Ovarian Cancer

Treatment

The main treatment options for patients who have ovarian cancer are surgery and chemotherapy. Radiation therapy is used in some cases, especially recurrent cancer. Other potential treatments that are currently being evaluated include immunotherapy, bone marrow transplant, gene therapy and hormone therapy.

Surgery

Surgery to treat ovarian cancer is complex. It requires a high level of specialized skill. Studies indicate that women whose surgery is performed by a gynecologic oncologist have significantly better survival rates. In most cases, surgical treatment requires the removal of both ovaries, the uterus, fallopian tubes, nearby lymph glands and a fold of fatty tissue called the omentum, a common site for ovarian cancer to spread. The surgery is known as laparotomy. The surgeon also removes as much of the tumor as possible. This process is known as surgical debulking or cytoreductive surgery. Mayo Clinic patients experience better outcomes than patients at most other medical centers in part because Mayo surgeons are able to achieve "optimal debulking" at signficantly higher rates than the national average. Optimal debulking is achieved when less than 1 cubic centimeter of tumor remains in the abdomen after surgery. The amount of residual tissue left after surgery is the most important factor for achieving the best long-term outcome. Mayo Clinic has long been known for pioneering the Frozen Section technique, which allows for rapid microscopic analysis of tissue removed from patients. Surgeons can determine in minutes whether tissue is benign or cancerous, dramatically increasing their ability to remove as much of the cancer as possible during the initial surgery.

Mayo Clinic also is a leader in demonstrating that aggressive procedures to remove ovarian cancer that has spread to other tissue can be done safely and effectively. This may include the removal of tumors that have spread to the liver, spleen and diaphragm.

Laparoscopy, a minimally invasive surgery, may be used in some cases of ovarian cancer. Further research into this procedure is needed before it can be used more frequently.

For some patients, physicians may recommend "second-look" surgery after chemotherapy to determine whether the cancer has returned or spread. Patients who benefit most from second-look surgery are those who had more than 1 cubic centimeter of tumor remaining after their first surgery and who have responded well to chemotherapy. For many patients, however, second-look surgery may not be recommended.

Chemotherapy

After surgery, most patients are treated with chemotherapy, which uses powerful drugs and drug combinations to kill cancer cells. This is known as adjuvant chemotherapy. Current standard chemotherapy for ovarian epithelial cancers generally combines two agents, carboplatin and paclitaxel (Taxol) for approximately six treatments given three to four weeks apart. Mayo Clinic research contributed to the establishment of this standard regimen. The overall response rate in advanced (Stage III or IV) disease is between 70 and 80 percent. There are many types of chemotherapy drugs, including platinum complexes (such as carboplatin), mitotic inhibitors (such as paclitaxel), alkylating agents, antimetabolites, antitumor antibiotics and DNA topoisomerase inhibitors. Because these medications work in different ways used together, they can be more effective against tumors than when used alone.

Mayo Clinic patients have access to new drugs through ongoing clinical trials. Patients should ask their doctor if they are eligible for clinical trials.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. The use of radiation therapy to treat ovarian cancer has declined in recent years, in part because of improvements in chemotherapy, but radiation therapy may still have a role for some patients. For example, radiation therapy may be considered for women who have a localized recurrence of ovarian cancer or women who can't tolerate chemotherapy. One form of radiation therapy is whole abdominal radiation, which uses external radiation to treat ovarian cancer that remains localized in the abdomen, especially for recurrent cancer. Mayo Clinic is one of a few medical centers that offers this treatment.