Ovarian Cancer, Fallopian Tube Cancer or Primary Peritoneal Cancer

What are the available treatment options for ovarian cancer?

Treatment depends on stage of cancer, reproductive state and general health of the patient.

Just like other cancers, treatment regimen for ovarian cancer also depends on the stage of the disease. Treatment also depends on whether the woman is still able to have children as well as general health of the patient. Depending on these factors, the doctor will discuss with the patient and come up with one or a combination of treatment options. Available treatment options are:

I. Surgery

Surgery is often the primary treatment for ovarian cancer. In women of childbearing age, at an early stage of cancer, it may be possible to treat the cancer without performing a complete surgery of both ovaries. Whatever stage the cancer is in, the main aim is to remove as much tumour as possible. Surgery usually involves removal of ovary and fallopian tubes (single or both). Uterus may or may not be removed, depending on spread of cancer.

II. Chemotherapy

Recurrent ovarian cancer can be either ‘platinum sensitive’ or ‘platinum resistant’ depending on how long it has been since the most recent platinum-based chemotherapy containing carboplatin or cisplatin. If it has been 6 months or more, the cancer is said to be ‘platinum sensitive’ (in which case there greater chances to respond to platinum-based treatment). If the cancer has returned in less than 6 months, then the cancer is ‘platinum resistant’ (hence, the cancer may be less likely to respond to a platinum-based treatment). The dosage regimen for Bevacizumab varies depending on whether the tumour is ‘platinum sensitive’ or ‘platinum resistant’. To know more, consult your doctor.

Chemotherapy, given orally or injected in vein, may be combined with surgery to kill cancer cells that might have remained at the cancer site even after surgery, or those that might have metastasized. Chemotherapy can also be administered to shrink large tumours. Some examples of chemotherapeutic drugs, which are usually given as a combination are:

• Albumin bound paclitaxel, Altretamine, Capecitabine, Cyclophosphamide, Etoposide, Irinotecan, Melphalan, Pemetrexed, Topotecan

In women at stage III ovarian cancer, chemotherapeutic drugs such as cisplatin and paclitaxel may be injected directly into the abdominal cavity (‘Intraperitoneal/IP chemotherapy’), in addition to earlier mentioned ‘systemic’ chemotherapy. IP chemotherapy helps the site of cancer directly exposed to more concentrated drug. But, there may be serious side effects to it, such as severe abdominal cramps, nausea, vomiting, which the doctor will help understand better.

III. Radiation therapy

External beam radiation therapy (EBRT), where a high intensity beam of X-rays is concentrated on the affected area is the preferred radiation therapy in ovarian cancer. Treatment is usually given for around 5 days a week for several weeks.

IV. Hormone therapy

Hormone therapy is more often used to treat ovarian stromal tumours, and rarely for epithelial ovarian tumours. Here, hormones are used to lower oestrogen levels in the body, thereby keeping oestrogen from stimulating cancer cell growth. Examples include LHRH antagonists, Tamoxifen and Aromatase inhibitors.

V. Targeted therapy

Each type of targeted therapy works in different ways, but in effect, these drugs specifically target the cell signaling circuitry of the cancerous cells, thereby causing minimal effect on non-cancerous cells. Examples are Bevacizumab and PARP inhibitors

Cancer, if it comes back after initial treatment is called ‘recurrent’. Recurrence can occur at the initial site or at a distant location. After the initial treatment, even if no traces of cancer is detected, the doctor may recommend ‘maintenance therapy’, so as to prevent the cancer from coming back. The drugs used for maintenance therapy include paclitaxel, pazopanib, niraparib and olaparib. In addition, depending on the stage of the disease, one’s doctor may also recommend palliative treatment to relieve the symptoms of cancer. At advanced stages, there may be build-up of fluid in the abdomen. This is called ascites, which can be very uncomfortable. Ascites can be relieved with a procedure called paracentesis. During this, the fluid is drawn out through a needle, guided by ultrasound.

What measures can one take to cope with the disease?

Coping with the disease

Living with ovarian cancer can be a challenge. It is helpful to talk to your doctor to understand palliative and other measures to try to make life easier and go on with daily activities as much as possible.

• Surgery is a primary choice of treatment for ovarian cancer. Like any major operation, it can take upto 3 months to recover from surgery. You will return to daily life soon if you allow your body to rest during the initial weeks of surgery, not go for strenuous work or exercise, not choose to drive until your doctor approves. Also, talk to your doctor to know more on physiotherapy help in exercises that will help in recovery.
• Ascites refers to fluid build-up in the abdomen, and is often experienced by women at later stages of the cancer. Discomfort relating to ascites can be relieved with a process called paracentesis, during which, the skin is numbed and fluid is drained out by inserting a needle through abdomen. The fluid may build up again and this process is repeated.
• Obstruction refers to blocking of intestinal tract by the growing cancer, which may cause abdominal pain, nausea and vomiting. To relieve these symptoms, doctors may drain out some digestive juices, or place a stent in the large intestine.
• Chemotherapy may cause unpleasant side effects like nausea, vomiting, loss of appetite, loss of hair, hand and foot rashes or mouth sores, increased rashes, bleeding of gums and fatigue. These side effects usually go away after some time. Some long term side effects of chemotherapy include kidney damage, neuropathy (numbness, tingling etc.), hearing loss etc. One must talk to the doctor to understand and talk about side effects felt, so that he/she can additionally recommend measures to relieve these symptoms.