Ovarian cancer : We explain the available treatments

Ovarian cancer affects 1 out of every 78 women and accounts for around 13,000 deaths per year in the US. The high mortality rate is partly explained by the fact that ovarian cancer is often diagnosed at a very advanced stage (stages 3 or 4). The most common treatment is surgery, often accompanied by chemotherapy or immunotherapies.

Surgery

This is the most common treatment for ovarian cancer. The surgical procedure differs depending on the cancer stage, but the goal is the same: removal of all detectable cancerous growths. In most cases, it's done by "laparotomy" (opening up the abdominal area) or at times laparoscopy (small incisions) if the cancer cells are concentrated in one area.

Before the surger, the stage the cancer is at must be determined before the patient is matched with a surgeon and anesthesiologist.

For which patients is surgery the best option?

All patients from early (1) to advanced (1C) stage cancer.

When?

Surgery is often proposed as soon as the cancer is diagnosed, and after determining what stage the tumor is at.

How is it performed?

If the cancer is caught early

The surgeon will remove the ovaries, Fallopian tubes and uterus. If the patient wants to have children and the cancer is at a very early stage (only one of the ovaries is affected), the surgeon may be able to perform a "conservative surgery": removal of the affected ovary and fallopian tube only.

If the cancer is in an advanced stage

The surgeon will generally remove the ovaries, uterus, Fallopian tubes, omentum, pelvic and paraaortic lymph nodes, the appendix and any other abdominal zones touched by cancer as necessary (peritoneum, sections of the intestines, colon or rectum, etc.).

What are the advantages of surgery?

Removal of the entire or nearly the entire tumor.

What are its limits?

Surgery is not recommended when the cancer has already metastasized beyond the peritoneum (into the liver or lungs for example), in which case the treatment offered to the patient will vary depending on her individual case. Surgery means the patient will no longer be able to have children (unless a conservative surgery is possible). There are also serious impacts on the patient's digestive and urinary tracts and sex life.

Chemotherapy

Chemotherapy is generally made up of two types of medications: alkylating agents (ex: carboplatin) and a taxane (ex: paclitaxel). The medications prescribed and the dosage and duration of the treatment depend on the characteristics of the cancer and the patient's tolerance for the treatment.

For which patients is chemotherapy the best option?

Patients at stages 1A and 1B of grade 3 cancer (limited to the ovaries, but aggressive) and up to stage 3C (cancer has spread or is metastatic)

How is it administered?

Via an implantable port (a small box inserted below the skin and hooked up to a catheter placed in a vein), directly into the abdomen by catheter, or applied for ten minutes following surgery.

When?

Chemotherapy can be neoadjuvant, meaning it is administered before surgery to reduce the size of the tumour, and/or adjuvant, meaning it's administered after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. It may also be a treatment of last resort if the cancer has already metastasized beyond the peritoneum.

What are the advantages of chemotherapy?

Chemotherapy can shrink tumors (making surgery easier), kill cancer cells remaining after surgery, and reduce the risk of cancer recurrence.

What are its limits?

Side effects can be numerous and lower patient quality of life during treatment: nausea, diarrhea, hair loss or fatigue.

Targeted therapies

Targeted therapies focus on a single constituent of the tumor, in contrast to chemotherapy which attacks both cancerous and healthy cells. The first example of this new class of medications is olarparib (Lynparza®).

For which patients are targeted therapies the best option?

For patients in which the ovarian tumor shows a mutation in the BRCA1 or 2 genes only. A genetic screening is conducted on a sample taken from the tumor in order to determine if those mutations are present. 

When?

For patients with advanced or recurrent cancer, following chemotherapy.

What are the advantages of targeted therapies?

Target therapy has shown promising results in affected patients and appears to limit cancer recurrence.

What are its limits?

It's not recommended for all patients suffering from ovarian cancer.