If you have ovarian cancer, you will probably have surgery to remove the tumor and, if necessary and possible, cancer that has spread. You might also have chemotherapy (medication treatment) before surgery to make your cancer easier to remove and afterward to kill cancer that was left behind or that may have spread.
Surgery confirms your ovarian cancer diagnosis, determines how far it has spread—called staging—removes your ovaries and fallopian tubes, and removes cancer that has spread—called cytoreduction or debulking.
Gynecologic oncologists are the best surgeons for ovarian cancer. They have extended training in surgical management of ovarian cancer and expertise in staging and debulking procedures. Our surgeons at Columbia University are world-renowned specialists from several disciplines to undertake the most complex surgeries as a team.
If ovarian cancer is detected early, you may be able to have fertility-sparing surgery. This surgery spares your uterus and an uninvolved ovary. You may also be a candidate for fertility-sparing surgery if you have nonepithelial ovarian tumors. Our team of gynecologic oncologists are leaders in the field of fertility preservation.
If it appears that cancer is confined to your ovary, you’ll typically have a staging surgery. This operation aims to detect microscopic spread of cancer outside your ovary. Up to 30% of people with ovarian cancer have microscopic spread but no visible evidence of cancer outside the ovary.
Your gynecologic oncologist will typically remove both of your ovaries and fallopian tubes in staging surgery, called bilateral salpingo-oophorectomy. They will also remove your uterus, called hysterectomy, pelvic lymph nodes, and the fatty tissue that connects your abdominal organs, called the omentum.
Your surgeon may also take biopsies of the lining of your abdominal cavity. If there’s fluid in your abdomen, they may also “wash” it with liquid then send the liquid to a pathologist to examine for cancer cells.
If ovarian cancer has spread to your abdominal cavity, you will have debulking surgery instead of staging surgery. The goal is to remove as much cancer as possible.
Debulking typically removes both ovaries, your uterus, and any cancer nodules found in your abdomen. Your surgeon may also need to remove:
- Part of the lining of your abdominal cavity (peritonectomy)
- Part of your small intestines or colon (colectomy)
- Your spleen (splenectomy)
- Your omentum—the fatty tissue that sits on your intestines (omentectomy)
- Part of your diaphragm
- Part of your liver (partial hepatectomy)
How much cancer is left after debulking surgery influences survival for ovarian cancer. After surgery, you are classified as having had an optimal or suboptimal cytoreduction (cancer removal).
- Optimal cytoreduction means no or a limited amount of cancerous areas remain. Your prognosis is better.
- Suboptimal cytoreduction means you still have cancer nodules bigger than 1 cm.
Cancer stages define whether cancer is confined to its site of origin or has spread into nearby tissues or further into your body.
Your cancer’s stage, among other things, will determine your course of treatment. To stage cancer, your gynecologic oncologist will send tissue samples from your surgery to a pathologist, who will check them for abnormalities.
Each stage also has substages. We’ve simplified this information, but you can find full details at the American Cancer Society Website.
Stage I: Cancer is confined to one or both ovaries or fallopian tubes but hasn’t spread to the outer surface. No cancer cells are found in laboratory washings from your abdomen.
Stage II: You have cancer in one or both ovaries or fallopian tubes and in other organs within your pelvis, such as your uterus, fallopian tubes, bladder, sigmoid colon, or rectum. There’s no spread to your lymph nodes or distant sites.
Stage III: You have cancer in one or both ovaries or fallopian tubes, and it’s spread to nearby organs or lymph nodes in your pelvis or abdomen.
Stage IV: You have cancer inside of your spleen, liver, lungs, brain, or other organs outside of your peritoneal cavity—the area enclosed by a membrane that lines the inner abdomen and some of the pelvis and covers most of its organs.
Chemotherapy is the most commonly known cancer treatment. Chemotherapy uses medications (chemicals) to stop cancer growth and spread and to prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die.
Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why it causes side effects like hair loss. Most women with epithelial ovarian cancers require chemotherapy. Chemotherapy may be given before (neoadjuvant) or after (adjuvant) surgery and may be given intravenously (IV) or directly into the abdominal cavity-intraperitoneal (IP).
You may have chemotherapy before surgery (neoadjuvant) to shrink the cancer so it can be removed with less extensive surgery. You will receive several cycles of chemotherapy before surgery, then more after surgery.
Multiple research studies have shown that people do better after surgery and have fewer complications if they get chemotherapy first. Other studies show that neoadjuvant chemotherapy doesn’t increase survival for ovarian cancer. It’s critical to discuss the pros and cons with your doctor.
Or you may have chemotherapy after surgery (adjuvant) to eradicate cancer cells that might have been left behind or may have spread but can’t be detected. Most people with ovarian cancer have six to eight cycles of chemotherapy then enter a period of surveillance or may receive maintenance therapy.
Chemotherapy is most commonly given through an IV in our infusion center, intravenous chemotherapy. It’s given in cycles across a few weeks, with each treatment followed by a rest period. The most commonly used drugs for ovarian cancer are carboplatin and paclitaxel. You will get an infusion weekly or every three weeks.
Sometimes we administer chemotherapy for ovarian cancer directly into your abdominal cavity, called intraperitoneal chemotherapy. By putting the medication directly into your abdomen, we can deliver a higher concentration directly into the tumor cells.
Studies suggest that intraperitoneal chemotherapy may increase long-term survival in some women, but it is associated with more side effects and you might not tolerate it well.
You’ll have a port placed in your abdomen during your first or subsequent operation. Your doctor will put the medication into your abdomen through this port.
But you might also have maintenance (consolidation) chemotherapy after completing chemotherapy.
Maintenance chemotherapy may prevent ovarian cancer from recurring, but research shows mixed results. Maintenance therapy may consist of medications given intravenously, most commonly a drug called bevacizumab, or medications by mouth called PARP inhibitors. Your gynecologic oncologist will discuss the pros and cons of maintenance therapy to help make an individual decision.
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of cervical cancer patients. You can talk to your care team about whether a clinical trial is an option for you.
Gynecologic Oncology Survivorship Program
Once you’re finished with treatment, you’ll enter a period of surveillance to make sure your cancer doesn’t return, and if it does, to catch it early.
Our experts in the Gynecologic Oncology Survivorship Program create an individualized survivorship plan for you. This plan is a comprehensive assessment that includes all the treatment you received, possible late side effects to watch for, a blueprint for future cancer screening, a surveillance plan, and a personalized plan for wellness activities to improve your lifestyle.
Surveillance for ovarian cancer typically includes blood tests to evaluate serum tumor markers, like CA125, and possibly imaging tests. You’ll usually see your gynecologic oncologist instead of your regular gynecologist for these tests. They’ll tailor your surveillance plan to your needs.
When cancer comes back after treatment, it’s called recurrence. Cancer can recur anywhere in your body, often in your abdominal cavity.
Symptoms of recurrence are abdominal pain, bloating, nausea, or vomiting and changes in bowel or bladder habits. If you have these symptoms, please talk to your gynecologic oncology team quickly.
If ovarian cancer returns, you will likely have chemotherapy, either one type alone or several kinds in combination. You may also have another operation followed by more chemotherapy.
Less common treatments for recurrent ovarian cancer are hormone therapy and radiation therapy.