Treatment Options

Ovarian cancer is a serious disease, but a number of new and better drugs have become available for the treatment of this cancer over the past few years. In addition, we have new and more effective drugs to help control the side effects of cancer-fighting chemotherapy drugs.

If you have been diagnosed with ovarian cancer, you will want to know what your treatment options are. There are more than 30 types of ovarian cancer, but by far the most common is epithelial carcinoma, which begins on the surface of the ovary. The information below, while general, refers to treatment options for epithelial ovarian cancer.

When caught in the early stages, epithelial ovarian cancer can often be cured. If the disease has already advanced by the time of diagnosis, then the goal of treatment is to control the disease, or put it into remission, while realizing that a complete cure is not likely. Unfortunately, because of the difficulty of diagnosing ovarian cancer early, most woman have stage III disease--meaning the cancer has spread beyond the ovaries--by the time they are diagnosed.

Even so, the majority (70 percent or better) of the women we treat for ovarian cancer can expect a complete response to their initial treatment. In addition, women who come to SCCA for treatment of ovarian cancer can expect a better quality of life while in cancer treatment than ever before.

You also will find a new attitude toward this disease: Your doctors will talk with you about "managing ovarian cancer as a chronic disease" in much the same way as a woman with congestive heart failure would manage her disease.

If you have been referred to SCCA for treatment, here are some of the treatment choices you may be offered. Remember, each woman's cancer is different, as are her circumstances, preferences, and beliefs. A treatment that works well for another woman may not be right for you.

Standard Treatment

• Surgery
• Chemotherapy
• Treatment for Recurrent Ovarian Cancer

Surgery

Surgery is the standard treatment for ovarian cancer. Your doctors may recommend following your surgery with chemotherapy. Radiation therapy is not generally used to treat ovarian cancer, but it may be a useful treatment for a small minority of women with ovarian cancer. Studies show that outcomes are better for women whose surgery is performed by a gynecologic oncologist. All the surgeons who see patients at SCCA are gynecologic oncologists. Depending on how far your cancer has advanced, you may have surgery to remove just one ovary (and the fallopian tube), both ovaries, or a hysterectomy to remove the uterus as well as the ovaries and fallopian tubes.

Rather than relying on a biopsy to make treatment decisions, as with other types of cancer, ovarian cancer is most often diagnosed by the symptoms and with scans such as a CT or ultrasound.

If ovarian cancer is suspected, your gynecologic oncologist will recommend an exploratory surgery. If cancer is found, it will be removed at that time. The results of the surgery will allow your doctors to "stage" your disease. Any further treatment they recommend will depend to a large degree on the "stage" of your cancer, which means how far the disease has progressed.

Minimally Invasive Surgery Option

Hysterectomies, node dissections and, when appropriate, ovarian or endometrial cancer staging/restaging can now be performed minimally invasively with robotics, like the da Vinci Surgical System. This system enhances the surgeon's capabilities and is shown to improve outcomes. The robot allows surgeons to do surgery without a large incision. It does not improve tumor control, but it does improve patient outcomes by reducing post operative pain, infection, blood loss, and reducing recovery time.

If there is cancer elsewhere in the abdomen, your doctor will remove as much of the tumor as possible, a procedure that is called "debulking." Chemotherapy is more effective if as much of the cancer as possible is removed and your doctors may recommend chemotherapy following your surgery to destroy any cancer cells remaining.

Your surgeon will also remove lymph nodes from the pelvis and abdomen. The lymph nodes are biopsied to determine if the cancer has spread.

Surgery for SCCA patients is performed at University of Washington Medical Center by gynecologic oncologists who provide care at both UWMC and SCCA.

Chemotherapy

Most women treated at SCCA for ovarian cancer will receive chemotherapy after their surgery to kill any cancer cells remaining. Some women will be treated with chemotherapy but not surgery. Generally these women are in poor general health and not good candidates for surgery.

Chemotherapy works by killing fast-growing cells, but the drugs cannot discriminate between cancer cells and other fast-growing cells such as hair follicles. That is one reason for many of the typical side effects of chemotherapy treatment, including hair loss.

You will probably receive a combination of two chemotherapy drugs. The standard chemotherapy for ovarian cancer is a combination of paclitaxel (Taxol®) plus either carboplatin (Paraplatin®) or cisplatin (Platinol®).

Recent research, conducted partly at SCCA's parent organizations, has found that the combination of pacitaxel and carboplatin has fewer side effects and is easier to tolerate than paclitaxel plus cisplatin, while being just as effective.

You will probably have six cycles, or treatments, spaced three weeks apart. The chemotherapy is given intravenously, with a drip into a vein.

Chemotherapy is given in the Infusion Suite on the fifth floor of SCCA. You may bring a friend or family member to sit with you during your treatment, which may take several hours.

New Treatments

Consider participating in a clinical trial. Promising new treatments, such as biological therapy, are only available through a clinical trial at this time.

More Information
Dr. Benjamin Greer, director of the division of Gynecologic Oncology at UW Medicine and head of the Gynecologic Cancer Program at SCCA, is a member of the panel that wrote the standard treatment guidelines for ovarian caner.
You may want to read the "PDQ" summary on the National Cancer Institute web site for more detailed information about ovarian cancer.

Treatment for Recurrent Ovarian Cancer

Because of the difficulty of diagnosing ovarian cancer early, most woman have stage III disease--meaning the cancer has spread beyond the ovaries--by the time they are diagnosed.

Even so, the majority (70 percent or better) of the women we treat for ovarian cancer can expect a complete response to their initial treatment.

Despite treatment, however, ovarian cancer sometimes recurs. It may come back elsewhere in the abdomen or in distant sites.

This is recurrent ovarian cancer. Although tumors may appear in distant sites it is not a new cancer, it is a recurrence of the original cancer.

If you have recurrent ovarian cancer, SCCA can offer you new medical procedures and treatments, as well as access to clinical trials, that your community doctor may not know about.

No one at SCCA will tell you that a diagnosis of recurrent disease is not serious, but there is hope. There are a number of new drugs that are effective against recurrent ovarian cancer, and one of these drugs may put you back in remission. Gynecologic oncologists are beginning to treat ovarian cancer as a chronic disease, one that can be managed with periods of treatment and periods of remission, with fairly good quality of life throughout.

The treatment you receive for a recurrence of your ovarian cancer may include surgery or chemotherapy or a combination of these treatments. Radiation therapy is not commonly used to treat recurrent ovarian cancer. Your treatment will depend on a number of factors, including the type of treatment you have received in the past, and the symptoms you are experiencing with the new cancer.

If you did not have chemotherapy previously, then your doctors will probably recommend that you have exploratory surgery, during which as much tumor as possible will be removed. They will probably recommend that you follow surgery with six chemotherapy treatments with a combination of paclitaxel (Taxol®) and carboplatin (Paraplatin®).

If you were treated with chemotherapy previously, your doctors may not recommend that you have further surgery. Rather, they may suggest a new chemotherapy or hormonal therapy such as tamoxifen, especially if the only indicator that you have a recurrence is a rising CA 125 tumor marker level.

Ask your doctor about taking part in clinical trials of promising treatments for metastatic disease. One of these is biological therapy, which is only available in a clinical trial at this time.