Treatment options for ovarian cancer

A team of health professionals will discuss the best treatment for you. This depends on factors such as your cancer stage and grade. You might have one or more treatments. The most common treatments are surgery and chemotherapy.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The team might include a:

• surgeon specialising in cancer of the womb, ovaries, cervix and vagina (gynaecological oncologist)
• cancer specialists who treat cancer with drugs (medical oncologist) and radiotherapy (clinical oncologist)
• gynaecological cancer specialist nurse (also called a clinical nurse specialist or CNS)
• pathologist who examines any cancer or tissue the surgeon removes
• radiologist who looks at your scans and x-rays
• MDT coordinator who makes sure all your results are ready and appointments are booked
• research nurse who specialises in clinical trials, and supports people who take part in them

The treatment you have depends on:

• the type of cancer you have

• where your cancer is

• how far it has grown or spread (the stage)

• how abnormal the cells look under a microscope (the grade)

• whether the cancer has spread to another part of the body (this is called secondary cancer or metastases)

• your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you. They may suggest a treatment on its own, or a combination of treatments.

Treatment overview

The main treatments for ovarian cancer are surgery and chemotherapy. Some women with ovarian cancer have:

• targeted drug treatment
• hormone treatment
• radiotherapy

Surgery

Most women with ovarian cancer need surgery. The amount and type of surgery you have depends on your stage and type of cancer.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. 

You might have chemotherapy:

• into your vein - the drugs circulate throughout your body in the bloodstream
• directly into your tummy (abdomen) during surgery - this is called hyperthermic intraperitoneal chemotherapy (HIPEC)

Targeted drug treatment

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive.

You may have treatment with a targeted cancer drug. This will depend on your situation.

Hormone treatment

Some ovarian cancers use hormones to grow or develop. This means the cancer is hormone sensitive or hormone dependent. If your cancer is hormone sensitive you might have hormone therapy.

This is not a common treatment for ovarian cancer.

Radiotherapy

Radiotherapy uses high energy x-rays to destroy ovarian cancer cells. Doctors don't often use radiotherapy to treat ovarian cancer.

You might have radiotherapy to try and shrink the size of the cancer. Or to reduce the symptoms of advanced cancer.

Treatment by stage

Stage 1 ovarian cancer

Surgery is the main treatment for stage 1 ovarian cancer. Your specialist surgeon (gynaecological oncologist) usually removes:

• your ovaries
• fallopian tubes
• womb (including the cervix)

The surgeon also examines the inside of your abdomen for signs of cancer.

For some low grade stage 1A cancers, it might be possible to only remove the affected ovary and fallopian tube. The unaffected ovary and your womb are not removed. This means you might be able to become pregnant and have a baby afterwards. 

After surgery, your doctor might suggest you have chemotherapy. This is called adjuvant chemotherapy and aims to lower the risk of your cancer coming back.

Stage 2, 3 and 4 ovarian cancers

Surgery and chemotherapy are the main treatments for stage 2, 3 and 4 cancers. Your specialist surgeon (gynaecological oncologist) removes:

• both ovaries
• fallopian tubes
• your womb (including the cervix)

They will also check where the cancer has spread to in your pelvis and if it is in your lymph nodes. Your gynaecological oncologist will aim to remove as much of the cancer as possible. 

This is called cytoreductive surgery. You may also hear it called debulking surgery.

When you have chemotherapy will depend on your individual case. You might have:

• chemotherapy after surgery – this is called adjuvant chemotherapy with cytoreductive surgery
• chemotherapy before and after surgery – this is called neoadjuvant chemotherapy with interval cytoreductive surgery
• chemotherapy into your abdomen during surgery – this is called hyperthermic intraperitoneal chemotherapy or HIPEC

You might not have surgery if you have very advanced cancer or you are not well enough. You might have chemotherapy on its own or combined with other treatments. 

Some women with stage 3 or 4 ovarian cancer have also targeted cancer drugs. You might have this with chemotherapy, or on it’s own after chemotherapy.

Getting a second opinion

Some people like to get an opinion from a second doctor. This is before they decide on their treatment. Most doctors are happy to refer you to another NHS specialist if you would find this helpful. 

Clinical trials

Your doctor may ask if you’d like to take part in a clinical trial.

Doctors and researchers do trials to:

• improve treatment
• reduce the side effects of treatment
• develop new treatments