Treating and Managing Ovarian Cancer

*Please note: This slide show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about any questions you may have regarding a medical condition.

Customizing your ovarian cancer treatment plan

Your ovarian cancer treatment plan should be customized based on:

• The type, location, and stage of your cancer
• Your age
• Whether you plan to have children
• Your overall health

You and your doctor should share decisions about your treatment plan.

Consulting a specialist

A gynecologic oncologist specializes in caring for women with cancers of the reproductive organs.

Studies show that women with ovarian cancer have better outcomes when a gynecologic oncologist who does many surgeries performs their cancer surgery.

Ask your doctor for a referral to a gynecologic oncologist.

Goals of surgery for ovarian cancer

For ovarian cancer the goals of surgery are:

• To find out the cancer's stage, or how far it has spread
• To remove as much of the tumor as possible; this is called debulking or cytoreduction. Ideally, all visible tumor is removed

Surgery for ovarian cancer

The type of surgery performed will depend on factors such as:

• The cancer's location
• The type of tumor
• The patient's age

Surgery for ovarian cancer

Surgery may include removing the uterus, one or both ovaries, or one or both fallopian tubes.

Surgery for ovarian cancer

If you want to have children in the future, ask your doctor if fertility-sparing surgery is an option for you.

Ovarian cancer surgery and menopause

Menopause is the time of life when your menstrual cycles stop. For many women, natural menopause occurs in their early 50s.

If you have surgery to remove both ovaries before you've entered natural menopause, the surgery will cause you to enter menopause right away. This is often called surgical menopause.

Ovarian cancer surgery and menopause

Common symptoms of menopause include:

• Hot flashes
• Mood changes
• Changes in sexual function

Menopause also increases your risk for bone loss in the future.

Before you have surgery, ask your doctor what can be done to treat symptoms of menopause and protect your bone health.

Chemotherapy for ovarian cancer

Chemotherapy, or chemo, uses anticancer drugs to destroy cancer cells. Chemo may be given:

• Before surgery to shrink the tumor and make surgery easier
• After surgery to kill any remaining cancer cells

Chemotherapy for ovarian cancer

Patients with ovarian cancer most often receive combination chemo with two or more drugs that attack the cancer in different ways.

Chemo for ovarian cancer is usually injected into a vein through an IV.

In select cases, it may be heated and injected into the abdomen either during or after surgery. This is called "hot chemo", or HIPEC.

Targeted therapy for ovarian cancer

Cancer starts when abnormal cells grow and multiply without stopping. Targeted therapy uses drugs that attack these abnormal cells to stop the cancer from growing or spreading.

PARP inhibitors, which we will discuss shortly, are a type of targeted therapy, called maintenance therapy, used to treat ovarian cancer.

Other treatment options for ovarian cancer

• Hormone therapy uses hormones or hormone-blocking drugs to kill cancer
• Radiation therapy, less commonly used to treat ovarian cancer, uses high-energy X-rays to kill cancer cells
• Immunotherapy uses the body's immune system to kill cancer. Researchers are studying how best to use immunotherapy to treat ovarian cancer

Clinical trials

Clinical trials are studies of new drugs or procedures in people. They are used to test whether new medications are safe and more effective than existing ones.

By enrolling in a clinical trial, you may be able to get a new treatment for ovarian cancer before it's generally available.

Ask your doctor if enrolling in an ovarian cancer clinical trial is right for you.

Maintenance treatment

After you complete chemo, your doctor may prescribe maintenance treatment to prevent or delay a return of your cancer based on your surgery findings or specific testing of your tumor.      

For example, studies show that when PARP inhibitors are given as maintenance treatment, they delay recurrence in some patients. They may also reduce the risk that cancer will return.

Your doctor also will want to do periodic blood tests and scans to make sure there is no evidence of disease.

Managing side effects

Most treatments for ovarian cancer have side effects that can affect your body, your emotions, and your mental state.

Talk with your healthcare team about any side effects you're having. They can work with you to find ways to relieve and manage your side effects.

Getting support for ovarian cancer

It’s also important to get social and emotional support for your well-being. Consider talking to a counselor or joining a support group to help you through this time.

Your healthcare team, friends, family members, and others can help you cope with your emotions and guide you on this journey.

References

1. American Cancer Society. Treating Ovarian Cancer.
   https://www.cancer.org/cancer/ovarian-cancer/treating.html
2. Brodsky AN. How Immunotherapy Is Making an Impact in Ovarian Cancer. September 12, 2019.
   https://www.cancerresearch.org/blog/september-2019/immunotherapy-ovarian-cancer-zamarin-q-a
3. CancerNetwork.com. FDA Grants Fast Track Designation to GEN-1 Immunotherapy for Treatment of Advanced Ovarian Cancer. Last Revised: February 22, 2021.
   https://www.cancernetwork.com/view/fda-grants-fast-track-designation-to-gen-1-immunotherapy-for-treatment-of-advanced-ovarian-cancer
4. Cancer Research Institute. How is Immunotherapy for Ovarian Cancer Changing the Outlook for Patients?
   https://www.cancerresearch.org/immunotherapy/cancer-types/ovarian-cancer
5. Healthline.com. Ask the Expert: How Does Maintenance Therapy for Ovarian Cancer Work?
   https://www.healthline.com/health/ovarian-cancer/how-does-maintenance-therapy-work
6. Marks J. Immunotherapy for Ovarian Cancer. Last Revised: April 30, 2020.
   https://www.everydayhealth.com/ovarian-cancer/immunotherapy-for-ovarian-cancer
7. National Cancer Institute. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ^®)–Patient Version. Last Revised: January 8, 2021.
   https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq
8. National Ovarian Cancer Coalition. Ovarian Cancer Quality of Life Issues.
   https://www.ovarian.org/storage/documents/NOCC_Quality_of_Life_Issues.pdf
9. National Ovarian Cancer Coalition. Ovarian Cancer Treatment Options.
   https://www.ovarian.org/about-ovarian-cancer/treatment
10. National Ovarian Cancer Coalition. Resource Guide for Newly Diagnosed Patients. 2019.
    https://www.ovarian.org/storage/documents/guides/newlydiagnosedguide_nocc_2019.pdf
11. National Ovarian Cancer Coalition. Side Effects of Treatment for Ovarian Cancer.
    https://www.ovarian.org/about-ovarian-cancer/treatment/side-effects
12. Ovarian Cancer News Today. Keytruda (Pembrolizumab) for Ovarian Cancer.
    https://ovariancancernewstoday.com/keytruda-pembrolizumab-for-ovarian-cancer