Ovarian Cancer Treatment Options

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Ovarian cancer treatment options depend on how far your cancer has progressed — the stage — and the nature, or grade, of tumor cells.

Epithelial ovarian cancer is the most common form of the disease. It is characterized by cancer cells developing in the exterior lining of the ovary, or epithelia.

The first approach for treatment in nearly all instances of epithelial ovarian cancer is surgical removal of one or both ovaries and tumors. If the cancer has spread to other organs, surgery would be more aggressive. After surgery, the next course of treatment is typically chemotherapy.

The regimen of surgery and chemotherapy erases evidence of cancer in imaging scans and blood tests about 80% of the time. Sometimes more aggressive measures are needed to achieve a full response to treatment or address any recurrence.

The outlook for recovery depends on the type of ovarian cancer, how far it’s progressed and the effectiveness of treatment. In cases when diagnosis is made before any cancer cells spread to nearby tissue, about 92% of patients survive five years and longer. Overall, the five-year survival rate for epithelial ovarian cancer is about 51%.

At the Forefront of Ovarian Cancer Care

Norton Cancer Institute uses advanced testing options to help your specialist determine a care plan and tailor it for you. Our gynecologic specialists will coordinate your care with surgical oncologists, medical oncologists and, if appropriate, radiation oncologists.

Norton Cancer Institute gynecologic oncologists are also researchers. As principal investigators in a number of clinical trials that could offer innovative approaches, they can provide patients easier access to appropriate trials. Once experimental treatments are approved for wide use, Norton Cancer Institute oncologists often have years of experience with the therapy.

The Norton Cancer Institute Genomics Lab is a state-of-the art facility providing fast access to information about your specific cancer. The genomic testing guides development of advanced treatments that target the precise genetic composition of your cancer. Because speed is essential in cancer treatment, the genomics lab is part of Norton Cancer Institute, saving time that’s lost when working with outside laboratories.

Norton Cancer Institute patient navigators help ease stress and offer emotional support to patients and families. From the point of a suspicious finding through diagnosis, treatment and survivorship, patient navigators help with emotional support, arranging appointments, connecting with resources and more.

What to Expect at Norton Cancer Institute Women’s Cancer Center

Once you’ve been referred to gynecologic oncology at Norton Cancer Institute with a diagnosis, a member of the team will contact you to make an appointment at Norton Cancer Institute Women’s Cancer Center in downtown Louisville. If your records aren’t already in your free Norton MyChart account, the team will contact the referring physician.

Your appointment will be with the first available physician. You’ll also meet the nurse practitioner, nurse clinician and a patient navigator who will help you through treatment and survival.

At your first appointment, your oncologist will review your records and history, including the symptoms that led to the diagnosis. There will be a pelvic exam and a review of the care plan, including any additional imaging, a date for surgery and the plan for any chemotherapy and immunotherapy.

The date for surgery will be within a couple weeks of your first appointment. Depending on your diagnosis, chemotherapy and immunotherapy may start in about a week.

You’ll have surgery scheduled before you leave your first appointment.

Early Stage Ovarian Cancer Treatments

At Stage 1, or early stage ovarian cancer, the cancer cells are limited to one or both ovaries and possibly one or both fallopian tubes. Symptoms such as bloating or feeling full after not eating much can be attributed to far less serious conditions.

Treatment for early ovarian cancer starts with surgery to remove as much of the cancer as possible. In some cases when just one ovary is diseased, fertility can be preserved by retaining the healthy ovary and fallopian tube.

Depending on your condition, several types of surgery could be pursued.

  • Hysterectomy (removal of the uterus and cervix) with bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) and omentectomy (removal of a section of peritoneum that connects the stomach to other abdominal organs). Lymph nodes and other tissue samples are taken to be examined for spread of cancer cells.
  • Unilateral salpingo-oophorectomy removes one ovary and fallopian tube from those who may want to become pregnant at some point. This surgery may not be appropriate in cases where cancer cells are present in both ovaries.

Chemotherapy

After surgery, further treatment such as chemotherapy depends on the grade of the tumor or how abnormal the cells appear when examined by a pathologist. Cancer cells that look more like healthy cells and aren’t considered likely to grow fast and spread are considered low grade. The more cancer cells look less like healthy cells and are considered more likely to grow quickly, the higher the grade.

Stage 1, low-grade ovarian cancer typically requires no additional treatment after surgery. Treatment of Stage 1 ovarian cancer with higher grade cancer cells can range from observation after surgery to more aggressive chemotherapy, depending on the stage and grade of the tumor.

Chemotherapy drugs are taken either as a pill or through injection to kill or slow the growth of cancer cells. Some chemotherapy is delivered directly to the peritoneal cavity — the part of the abdomen that holds internal organs — either during surgery or after.

