Treatment decisions for ovarian cancer

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

The team includes a:

• gynaecological oncologist who specialises in women's cancer surgery
• medical cancer specialist (an oncologist)
• gynaecological cancer specialist nurse

The treatment you have depends on:

• where your cancer is
• how far it has grown or spread (the stage)
• the type of cancer
• how abnormal the cells look under a microscope (the grade)
• your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

The main treatments

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

• targeted drug treatment
• hormone treatment
• radiotherapy

Surgery

Almost all 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. The drugs circulate throughout the body in your bloodstream.

Doctors most commonly use the chemotherapy drug carboplatin to treat ovarian cancer. You might have it on its own or with another chemotherapy drug called paclitaxel (Taxol).

Treatment by stage

Stage 1

Doctors usually class stage 1 cancer as early ovarian cancer. This means the cancer is still contained within the ovaries.

Surgery

Surgery is the main treatment. Your specialist surgeon (gynaecological oncologist) removes your cancer. They might need to remove:

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

The surgeon examines the inside of your abdomen. And your abdominal organs for signs of cancer.

For some low grade stage 1a cancers, it might be possible to just remove the affected ovary and fallopian tube. This leaves behind the unaffected ovary and your womb. It means you might be able to become pregnant and have a baby afterwards. 

Chemotherapy

After surgery, your doctor might suggest you have chemotherapy if you have one of the following:

• stage 1c ovarian cancer 
• high grade (grade 3) cancer

This is called adjuvant chemotherapy and aims to lower the risk of your cancer coming back.

 Stage 2, 3 and 4 ovarian cancers

Doctors classify stage 2, 3 and 4 ovarian cancers as advanced cancer. This means the cancer has spread outside the ovary.

The main treatments are surgery and chemotherapy.

Surgery

Most women with ovarian cancer have surgery to remove:

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

If the cancer has spread to other areas in your pelvis or abdomen, your specialist surgeon (gynaecological oncologist) will aim to remove as much of the cancer as possible. Sometimes the surgeon has to remove part of the bowel if the cancer has spread there. And is blocking the bowel. 

Chemotherapy

You might have:

• chemotherapy after surgery – this is called debulking surgery with adjuvant chemotherapy
• chemotherapy before and after surgery – this is called neoadjuvant chemotherapy and interval debulking surgery (IDS)  

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. 

Targeted cancer drugs

Some women with advanced ovarian cancer have targeted cancer drugs. These drugs change the way that cells work and help the body control the growth of cancer

Getting a second opinion

Some people like to get an opinion from a second doctor. This is before they decide on their treatment. If a surgeon who specialises in women's cancer (gynaecological oncologist) is treating you, you should also get an opinion from a cancer specialist (oncologist). You can ask them if you need chemotherapy.

Most doctors are happy to refer you to another NHS specialist for a second opinion if you would find this helpful.

Note: A second opinion means just that. It does not mean that the second doctor will take over your care. Your treatment will usually still be managed by your original specialist.

If you want a second surgical opinion, you need to make sure that it is from someone who specialises in ovarian cancer surgery. And not a general gynaecologist.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.