Ovarian cancer is the deadliest gynecologic malignancy, often diagnosed at advanced stages when the disease has spread widely1 . Treatment strategies are tailored to the cancer subtype, stage, and patient health, involving surgery, chemotherapy, targeted therapies, and occasionally radiation or hormonal treatments2 . Advances in understanding tumor biology have led to more personalized approaches, improving outcomes and quality of life for many patients3 .
Surgical Procedures for Ovarian Cancer
Surgery is the primary treatment for most ovarian cancers, aiming to accurately stage the disease and remove as much tumor as possible4 . For epithelial ovarian cancer, surgery has two main goals: staging and debulking4 . Proper staging determines how far the cancer has spread, guiding subsequent treatment decisions4 . Debulking surgery removes visible tumors to improve prognosis, with optimal debulking defined as leaving no visible disease or tumors smaller than 1 cm5 4.
Standard surgical procedures include:
- Bilateral salpingo-oophorectomy (BSO): Removal of both ovaries and fallopian tubes, a cornerstone of ovarian cancer surgery2 4.
- Hysterectomy: Removal of the uterus, often performed alongside BSO2 4.
- Omentectomy: Removal of the omentum, a fatty tissue layer where ovarian cancer commonly spreads2 4.
- Lymph node and peritoneal biopsies: Sampling lymph nodes and peritoneal tissues to assess cancer spread2 .
- Additional organ resections: In advanced cases, parts of the colon, small intestine, bladder, spleen, gallbladder, or other abdominal organs may be removed to achieve optimal debulking4 .
Surgical approaches vary based on patient and tumor characteristics. Laparotomy, involving a large abdominal incision, remains standard for extensive disease2 . However, laparoscopic (minimally invasive) surgery is increasingly used for staging and selected treatments due to less invasiveness and faster recovery, offering comparable oncologic outcomes with reduced morbidity6 27. Surgeons may also use intraoperative imaging with fluorescent agents like pafolacianine (Cytalux) to better identify cancerous tissue during surgery4 .
Recovery typically involves a hospital stay of 3 to 7 days, with most patients resuming normal activities within 4 to 6 weeks4 . For women of childbearing age with early-stage tumors, fertility-sparing surgery may be considered, preserving one ovary and the uterus when appropriate2 4.
Chemotherapy Treatment Approaches
Chemotherapy is a standard treatment for ovarian cancer, especially epithelial types, except for certain early-stage cases8 9. It aims to kill microscopic cancer cells remaining after surgery, shrink tumors before surgery (neoadjuvant), or treat recurrent disease8 10.
- Platinum-based agents: Carboplatin and cisplatin are mainstays, often combined with taxanes like paclitaxel for synergistic effects11 9.
- Administration: Most chemotherapy is given intravenously (IV) every 3 to 4 weeks in cycles, typically 3 to 6 cycles depending on disease stage and response8 9.
- Intraperitoneal chemotherapy: Drugs are delivered directly into the abdominal cavity via a catheter, increasing local drug concentration and potentially improving outcomes in selected patients with optimally debulked stage III disease11 9.
Neoadjuvant chemotherapy is used to reduce tumor burden before surgery in patients with extensive disease or poor surgical candidates, followed by interval debulking surgery and adjuvant chemotherapy10 12. This approach can improve surgical outcomes and reduce complications12 .
Chemotherapy can cause side effects, including:
- Immunosuppression leading to increased infection risk11 9.
- Nausea, vomiting, hair loss, and mouth sores9 .
- Neuropathy (nerve damage), especially with platinum agents and taxanes9 .
- Kidney damage (cisplatin), ototoxicity (hearing loss), and early menopause9 .
Supportive care and symptom management are essential to maintain treatment adherence and quality of life9 .
Targeted Therapy Options
Targeted therapies interfere with specific molecules involved in cancer growth, offering personalized treatment options based on tumor biology13 14.
- Bevacizumab (Avastin): A monoclonal antibody that inhibits vascular endothelial growth factor (VEGF), blocking tumor blood vessel formation and growth13 14.
