How Ovarian Cancer is Treated

Ovarian cancer is treated by a gynecologic oncologist—a gynecologist who specializes in the diagnosis and treatment of women with cancers of the ovary, uterus, fallopian tubes, vagina, and vulva. Your primary care doctor or regular gynecologist will be able to refer you to this type of doctor. And if you've been treated for breast cancer and have a relationship with a cancer care team, they can also refer you to someone. You want to connect with a gynecologic oncologist from the start. Research shows that survival tends to be better when the first surgery for ovarian cancer is done by a gynecologic oncologist.

If a doctor suspects you have ovarian cancer, he or she will usually have you undergo a number of preliminary diagnostic tests. They are likely to include an imaging procedure of the ovaries such as a CAT scan, a transvaginal ultrasound, and a pelvic and rectal exam. An imaging procedure of the abdomen, which is the body area to which ovarian cancer most commonly spreads, may also be performed. All of these tests help the doctor to begin to determine the presence and extent of the cancer and the need for surgery.

The initial surgery and staging of ovarian cancer is very important in terms of deciding the best course of treatment, and can make a difference in length of survival.

Like breast and other cancers, ovarian cancer is described in stages. As the stage number goes up from I to II to III to IV, the extent of disease increases and the situation becomes more serious. Treatment options are based on the stage.

Stage I: Ovarian cancer is inside one or both ovaries.

Stage II: Cancer is inside one or both ovaries and has spread to other parts of the pelvis.

Stage III: Cancer is inside one or both ovaries and has spread to nearby lymph nodes or to other abdominal organs, except for the liver.

Stage IV: Cancer is inside one or both ovaries and has spread to the liver or sites outside the abdomen.

The goal of surgery is to remove as much of the cancer as possible. Surgery for stages II, III, and IV ovarian cancer usually involves removing both ovaries, the uterus, the fallopian tubes, and the omentum (the fat blanket that covers the small intestines). With stage I cancer, one or both ovaries are removed and the other organs are left intact. At times, if only one ovary is affected, then that ovary is removed and the other is left intact.

Surgery is typically followed by chemotherapy. Some of the medicines used for breast cancer can also be used for ovarian cancer. But in general, the chemotherapy combinations and scheduling for ovarian cancer are different from breast cancer. During and after chemotherapy, doctors monitor progress with pelvic exams and with a CA-125 blood test. Even though this blood test is not a highly reliable screening tool before diagnosis, it can help show whether the disease has come back in women who have already been treated.