Management and Treatment

Treatment Options for Ovarian Cancer

The various treatment options for ovarian cancer treatment include either treating or managing the condition. In some cases, the cancerous tumor can be successfully removed from the body, providing an effective solution for the patient. However, in some cases, the treatment focuses on providing relief from the existing symptoms and improving the patient’s quality of life. Typically, both these approaches are combined for the best outcome. However, ultimately, the outcome depends on how well the patient’s body responds to a specific treatment method.

Surgical Options

Surgery is generally the first line of treatment for ovarian cancer and it plays a major role in the outcome as well. The different surgical options are explained below:

• Total Hysterectomy: In a total hysterectomy, multiple surgeries are combined- hysterectomy(uterus removal), oophorectomy (ovaries removal), and a salpingectomy (fallopian tube removal). These procedures are combined for the complete removal of the reproductive organs which are the primary site for ovarian cancer.
• Bilateral Salpingo-Oophorectomy (BSO): This surgical procedure involves removing both ovaries and fallopian tubes to remove the cancer entirely. It can be performed as a preventative measure for women with genetic markers for ovarian cancer or to reduce the risk of recurrence.
• Omentectomy: Omentum is the layer of fatty tissue that covers the intestines and organs in the lower abdomen. Omentectomy involves removing this layer if the tissues are invaded by cancer cells. This procedure reduces the risk of metastasis to other abdominal organs and improves the prognosis of the treatment.
• Lymphadenectomy: In this surgery, the lymph nodes present near the ovaries are removed. This procedure helps to determine the stage of the cancer and its extent of spread. If the lymph nodes have already been invaded by the cancer cells, then lymphadenectomy will ensure that the cancerous lymph nodes are removed to prevent further spread.

It should be noted that not all patients with ovarian cancer need to undergo total hysterectomy and other procedures for complete removal of the cancer. The correct surgical option is chosen based on the stage of the cancer and its spread. Also, before the surgery, especially in the case of younger women, patients are always suggested to take measures to preserve their eggs for future family planning.

Chemotherapy

Chemotherapy is one of the most effective systemic treatments that uses strong drugs to destroy the cancer cells. It is commonly used after surgical treatment to eliminate the remaining cancer cells and reduce the risk of recurrence. The chemotherapy administration methods include the following:

• Intravenous (IV) Chemotherapy: This method involves administering chemotherapy drugs directly into the bloodstream through an IV line inserted into a vein. The most commonly used chemotherapy drugs include carboplatin and paclitaxel. These drugs are given to the patient in cycles over several months.
• Intraperitoneal (IP) Chemotherapy: In this method, the chemotherapy drugs are directly administered into the abdominal cavity using a catheter. It is a more targeted approach as the drugs are directly delivered to the affected area. This approach is more effective than IV chemotherapy for patients with advanced-stage ovarian cancer but also has more side effects.

Chemotherapy is considered the most successful systemic therapy for cancer treatment. But it is not without side effects. The doctors usually inform the patient about the various side effects of chemotherapy and how to manage them.

Radiation Therapy

Radiation therapy involves using high-energy rays to target and destroy cancerous cells in the body. It is not a primary treatment for ovarian cancer but can be used in certain circumstances. The methods include the following:

• External Beam Radiation Therapy: This type of radiation therapy is administered externally using a beam that targets the cancer cells in the abdominal region. The beam makes it possible to treat small areas where the cancer might have spread and prevent unnecessary exposure of the body to radiation.
• Brachytherapy: To further make the radiation therapy more precise, this therapy is administered by placing the radioactive source directly inside or next to the tumor or cancer cells. It delivers a high dose of radiation to the cancer cells while preserving the healthy tissues.

Typically, radiation therapy is recommended for a patient when there is a high risk of ovarian cancer recurrence.

Targeted Therapy

Targeted therapy involves using specific drugs that attack cancer cells and reduce the extent of harm/damage to normal and healthy cells. It is of two types:

• PARP Inhibitors: PARP inhibitors are a class of drugs that block the PARP enzyme which triggers the repair mechanism in the DNA cells. When this enzyme function is blocked, the DNA repair process is halted automatically, which prevents new cancer cells from forming in the body. This therapy is very effective for patients who have the BRCA1 and BRCA2 gene mutations and have a higher risk of cancer recurrence. The commonly used PARP inhibitors used for ovarian cancer are olaparib, niraparib, and rucaparib.
• Anti-Angiogenesis Therapy: All tumors need a fresh blood supply to grow. The anti-angiogenesis therapy blocks the growth of new blood vessels within the tumor to prevent it from growing and spreading to the healthy tissues. Avastin is the most commonly used targeted therapy for ovarian cancer which is often used in combination with chemotherapy to prevent cancer growth.

Hormone Therapy

As ovarian cancer has a significant impact on the hormonal balance of the body, hormone therapy is deemed beneficial to manage ovarian cancer symptoms. Hormone therapy involves using drugs that block or lower the estrogen levels in the body to slow down the growth of ovarian cancer. The commonly used hormone therapy drugs are:

• Tamoxifen: It is a selective estrogen receptor modulator (SERM) that blocks the effects of estrogen hormone in the body and prevents further growth of hormone receptor-positive cancer. Tamoxifen is typically used to treat breast cancer, but it can be effective in certain cases of ovarian cancer as well as to prevent recurrence.

Aromatase Inhibitors: This class of drugs works by blocking aromatase enzymes which convert androgens into estrogen. When this enzyme is blocked, the estrogen hormone levels are reduced in the body, which further reduces the chance of ovarian cancer recurrence.