Treatment Options for Ovarian Cancer
by Sandra Ray, Staff Writer

According to the latest statistics from the American Cancer Society, ovarian cancer ranks number eight on the list of cancers to affect women. It is also ranks as the fifth most deadly. Ovarian cancer is largely silent until it has spread beyond the ovaries. There are few tests that reliably detect ovarian cancer, making regular screenings important, coupled with providing your family doctor with information about how your body feels in relation to your overall health. Sometimes symptoms speak louder than tests when it comes to ovarian cancer.

Treatment options vary widely, depending on the staging of the disease. Almost all will involve some type of surgery to remove the affected tissue. The extent of chemotherapy and radiation therapy is determined by the stage of the cancer and the patient’s options for successful treatment.

Stage I Treatment:

            In Stage I epithelial ovarian cancer, surgical treatment generally involves removal of one or both ovaries. Since the disease has not spread beyond the ovaries at this point, chemotherapy may not be required. Doctors may try to preserve at least one ovary in women who are young enough to still have children as long as it does not appear that the disease has spread. A complete hysterectomy is also an option to physicians at this stage. Doctors will also biopsy nearby tissue to be assured that the cancer has not spread further. A biopsy of the lymph tissue is also included since cancer spreads most rapidly through the lymphatic system.

Some doctors will recommend a low level of chemotherapy if they feel that the cancer is likely to recur. Keep in mind that less than 20 percent of all ovarian cancer cases are detected at this early stage, making chemotherapy and other treatment forms more likely as the seriousness of the cancer increases. This stage also has the best prognosis at five years, with approximately 90 percent of women surviving according to statistics released from the University of Maryland Medical Center (UMMC).

Stage II Treatment:

With Stage II cancer, the disease has spread beyond one or both ovaries and into the stomach area. It is more aggressive and will require surgery in order to remove tissue affected by the cancer. Almost all surgeons will perform a complete hysterectomy and biopsy surrounding tissue to determine the extent of the cancer. Lymphatic tissue biopsies are also performed.

Chemotherapy will definitely be included in the treatment plan since the disease could have spread further than the cells detected in the surgery. The types of chemotherapy vary and usually include a combination of more than one type. Radiation therapy enters into the treatment mix at this point as well, with some doctors using it while others prefer to use chemotherapy only. Prognosis for this stage is still fairly high, with five year survival rates as high as 60 to 80 percent.

Stage III Treatment:

Stage III ovarian cancer is treated much the same as stage II cancer, although the chemotherapy involved is much more aggressive. Radiation therapy becomes more likely at this stage, especially given that the cancer is much more aggressive and has spread further into the body. Since the prognosis drops significantly with stage III ovarian cancer, doctors will use combination chemotherapy during their treatment.

Surgery becomes possible both before chemotherapy and after. The second round of surgery is done primarily to ensure that all of the cancerous tissue has been removed and none has escaped undetected, either by the first surgery or by the chemotherapy sessions. Survival rates drop significantly with stage III ovarian cancer, report UMMC, with a five year survival rate of 20 percent.

Stage IV Treatment:

Stage IV ovarian cancer has the poorest prognosis according to UMMC with only 10 percent of women surviving after five years. Doctors concentrate heavily on surgery and chemotherapy in order to treat the disease. More than one round of both types of treatment is often utilized since the disease has metastasized or spread into many different areas of the body by now and can rapidly grow undetected by doctors.

Radiation Therapy Issues:

When assessing the role of radiation therapy, patients and caregivers need to understand the reason why it is used or not used in specific cases. Ovarian cancer cells actually respond quite well to radiation therapy and tend to shrink quickly. Radiation therapy, however, can cause problems for healthy cells n the affected area. For example, when treating ovarian cancer that has moved into the abdomen, doctors do not like to “radiate” the entire abdominal area for fear that healthy tissue will be destroyed by the treatment. (Years ago, this type of approach was used, and it has since lost its popularity.)

If a doctor feels they can focus the area that needs to receive radiation, it is definitely considered as a treatment option. If, however, the whole abdomen needs radiation, the doctor will more likely resort to using different types of chemotherapy to treat the disease rather than risk destroying tissue through radiation and increasing the amount of toxicity in the body.

Treating Recurrent Cancer:

Treating the disease the first time does not guarantee that the disease is gone entirely. Researchers in Rockville, MD reported in 2000 that that “emergence of drug-resistant tumors during therapy for ovarian cancer remains an obstacle to improving long-term outcomes.” In other words, more types of ovarian cancer are becoming resistant to the type of chemotherapy drugs available on the market today making the disease more likely to either continue to spread or to recur after the first round of treatment is completed.

One reason that ovarian cancer is a likely candidate for recurring is due to its low rate of early detection. In cancers other than stage I cancers, the disease has spread outside the ovaries and pelvis, making it more difficult to determine its extent. Doctors at Johns Hopkins Pathology estimate that between 70 and 90 percent of women who are first treated for ovarian cancer will have their cancer recur.

These findings make continuing follow-up treatment with the oncologist and the patient’s gynecologist especially important. Early detection is, of course, one of the best ways to treating ovarian cancer if it does recur. Tests to detect its recurrence include blood tests for the CA125 protein or tumor marker, CT and PET scan imaging, as well as the possibility of additional surgical procedures.

When doctors decide to treat a recurring case of ovarian cancer, there are many factors that need to be taken into consideration. Some of these include:

  • How long ago did the patient end their first round of treatment? Patients who ended their treatment only months prior have a lower prognosis than does the patient who managed several years in remission.

  • How did the patient respond to chemotherapy the first time? Since there are varying tolerances to chemotherapy, those patients who had issues relating to toxicity and low red blood cell count will have different treatment issues than those patients who had neither of those issues.

  • Where has the cancer recurred? While it is possible to treat cancer that has recurred in the abdomen area, patients who had or are still having difficulties relating to GI issues may have fewer treatment options than patients who are not facing these problems.

  • Is quality of life more important than treatment of the disease? Doctors will admit that not all recurrences of the disease are treatable, although almost all are willing to try those options until it becomes evident that the treatment simply will not work. Some patients and caregivers may decide that quality of life is more important than the type of treatment that will have to be endured in order for the disease to move into remission again.

These areas are but a sampling of those issues that doctors consider when deciding when to restart treatment and the type of treatment that is used when it is restarted. Communication at this point becomes critical between the doctor, patient, and caregiver to decide the best course of action.

Caregivers play an increasingly important role in the treatment of ovarian cancer. From discussing treatment options to helping patients understand the staging and treatment options available, the caregiver has a great deal of responsibility. Research and communication are the keys to understanding the disease, its progression, and the type of treatment needed at any one particular point.

Focusing on the patient and their need to make sense of their prognosis and treatment is only one role that the caregiver can play during treatment. There are several others. These can include support, research, communicating with physicians, and helping decide next steps, especially if the cancer recurs. Since ovarian cancer is silent with only few symptoms present in the initial stages, caregivers may experience the same types of frustration as the patient who encounters a diagnosis of advanced ovarian cancer. Getting rest and respite for the caregiver is much-needed and often encouraged by doctors who are working with the patient.

A positive treatment team can make a tremendous difference in the patient’s outcome. While gains have been made with regard to the success in treating ovarian cancer, there is still much work that needs to be done. Communicating with the treatment team all symptoms and managing expectations of therapy can contribute to a patient’s definition of success at any point in the process.           

 

 Subscribe to our weekly e-newsletter