- Administration: Given intravenously every 2 to 3 weeks, often combined with chemotherapy or as maintenance therapy13 14.
Side effects: Hypertension, bleeding, gastrointestinal symptoms, and rare but serious risks like intestinal perforation13 .
Mechanism: PARP inhibitors block DNA repair enzymes, leading to cancer cell death, especially effective in tumors with BRCA mutations or homologous recombination deficiency13 15.
- Common agents: Olaparib, niraparib, and rucaparib13 14.
- Use: Maintenance therapy after response to platinum chemotherapy in advanced or recurrent ovarian cancer13 14.
Side effects: Nausea, fatigue, anemia, and rare risk of blood cancers13 .
Mirvetuximab soravtansine: An antibody-drug conjugate targeting folate receptor alpha, overexpressed in many ovarian cancers13 .
- Indication: For platinum-resistant epithelial ovarian cancer expressing folate receptor alpha13 .
- Administration: Intravenous infusion every three weeks with premedication to prevent infusion reactions13 .
- Side effects: Headache, nausea, fatigue, abdominal discomfort, eye problems, and rare lung toxicity13 .
Other targeted agents address genetic alterations such as NTRK, BRAF, HER2, RET, and KRAS mutations, offering new options for selected patients13 . These drugs include kinase inhibitors and antibody-drug conjugates, administered orally or intravenously, with side effects varying by agent13 .
Additional Treatment Methods
Beyond surgery, chemotherapy, and targeted therapy, other treatments may be considered based on tumor subtype and patient needs.
- Hormonal Therapy: Primarily used for ovarian stromal tumors, which arise from connective tissue and may respond to estrogen-blocking agents2 .
- Radiation Therapy: Uses ionizing radiation to destroy cancer cells, typically via external beam radiation2 .
- Role of Radiation: Rarely used in ovarian cancer, mainly for palliation or treatment of brain metastases2 .
- Treatment Individualization: Decisions depend on cancer subtype, stage, and patient health status2 .
Clinical Trial Participation
Clinical trials are vital for advancing ovarian cancer treatment by testing new drugs, combinations, and strategies16 . Participation offers access to cutting-edge therapies not yet widely available and contributes to improving standards of care16 .
Patients are encouraged to discuss trial options with their healthcare providers to identify suitable studies based on their cancer characteristics and treatment history16 .
Living With Ovarian Cancer
A diagnosis of ovarian cancer affects physical, emotional, and social well-being2 . Patients often experience emotional distress related to symptoms and treatment side effects, with responses varying widely2 . Support from healthcare providers, family, and support groups can improve quality of life and coping2 .
Maintaining a positive outlook and seeking social and professional support are important aspects of managing life during and after treatment17 .
Laparoscopic surgery for ovarian cancer offers less invasiveness and faster recovery compared to traditional open surgery, with similar oncologic outcomes6 .
💡 Did You Know?
Intraperitoneal chemotherapy delivers drugs directly into the abdominal cavity, increasing local drug concentration and potentially improving survival in selected patients11 .
Treatment Summary
Ovarian cancer treatment is multifaceted, involving:
- Surgery: To stage and remove tumors, aiming for optimal debulking5 4.
- Chemotherapy: Platinum-taxane regimens remain standard, with neoadjuvant and intraperitoneal options for selected patients8 1011.
- Targeted therapies: Including anti-angiogenic agents, PARP inhibitors, and folate receptor alpha-targeting drugs, tailored to tumor genetics13 14.
- Other therapies: Hormonal and radiation treatments for specific subtypes or palliative care2 .
- Clinical trials: Offering access to novel treatments and contributing to research progress16 .
Early-stage diagnosis is associated with better survival, with a 5-year survival rate exceeding 90% for stage I disease, while advanced stages have lower survival rates around 50% 818. Personalized treatment plans based on tumor biology and patient factors optimize outcomes and quality of life2 .
Ovarian cancer treatment continues to evolve with advances in targeted therapies and personalized medicine, improving progression-free survival especially for patients with specific genetic mutations15 13.
