Treatment

The importance of being treated by a gynecologic oncologist cannot be stressed enough. According to numerous medical studies, there are significant survival advantages for women who are managed, operated on and treated by a gynecologic oncologist. Why?

  • A gynecologic oncologist is a subspecialist who specializes in treating women with reproductive tract cancers.
  • Gynecologic oncologists are initially trained as obstetrician/gynecologists and then undergo three to possibly more than five years of specialized education in all of the effective forms of treatment for gynecologic cancers (surgery, radiation, chemotherapy and experimental treatments) as well as the biology and pathology of gynecologic cancers.
  • Gynecologic oncologists are five times more likely to completely remove ovarian tumors during surgery.
  • Eighty percent of ovarian cancer patients receive inadequate surgical debulking–the removal of tumor tissue during surgery–and staging when done by non-gynecologic oncology surgeons.
  • Survival rate and outcomes for women with ovarian cancer vastly improve with gynecologic oncologists.
  • For those women with ovarian cancer who live in rural areas that may not have a gynecologic oncologist at a local hospital, her care can be supervised by a gynecologic oncologist at a major medical center who has relationships with medical oncologists in surrounding areas to provide the chemotherapy treatment.

How can I find a gynecologic oncologist in my area?

If you are in the Oregon or Southwest Washington area, please see Finding a Gyn-Onc.

If you are outside our area, you can call The Foundation for Women’s Cancer toll-free hotline at 1-800-444-4441 or visit them online at http://specialist.foundationforwomenscancer.org/.

Treatment

Navigating and understanding treatment options are critical for an ovarian cancer patient’s survival. All treatment decisions should be made by a patient in consultation with her medical professional.

The standard treatment for ovarian cancer consists of debulking surgery followed by six rounds of chemotherapy. One recent study found that just 37 percent of women receive this standard treatment, despite evidence showing that it is the most effective.

The goal of treatment for ovarian cancer is to surgically remove as much of the cancer as possible through the debulking and then to provide what is called adjuvant, or additional therapy, such as chemotherapy, to kill any possibly remaining cancer cells in the body. Radiation therapy, which uses high energy rays to kill cancer cells, is not typically utilized in ovarian cancer.

Surgery

During surgery, doctors attempt to remove all visible tumors (tumor debulking). Women whose surgery was performed by a gynecologic oncologist have better outcomes than patients whose surgeons were not oncologists, including improved survival and longer disease-free intervals. Learn more information about ovarian cancer surgery.

Chemotherapy

Patients undergo chemotherapy in an effort to kill any cancer cells that remain in the body after surgery. Women will usually have either systemic chemotherapy or systemic chemotherapy and intraperitoneal therapy. Besides the gynecologic oncologist (or medical oncologist for those women in rural areas who don’t have access to a gynecologic oncologist) taking care of you, a chemotherapy nurse will assist in providing the drug treatment that will attempt to kill remaining cancer cells in the body. The chemotherapy nurse is a very important health care professional in a patient’s life because s/he assesses the side effects of the drugs and helps alleviate them. Side effects are common with chemotherapy and depend on the type and length of treatment. Each woman is different in her response to chemotherapy and the doctor and nurse will explain possible side effects and provide suggestions and treatments about ways to manage them. For more information, see Chemotherapy: Dealing with Side Effects. Learn more about chemotherapy.

Intraperitoneal Chemotherapy

This therapy places the medicine directly into the peritoneal area through a surgically implanted port and catheter. While intraperitoneal (IP) therapy has been in use since the 1950s, new advances have combined it with intravenous (IV) therapy, using chemotherapy agents that work best for treating ovarian cancer. The National Cancer Institute recommends that, for select ovarian cancer patients, chemotherapy be given by both IV and IP. This combination has been found to increase survival for women with advanced stage ovarian cancer.

Neoadjuvant Chemotherapy

Some patients may receive chemotherapy before having surgery to remove their tumors. This is known as neoadjuvant chemotherapy.

Other Drugs

Other drugs, including angiogenesis inhibitors and targeted therapies, may be recommended either in conjunction with chemotherapy or as single agents. These drugs may have very different side-effects than chemotherapies and may be useful only for specific populations.

Radiation Therapy or Radiotherapeutic Procedures

These procedures may be used to kill cancer cells that remain in the pelvic area.

Complementary Therapies

With a diagnosis of cancer, some women might opt to try complementary to help themselves. Complementary therapies are those used along with conventional medicine. Acupuncture, massage therapy, herbal products, vitamins, special diets and meditation are examples of these approaches. You should talk with your doctor about treatments you may use because although products, such as herbal teas, are routinely sold, they may interact with cancer drugs and change the drugs’ effectiveness. More and more healthcare facilities these days are offering integrated medical approaches that combine both conventional and complementary therapies for which there is evidence of safety and effectiveness.

Treatment based on staging

Stage I

Generally women with Stage I ovarian cancer have a total abdominal hysterectomy, removal of both ovaries and fallopian tubes, an omentectomy, biopsy of lymph nodes and other tissues in the pelvis and abdomen. Women of childbearing age who wish to preserve their fertility and whose disease is confined to one ovary may be treated by a unilateral salpingo-oophorectomy without a hysterectomy. Depending on the pathologist’s interpretation of the tissue removed, there may be no further treatment if the cancer is low grade, or if the tumor is high grade the patient may receive combination chemotherapy.

Stage II

Treatment for Stage II ovarian cancer includes: hysterectomy and bilateral salpingo-oophorectomy, debulking of as much of the tumor as possible, and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After the surgical procedure, treatment may be one of the following: 1) combination chemotherapy with or without radiation therapy or 2) combination chemotherapy.

Stage III

Treatment for Stage III ovarian cancer is the same as for Stage II ovarian cancer: hysterectomy and bilateral salpingo-oophorectomy, debulking of as much of the tumor as possible, and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After surgery, the patient may either receive combination chemotherapy possibly followed by additional surgery to find and remove any remaining cancer.

Stage IV

Treatment for Stage IV ovarian cancer will consist of surgery to remove as much of the tumor as possible, followed by combination chemotherapy.

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