DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of ovarian cancer.
In general, the course of treatment is determined by the stage of the cancer. Stages range from I to IV based on the cancer's specific characteristics, such as whether it has spread beyond the ovaries.
In stage I, the cancer has not spread. It is confined to one ovary (stage IA) or both ovaries (stage IB). In stages IA and IB, the ovarian capsules are intact and there are no tumors on the surface. Stage IC can affect one or both ovaries, but the tumors are on the surface, or the capsule is ruptured, or there is evidence of tumor cells in abdominal fluid (ascites). The overall five-year survival rate for stage IA or IB can be as high as 90%, but the presence of other factors may affect this rate. For example, non-clear-cell pt well-differentiated cancer cells or borderline tumors have a favorable prognosis. Clear cells or those that are more poorly differentiated have a worse outlook. Stage IC has a poorer outlook than the earlier stages.
Treatment Options: Treatment for most women with stage IA and IB includes surgical removal of the uterus and both ovaries and fallopian tubes (total hysterectomy and bilateral salpingo-oophorectomy), partial removal of the omentum (the fatty layer that covers and pads organs in the abdomen), and surgical staging of the lymph nodes and other tissues in the pelvis and abdomen. (Carefully selected premenopausal women in stage I with the lowest-grade tumors in one ovary may sometimes be treated only with the removal of the diseased ovary and tube in order to preserve fertility.) Patients with stage IA or B disease, grade 1 (or sometimes grade 2), usually do not need further therapy after surgery. However, higher risk patients (e.g., stage IC, stage I/grade 3) are usually treated with platinum-based chemotherapy to reduce their risk of subsequent relapse.
In stage II, the cancer has spread to other areas in the pelvis. It may have advanced to the uterus or fallopian tubes (stage IIA), or other areas within the pelvis (stage IIB), but is still limited to the pelvic area. Stage IIC indicates capsular involvement, rupture, or positive washings (i.e., they contain malignant cells). The five-year survival rate for stage II is approximately 60% to 80%.
Treatment Options: Surgical management for most women in this stage is total hysterectomy, bilateral salpingo-oophorectomy, and removal of as much cancer in the pelvic area as possible (tumor debulking). Surgical staging should be performed.
After the operation, treatment with chemotherapy (e.g., paclitaxel and carboplatin) is usually necessary in an attempt to eradicate residual cancer and decrease the chance for relapse.
In stage III, one or both of the following are present: (1) The cancer has spread beyond the pelvis to the omentum (the fatty layer that covers and pads organs in the abdomen) and other areas within the abdomen, such as the surface of the liver or intestine. (2) The cancer has spread to the lymph nodes. The average five-year survival rate for this stage is 20%.
Treatment Options: Surgical management for most women in this stage is total hysterectomy and bilateral salpingo-oophorectomy and removal of as much cancer as possible (tumor debulking).
Following surgery, chemotherapy (e.g., paclitaxel plus carboplatin) is usually necessary in an attempt to eradicate residual cancer. A number of approaches are under investigation for reducing high rates of recurrence (about 80%), including the following: experimental chemotherapy agents, anti-angiogenic therapies, gene and biological therapies, intraperitoneally administered high-dose chemotherapy, neoadjuvant therapy (chemotherapy before surgery), high-dose chemotherapy and peripheral blood stem cell transplantation (to date this approach has proven to be very toxic with no convincing improvement in survival).
Stage IV is the most advanced. The cancer may have spread to the inside of the liver or spleen. There may be distant metastases, such as ovarian cancer cells in the fluid around the lungs. The average five-year survival rate for this stage is less than 10%.
Treatment Options: Tumor debulking before chemotherapy sometimes may be performed.
Recurrent Ovarian Cancer
Treatment Options: If ovarian cancer returns, chemotherapy is the mainstay of treatment, although it is not generally curative in the setting of relapsed disease.
If the interval between the last platinum-containing chemotherapy (carboplatin or cisplatin) and relapse is long (greater than six months), it is reasonable to attempt a repeat trial of platinum-based chemotherapy, with or without paclitaxel.
If the interval is short, or if these drugs fail to control the tumor, then other second-line drugs may be useful in achieving a response. They include topotecan, liposomal doxorubicin, etoposide, docetaxel, gemcitabine, or tamoxifen. There is no evidence as yet that second-line drug combinations are any more effective than single agents, although they are generally more toxic.
Clinical trials using various investigative approaches are under way. It is not clear if there is a role of a second debulking surgical procedure.