Treatment for ovarian cancer depends on the stage of the disease and the microscopic structure (histology) of the tumor tissue. Usually, however, the first step in treatment is surgery, which first removes as much tumor mass as possible. This is often followed by chemotherapy to kill any remaining cancer cells and prevent a relapse (recurrence). The prognosis of ovarian cancer depends on several factors, such as tumor characteristics. In general, if ovarian cancer is detected in time, the chances of cure are relatively good. However, in the advanced stage of the disease, the prognosis is rather unfavorable.
Surgery: the basis of treatment for ovarian cancer
The most important element of ovarian cancer treatment is the surgical removal of as much tumor tissue as possible. In most cases, this can be done during the diagnostic surgery that must be performed to confirm the diagnosis of ovarian cancer. First, a tissue sample is taken, which is examined by a pathologist while the operation is still in progress. If this confirms the diagnosis of ovarian cancer, both ovaries, fallopian tubes as well as the uterus are usually removed. In addition, lymph nodes from the pelvis and abdomen are usually removed. To clarify how far the tumor has spread (staging), tissue samples are also taken from the peritoneum and from any abnormal areas.
Extent of surgery depends on tumor stage
The extent of radical surgery depends on the stage of the disease. For example, in the early stages of ovarian cancer, it is possible to perform fertility-preserving surgery. The prerequisite for this is that the tumor has a low degree of degeneration (grading) and is also locally limited to one ovary (stage IA). Then it is possible to preserve the healthy ovary as well as the uterus, so that the patient can still become pregnant later. In certain special forms of ovarian cancer (germ cell tumors and germ line tumors), it is more often possible to preserve fertility. However, in advanced ovarian cancer, it may be necessary to remove parts of other organs, such as the liver, spleen, pancreas, or intestines, in addition to the ovaries and uterus if they are affected by the cancer.
Ovarian cancer: chemotherapy often useful
In most cases of ovarian cancer, chemotherapy is given after surgery (adjuvant), even if the tumor has been completely removed. This is to destroy any remaining cancer cells and thus prevent recurrence. In stage IA and in certain forms of ovarian cancer (for example, so-called borderline tumors), chemotherapy is usually not necessary. In all other cases, a drug combination of a so-called taxane and a platinum-containing chemotherapeutic agent is used, usually administered six times at intervals of three weeks.
Repeat chemotherapy for recurrence
If a recurrence occurs after treatment for ovarian cancer, the timing of chemotherapy is relevant: If a recurrence occurs within six months after completion of platinum-containing chemotherapy, it means that the tumor has little or no response to agents containing platinum (platinum-resistant). Accordingly, the recurrence is treated with another chemotherapeutic agent without platinum. If, on the other hand, the ovarian cancer recurs later than after six months, it has initially responded to the first chemotherapy and can again be treated with a platinum-containing drug combination (platinum-sensitive). Whether another surgery is appropriate for a recurrence must be decided on a case-by-case basis for each patient.
Antibody therapy in special cases
In advanced stages and in recurrences, the drug bevacizumab (Avastin )may be used in addition to chemotherapy under certain circumstances. This is an antibody that targets a vascular growth factor and thus inhibits new vessel formation. Since the tumor needs nutrients and oxygen from the blood to grow and is therefore dependent on the formation of new blood vessels, bevacizumab can inhibit tumor growth and prevent metastases.
Palliative therapy for better quality of life
If ovarian cancer is already so far advanced that there is no chance of a cure, doctors will start a so-called palliative therapy. This means that the goal of the therapy is not to cure the disease, but to extend life expectancy and provide the best possible quality of life. In the case of ovarian cancer, this is usually the case when the tumor has spread outside the abdominal cavity or comes back despite surgery and multiple chemotherapy treatments. However, there are no universal guidelines for end-stage therapy. Rather, an individual decision must be made as to which treatment will benefit the ovarian cancer patient the most.
Radiation of metastases in ovarian cancer.
Radiation therapy does not play a major role in the treatment of curable ovarian cancer because the tumors themselves usually do not respond to it. However, in the terminal stage, radiotherapy of metastases – in the bones, for example – can lead to significant pain relief and thus to a better quality of life. In addition, the treatment of symptoms is an important part of palliative therapy: for example, there are a variety of drugs that can usually be used to treat symptoms such as nausea, pain and shortness of breath well.
Alternative treatment: efficacy questionable
So-called unconventional healing methods – for example mistletoe therapy or other herbal therapies – are widely used in alternative medicine. However, there is no scientific evidence to date that alternative treatments are effective for ovarian cancer. Therefore, alternative medicine treatment should not be used in place of medically recommended therapy. However, herbal preparations or homeopathy may help relieve symptoms in some circumstances and thus be a useful complement to conventional medical treatment.
Prognosis depending on stage
As with most diseases, the chances of cure for ovarian cancer are better the earlier it is diagnosed. The following factors may influence the prognosis:
- Tumor stage: the size and spatial spread of the tumor, as well as the presence and localization of metastases, significantly determine the chances of cure.
- Tumor residue after surgery: Based on a classification into R0 (tumor was completely removed), R1 (microscopically visible tumor remnants) and R2 (tumor remnants visible to the naked eye) is indicated how much tumor tissue could be removed.
- Microscopic structure: The different subtypes of ovarian cancer such as ovarian cancer, borderline tumors or germ cell tumors have different chances of cure.
- Grading: the aggressiveness of the tumor is related to the degree of degeneration.
- Age and general condition of the patient: severe pre-existing conditions may be a limitation for surgery or aggressive chemotherapy, for example.
Because ovarian cancer is often diagnosed late compared with other cancers due to a lack of signs in the early stages, the prognosis is generally considered rather unfavorable.
Estimation of the chance of survival is limited
One way to express the approximate chance of survival in numbers is the so-called five-year survival rate. It indicates what percentage of patients are still alive five years after diagnosis. If the tumor is localized to one or both ovaries (stage I), the five-year survival rate is given as 80 to 95 percent. This means that 80 to 95 out of 100 patients are still alive five years after diagnosis. However, if metastases exist outside the abdomen (stage IV) or if the tumor remnant is visible to the naked eye after surgery (R2), the five-year survival rate is only about 10 to 20 percent.
Life expectancy varies from individual to individual
However, the validity of such figures is rather limited because, for example, they do not take into account whether the ovarian cancer itself or another cause led to death. In addition, the course of the disease is different for each individual patient. Therefore, a generally valid prediction of life expectancy in ovarian cancer is not possible either with the help of statistics or on the basis of prognostic factors.
