What is the treatment for ovarian (ovary) cancer?

Treatment of Ovarian Cancer

The standard treatment for ovarian cancer consists of surgical cytoreduction performed by a gynecologic oncologist, followed by platinum-based chemotherapy with carboplatin and paclitaxel for most patients. 1

Surgical Management

Early-Stage Disease (Stage I-II)

• Standard surgical approach for early-stage disease:

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy
  • Comprehensive staging including:
    • Collection of ascitic fluid/peritoneal washings for cytology
    • Complete exploration of abdominal cavity
    • Infracolic omentectomy
    • Appendectomy (particularly for mucinous tumors)
    • Pelvic and para-aortic lymph node sampling/dissection
    • Random peritoneal biopsies (diaphragm, paracolic gutters, pelvic peritoneum) 2

• Fertility preservation option:

  • May be considered in young patients with stage IA/B, grade 1-2, non-clear cell histology
  • Involves unilateral salpingo-oophorectomy with preservation of contralateral ovary and uterus 1

Advanced-Stage Disease (Stage III-IV)

• Primary cytoreductive surgery:

  • Goal is to remove all visible disease (complete cytoreduction) or achieve optimal cytoreduction with residual tumor nodules <1 cm 2
  • Procedures may include:
    • Total abdominal hysterectomy and bilateral salpingo-oophorectomy
    • Complete infragastric omentectomy
    • Bowel resection when necessary
    • Peritoneal or diaphragmatic stripping
    • Splenectomy or partial liver resection if needed 2

• Neoadjuvant chemotherapy:

  • May be considered for patients with bulky stage III-IV disease who are not surgical candidates
  • Followed by interval debulking surgery after 2-3 cycles 2, 1

Chemotherapy Regimens

Adjuvant Chemotherapy

• Standard first-line regimen:

  • Carboplatin (AUC 5-7.5) plus paclitaxel (175 mg/m²) every 3 weeks for 6 cycles 1, 3

• Stage-specific recommendations:

  • Stage IA/B, Grade 1: Observation without adjuvant chemotherapy 2
  • Stage IA/B, Grade 2-3, clear cell, or any Stage IC and above: Carboplatin/paclitaxel combination 2, 1

Recurrent Disease

• Platinum-sensitive recurrence (relapse >6 months after prior platinum therapy):

  • Combination platinum-based chemotherapy (carboplatin/paclitaxel) is preferred 4
  • Single-agent carboplatin if combination therapy is not indicated 4

• Platinum-resistant/refractory recurrence (relapse <6 months or progression during platinum therapy):

  • Single-agent therapy with paclitaxel, topotecan, or pegylated liposomal doxorubicin 4
  • Goals shift to improving quality of life and extending symptom-free interval 4

Prognostic Factors and Outcomes

• Key prognostic factors:

  • FIGO stage at diagnosis
  • Residual disease after surgery (most significant)
  • Histological type and grade
  • Patient age and performance status 1

• Survival outcomes:

  • Early-stage disease: 5-year survival rate of 70-95% 5
  • Advanced-stage disease: 5-year survival rate of 10-40% 5
  • Patients with BRCA mutations may have improved outcomes with PARP inhibitor maintenance therapy 5

Common Pitfalls to Avoid

1. Inadequate surgical staging - Approximately 30% of apparent early-stage disease is upstaged after comprehensive staging 1

2. Suboptimal cytoreduction - Residual disease after surgery is the most critical prognostic factor; maximal effort should be made to achieve complete or optimal cytoreduction 2, 1

3. Inappropriate fertility preservation - Should be limited to carefully selected patients with early-stage, well-differentiated, non-clear cell histology 1

4. Delayed referral to gynecologic oncologist - Surgery by a gynecologic oncologist improves outcomes and is strongly recommended 2

Despite high initial response rates to treatment, approximately 75% of patients with advanced disease will relapse within 2 years 5, 6. This underscores the importance of optimal initial treatment to maximize the chance of cure, which may be achievable in up to 20% of women with advanced-stage disease 7.