About 92% of patients diagnosed with Stage 1 ovarian cancer live five years and longer after diagnosis. Unfortunately, not enough ovarian cancers are diagnosed at this early stage, because symptoms such as bloating and feeling full without eating much can be attributed to other conditions.

Advanced Stage Ovarian Cancer Treatments

Stage 2, 3 or 4 ovarian cancer, fallopian tube cancer or primary peritoneal cancer describe cancer that has spread to some degree beyond the ovaries or fallopian tubes. About 75% of those with cancer that has spread from the ovaries to nearby organs and tissue such as lymph nodes survive five or more years after diagnosis, according to the American Cancer Society. Five-year survivability of ovarian cancer that has spread to more distant parts of the body such as the lungs or the liver is 31%.

Surgery for advanced stage epithelial ovarian cancer is more aggressive, meaning more tissue is removed than in Stage 1 surgery. The goal of cancer surgery is to remove as much of the cancer as possible.

Advanced ovarian cancer surgery may involve a radical hysterectomy — removal of the uterus, cervix, ovaries, fallopian tubes, lymph nodes and other tissue in the pelvis and abdomen. The tissue will be examined to determine the various grades of tumor. Low-grade cancer cells more closely resemble healthy cells and are likely to grow more slowly than higher-grade cancer cells.

Chemotherapy

 Advanced ovarian cancer treatment typically involves more aggressive chemotherapy aimed at killing the cancer cells or slowing their growth. Treatment could include one of the following:

  • Intravenous chemotherapy that enters the bloodstream to attack cancer cells
  • Intraperitoneal chemotherapy delivered directly to the abdomen through a small tube
  • Chemotherapy combined with targeted therapy with drugs that rob cancer cells of what they need to survive and grow
    • Some target the signals the cells rely on to grow, some stop them from forming blood vessels and some block the hormones the cells need to survive.
    • Some targeted therapies trigger the immune system to attack cancer cells.
    • Some targeted therapies, PARP inhibitors, limit the molecules the cancer cells need to repair DNA damaged by other cancer treatments.

Radiation Therapy

Because aggressive chemotherapy has proven to be more effective against ovarian cancer, radiation therapy is not commonly pursued. It can be a useful tool, however, to target cancer that has spread or metastasized.

External beam radiation therapy targets cancer cells with radiation from multiple directions. Each beam on its own won’t damage tissue, but when multiple beams are brought together on a precise location, the energy adds up to enough to kill cancer cells. Using multiple beams allows for precise targeting of diseased tissue, leaving healthy tissue unharmed.

Immunotherapy

Immunotherapy drugs can be a treatment option for some ovarian cancer patients. Immunotherapy triggers the immune system, which normally fights bacteria and viruses, to target cancer cells. Cancer cells sometimes can trick the immune system into thinking they’re healthy cells. Immunotherapy drugs can unmask cancer cells, exposing them to immune system attacks.

Immunotherapy drugs approved for use in certain advanced ovarian cancer patients include dostarlimab and pembrolizumab.

Hormone Therapy

Epithelial ovarian cancer rarely responds to hormone therapy. The treatment is used more often to treat tumors that develop in the connective cells — stromal tissue — of the ovaries. Ovarian stromal tumors are rare.

Norton Cancer Institute Gynecologic Cancer Clinical Trials

Ovarian cancer treatment is improving rapidly. Norton Cancer Institute oncologists are also researchers who lead clinical trials into the effectiveness of new therapies.

Why Choose Norton Cancer Institute

More patients in Louisville and Southern Indiana choose Norton Cancer Institute than any other provider in the area. We provide compassionate care for the whole person, not just the cancer.

Our Norton Cancer Institute oncologists are also researchers and principal investigators, offering patients sophisticated experience in the latest treatments and access to more than 200 clinical trials.

  • Access to more than 100 specialists, including board-certified and fellowship-trained oncologists
  • Multidisciplinary setting, meaning you get the benefit of opinions from multiple specialists across Norton Healthcare and often can schedule appointments for the same day in the same location
  • Immunotherapies such as CAR-T cell therapy, genetic therapies tailored to combat the unique genetic makeup of your cancer and the latest in surgical treatments, chemotherapy and radiotherapy
  • State-of-the-art Norton Cancer Institute Genomics Lab offering highly specialized testing that makes it possible to tailor advanced treatments based on a tumor’s specific genetic composition
  • Robotic-assisted bronchoscopy for minimally invasive lung biopsies that can reach more parts of the lung without major surgery
  • Medicare, Medicaid and most major commercial insurance accepted
  • At Norton Specialty Pharmacy, patients receive regular consultations on their medications and treatment plan, making sure they get their prescriptions quickly and accurately. Our specialty pharmacists collaborate closely with your oncology team.
  • Use your free Norton MyChart account to communicate with your provider, manage appointments, refill prescriptions, get on the wait list for an earlier appointment and more anytime from a mobile device or computer

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