What are the treatment options for epithelial ovarian cancer?
Treatment options include surgery, chemotherapy, and sometimes radiation therapy.
The recommended form of treatment depends on various factors, such as tumor stage and general condition.
The specialist will explain the advantages and disadvantages of the therapy, chances of success, possible side effects and details of the specific treatment options of the present tumor type and stage.
The patient and doctor must also discuss the treatment goal.
In some cases, treatment is aimed at curing the ovarian cancer. Doctors prefer to use the term regression. Regression means that there is no sign of cancer after therapy.
In some cases, however, the tumor comes back after months or years.
That’s why doctors are sometimes wary of the word “cure.”
In other cases, treatment is used only to control the tumor. If the therapy cannot cure the cancer, growth and spread can often be restricted and the progression of the disease can thus be slowed down.
In this way, the symptoms are stopped for a while.
In still other cases, treatment is designed to relieve symptoms. If the tumor has progressed, painkillers or other measures, for example, can be used to relieve pain and symptoms.
Some therapies help to reduce the size of the tumor, in this way symptoms and pain, such as pain in the ovaries, can be alleviated.
Surgery for ovarian cancer
In most cases, surgery is recommended. If the tumor is still in the early stages (it is limited to the ovary and has not spread), surgical intervention to remove the affected ovary and the associated fallopian tube may already be sufficient as a form of treatment.
Often, however, the tumor has already infiltrated the nearby structures or spread throughout the body.
In this case, the operation is more extensive.
For example, in addition to the affected ovary, the uterus, the other ovary and other affected regions in the abdomen can also be removed during surgery.
During the procedure, the surgeon can take a tissue sample of the abdominal and abdominal structures (e.g. from the pelvic floor or lymph nodes) and have it examined (biopsy).
The extracted material is analyzed under the microscope to determine whether the tumor cells have already spread to these structures. In this way, a precise staging of the cancer can be made, which may require further therapeutic measures.
Chemotherapy treats the cancer with anticancer drugs to destroy the cancer cells or prevent cell division and growth.
In most cases, the cells taken during surgery or biopsy are examined in the laboratory to control the risk of recurrence of the cancer.
At high risk, chemotherapy is performed.
Sometimes chemotherapy is injected before surgery to reduce the size of the tumor.
This may make the procedure easier and the chances of success greater.
Sometimes a second operation is scheduled after a chemo cycle.
This is used to inspect the abdomen; the successful effect of chemotherapy can be checked and cancerous tissue can be eliminated, which was not removed during the first operation, but has now been reduced by chemotherapy.
The chemotherapy drugs kill the tumor cells, but can also damage the healthy cells. The doctor must take care to keep the side effects, which depend on the type and dosage of the drug and the duration of treatment, as minimal as possible.
Common side effects of chemotherapy include:
Chemotherapy can damage blood cell production in the bone marrow, so patients may suffer from blood cell poverty.
- higher likelihood of infection (due to lack of white blood cells);
- bleeding or bruising after small cuts or trauma (due to lack of platelets);
- Fatigue (due to lack of red blood cells).
Most side effects disappear when the therapy is finished.
The hair grows back, even if it may look different.
There are remedies for many of the side effects caused by chemotherapy.
For example, nausea and vomiting can be very well prevented or treated with medication.
Radiotherapy uses high-energy beams of radiation that are concentrated on the tumor tissue.
In this way, the cancer cells are killed or their growth inhibited.
Radiation therapy is rarely used for ovarian cancer.
Sometimes it is used after surgery to destroy the tumor cells that remained in the body after the procedure.
Radiation therapy can also be used to reduce secondary tumors that have formed in other parts of the body and cause pain or symptoms.
Treatment of ovarian cancer
How ovarian cancer is treated depends on how far the disease has progressed and how far the cancer has already spread to other parts of the body.
The classification of the tumor is made by the surgeon (oncologist or gynecologist) when the ovarian cancer is removed.
