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Treatment

The first step in the treatment of ovarian cancer is the surgical removal of cancerous tissue. This is often done during the initial surgery, when the cancer is first discovered. For early stage ovarian cancer (Stage 1), only the affected ovary may need to be removed. However, lymph nodes in the pelvis and para-aortic areas, and a fatty apron inside the abdomen, called the omentum, usually need to be removed as well. The surgical removal of an ovary is called an oophorectomy. If one ovary is retained, a woman of childbearing age does not usually experience early menopause after the surgery.

More commonly, ovarian cancer is diagnosed at a later stage and the ovaries, fallopian tubes, uterus and cervix are all removed. This procedure is called a hysterectomy with bilateral salpingo-oophorectomy.

For women with advanced ovarian cancer, chemotherapy is sometimes used both before and after surgery. This makes the complete removal of the tumour easier and more successful.

Along with the reproductive organs, the omentum and some lymph nodes from the abdomen may be removed. If there is evidence that the cancer has spread throughout the abdomen, the surgeon will usually attempt to remove as much of the cancer as possible. This is called tumour debulking.

After the Surgery
After the surgery, depending on whether you had a laparoscopic procedure or laparotomy, you may experience some pain and abdominal discomfort. (Laparoscopy is generally associated with less pain and a quicker recovery.) You may also feel nauseous and not feel like eating. These side effects are temporary and can be controlled. Talk to your doctors about how you can control your pain and nausea.

If you are of childbearing age, the removal of both of your ovaries will prompt the early onset of menopause and symptoms like hot flashes are likely to occur soon after surgery. The symptoms of menopause that occur after surgery are often more severe than the symptoms of a natural menopause. Your doctor may suggest hormone therapy (HT) to prevent or alleviate your symptoms. However, evidence that highlights some of the risks associated with HT make this a controversial subject. Discuss the risks and benefits of HT in your particular case with your doctor. Ultimately though, it is your choice whether or not to take hormones.

After the cancerous tissue is removed, chemotherapy is commonly recommended unless the cancer was in the earliest stages. Radiation therapy is not a commonly used treatment, but may also be a part of a woman's therapy. Click on the links below to learn more about these therapies.

Chemotherapy | Radiation therapy | Monitoring your progress

Chemotherapy

Chemotherapy means using a combination of drugs to kill cancer cells. Before surgery, it is used to reduce the size of the tumour so that it will be easier to remove. After surgery, it is used to destroy any remaining cancer cells. The most common drugs used to treat ovarian cancer are Paraplatin and Taxol; however, others are available if this initial combination does not prove successful.

How Chemotherapy Is Given

Chemotherapy is usually used systemically, which means that the drugs are taken intravenously, and circulate through your system. Recent evidence suggests improved survival in patients who receive IP (intraperitoneal) chemotherapy. This requires the use of a portocath, which is a small device that is placed under the skin of the abdominal wall, and is either inserted during your initial surgery or afterwards in the radiology department.

The chemotherapy drugs used to treat ovarian cancer are often given in cycles, once every three to four weeks. The treatment is usually repeated six times. In most cases, you can receive these drugs as a day patient or through home care treatments. When administered intravenously, the total treatment may take up to five hours.

More recently, the standard intravenous therapy has been used in combination with chemotherapy injected directly into the abdominal cavity, using a catheter placed during the initial surgery. The chemotherapy drugs target the cancer cells attached to the lining of your abdomen. This combination has been shown to improve the survival rate of women with advanced ovarian cancer.

Side Effects

Chemotherapy drugs are most destructive to rapidly growing cells like cancer cells; however, they cause side effects because they are toxic to all of the body's cells. But it is important to remember that not everyone experiences severe side effects from chemotherapy. The side effects will vary depending on the specific drugs being used, the dosage, and the length of time you are on the medication. Side effects may include:

  • nausea and vomiting
  • loss of appetite
  • anemia (low iron)
  • diarrhea or constipation
  • fatigue
  • headaches
  • hair loss
  • peripheral neuropathy (nerve damage that causes pain or numbness in the hands or feet)
  • darkening of the skin and fingernails
  • hearing loss

You are not likely to experience all of these symptoms. Talk to your caregivers about what you are experiencing. In most cases, they can give you medications to relieve your symptoms, if, for example, you are feeling nauseous. They can also tell you more about how long your symptoms are likely to last and how other women have coped. Women using chemotherapy may need to drink extra fluids to prevent kidney damage.

Radiation Therapy

External radiation therapy (also called radiotherapy) uses high-energy x-rays to damage cancerous cells. This can be done by using a special machine that directs radioactive energy from outside the body at the cancerous cells or by implanting radioactive materials directly into or near the tumour. Radiation therapy is a useful way to target and reduce the size of a tumour, but because ovarian cancer cells have often spread throughout the abdomen, it is of limited use for treating ovarian cancer and is rarely used.

Radiation therapy is usually given five days a week, over the course of six or seven weeks.

Different people react in different ways to the treatment. The most common side effect of any radiation treatment is fatigue. You will likely feel very tired, particularly in the later weeks of treatment. It is common for fatigue to last for four to six weeks after your treatments are complete. Other side effects include red, itchy, sensitive skin and diarrhea. Most of these side effects stop once the radiation treatment has ended.

Monitoring Your Progress

Your doctor will do blood tests regularly, throughout your treatment, to monitor the side effects of your chemotherapy. The CA-125 blood test may also be used to gauge the effectiveness of treatment.

After your treatment is complete, your doctor will likely want to schedule regular check-ups. You should also watch for any unusual symptoms, such as:

  • abdominal bleeding
  • shortness of breath
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • vaginal bleeding

Most women have some of these symptoms occasionally, but if you experience these symptoms over a prolonged period, you should see your doctor.

What Happens If the Cancer Does Come Back?

You doctor will discuss the best treatment strategy for you. However, recurrences are most often treated with more chemotherapy, often using a different combination of drugs.

 

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