surgical cytoreduction. Debulking involves removing the ovaries, uterus, cervix, fallopian tubes and omentum (fatty tissue around these organs), and any other visible tumors in the pelvic and abdominal areas. This may include the removal or partial removal of other organs such as the spleen, lymph nodes, liver or intestines. Reducing tumor size improves the efficiency of chemotherapy and radiation therapy, since there is less tumor to treat.
While debulking is generally performed during the surgical biopsy, the patient's overall health may not allow it or the tumor may be attached to critical organs. For these patients, any remaining tumor will be treated with chemotherapy.
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Most ovarian cancer patients will require chemotherapy after surgery to destroy any lingering tumor cells. The standard chemotherapy treatment for ovarian cancer is paclitaxel plus a platinum-based drug such as carboplatin or cisplatin. Most chemotherapy treatments are given on an outpatient basis in a three- to four-week cycle. The length of treatment and the dose will vary depending on the stage of the disease.
Chemotherapy can also be delivered directly into the abdominal cavity, a procedure known as intraperitoneal therapy or IP therapy. The chemotherapy is infused into the peritoneal space, where it will come in direct contact with the cancer. IP therapy can be used to treat ovarian cancer if only a small amount of tumor remains after debulking. IP therapy can be given in an outpatient or inpatient setting through an implanted port or external catheter.
Although radiation therapy is rarely used to treat ovarian cancer, it may be used to kill any remaining cancer cells in the pelvic area if the cancer has returned after other treatments. In most cases, the main goal of radiation therapy is to control symptoms such as pain, not to treat the cancer.
Rarely, tumors can start in the fallopian tube or the peritoneum. These cancers are treated similarly to ovarian cancer.