During surgery, the surgeon takes small tissue samples from various points of the abdominal cavity (biopsy).
In this process, depending on the stage, the surgeon can remove only one ovary plus fallopian tubes, or both ovaries, both fallopian tubes and uterus.
Also, the surgeon will try to remove as many tumor cells as possible.
Ovarian cancer can be divided into the following stages of development:
The tumor is limited to one or both ovaries.
In phase II, the tumor affected one or both ovaries and spread to the uterus and/or fallopian tubes or other pelvic regions.
In phase III, in addition to one or both ovaries, the lymph nodes are also affected, or the area outside the pelvis but within the abdominal cavity, the outside of the liver or intestines.
In phase IV, one or both ovaries are affected and the cancer has spread beyond the abdominal region or within the liver.
Treatment options depending on the stage of cancer
Treatment of ovarian cancer depends on the stage of the disease, histological cell type, age of the patient and general condition.
Histological cell type and spread of the disease can be determined on the basis of tissue samples taken by the surgeon during surgery and examined by the pathologist under the microscope.
Treatment of epithelial ovarian cancer
In the first stage, standard surgery involves removal of the uterus (hysterectomy), both ovaries and fallopian tubes, the large mesh (omentum majus), biopsy of the lymph nodes and other tissue structures in the pelvis and abdomen.
In young women whose cancer is limited to one ovary, often only this ovary with associated fallopian tube is removed (unilateral salpingo-oophorectomy), uterus and other ovary are preserved.
Also, the large mesh is removed (omentectomy); further surgical measures may follow.
After assessment of the removed tissue by the pathologist, further interventions shall be dispensed with if:
- the tumor is in the early stages:
- the tumour is at an advanced stage, but the patient can undergo combined chemotherapy.
Treatment almost always includes a hysterectomy with bilateral adnexectomy, i.e. removal of the uterus, both ovaries and both fallopian tubes, as well as the complete removal of all visible cancerous tumors.
Furthermore, the lymph nodes and other tissues from the pelvic and abdominal cavity are examined for cancer.
After surgery, a combination treatment with chemotherapy, with or without radiotherapy, can be carried out.
Treatment is the same as for stage two ovarian cancer.
The surgery can be followed by chemotherapy, as well as other surgical procedures to detect and remove all cancer residues.
Treatment involves surgery to remove all cancerous tissue if possible, followed by chemotherapy.
What is the prognosis for ovarian cancer?
Ovarian cancer has good chances of recovery if it is detected and treated at an early stage, that is, if it is confined to the ovary and has not spread.
Unfortunately, most ovarian cancers are not diagnosed in the early stages, because the symptoms often do not appear until the tumor is already a certain size or has already spread.
In this situation, treatment is less effective, but still possible.
In general, it can be said that the prognosis gets worse and worse the further the cancer stage has progressed. If there is no definitive treatment, the therapy can slow the progression of the cancer.
The 5-year survival rate is about 1% in stage 85, but only 3-4% in stage 30 and 40.
The possibilities of cancer treatment are still in the development stage, therefore the information on the prognosis is of a general nature; Scientific studies are investigating the new experimental therapies, but they have not yet been completed.
The attending physician can provide more detailed information about the patient’s chances of recovery and explain how the cancer may respond to the particular form of treatment.
Screening for early detection of ovarian cancer
A lot of research has been done to find out whether early detection of ovarian tumors is possible and whether they can be treated more effectively.
This systematic testing procedure is called screening.
The first results of a series of tests carried out in postmenopausal women are promising.
The tumor marker CA125 was measured in the blood or a vaginal ultrasound was performed.
So far, the results have shown that both screening methods are suitable for detecting ovarian cancer in the early stages.
However, the measurement of the tumor marker CA125 is somewhat more accurate. The procedures are still under development and it may be a while before we know if they are precise enough to be used nationwide as a preventive examination.
Women at higher risk of ovarian cancer should talk to the doctor about a screening test.