Ovarian Cancer Treatment

There are four stages of cancer of the ovaries, fallopian tubes, and peritoneum, ranging from early to advanced cancer.

STAGE I :

Stage I ovarian cancer is considered an early cancer. This stage is divided into three substages, A, B, and C:

• Stage IA : Cancer cells are present in one ovary or fallopian tube.
• Stage IB : Cancer cells are present in both ovaries, or in both fallopian tubes.
• Stage IC : Cancer cells are present in one or both ovaries or fallopian tubes, and one of the following:
  • The outside of the ovaries or fallopian tubes has cancer cells.
  • The covering of the ovary, called the capsule, has broken open; or
  • Cancer cells are found in your peritoneal cavity, its tissue lining, or fluid from your abdomen.

STAGE II :

Stage II cancer has begun to spread. This stage is divided into two substages, A and B:

• Stage IIA: Cancer has spread from the ovary or ovaries to the fallopian tubes and/or the uterus, or it has spread from the fallopian tubes to the ovaries and/or uterus.
• Stage IIB: Cancer has spread in the peritoneal cavity to your bladder, colon, or rectum.

STAGE III :

Stage III cancer is more advanced. This stage is divided into three substages, A, B, and C:

• Stage IIIA is defined in one of two ways:
  
  • Cancer cells have spread to the closest lymph nodes, called the retroperitoneal lymph nodes.
  • The surgeon cannot see the cancer with the naked eye, but using a microscope to examine the samples, the pathologist can see that the cancerous cells have spread to the outside the pelvis to the peritoneum (lining). The cancer may also have spread to nearby lymph nodes.
• Stage IIIB: Cancer has spread in the peritoneal cavity to your bladder, colon, or rectum.
• Stage IIIC: The cancer has grown to 2 centimeters in diameter or larger and has spread to the peritoneum outside the pelvis. It may also have spread the outside of the liver and/or the spleen, as well as nearby lymph nodes.

STAGE IV :

Stage IV cancer is the most advanced form of ovarian cancer. There are two substages, A and B:

• Stage IVA: Cancer cells are found in extra fluid that has built up around the lungs.
• Stage IVB: Cancer has spread to organs and tissues outside the abdomen, including lymph nodes in the groin.

Surgery is the main treatment for ovarian, fallopian tube, and peritoneal cancer. It's used for women with early and advanced disease, as well for women whose cancer has come back after treatment.

The type of surgery you receive depends on several factors, including the type and stage of your cancer, your general health, and whether you plan on having children in the future.

Types of Surgery:

A) Laparotomy and Laparoscopy:

If you have early-stage ovarian cancer, meaning that the tumour is confined to the ovary and hasn't spread, one option to remove the tumour is a traditional open surgery, called a laparotomy. A laparotomy involves making a relatively large incision in the abdomen.

In many cases, we recommend a minimally invasive laparoscopy procedure that's done through smaller incisions. To perform laparoscopy, we insert a small video camera into the abdominal area through an endoscope (a device with a light at the end), and the surgical team guides the camera within the body.

For early-stage tumours, you might have a laparoscopy done to:

• Remove one of the fallopian tubes and ovaries along with the omentum, a thin fold of abdominal tissue that encases the stomach, large intestine and other abdominal organs. (This procedure is called an Omentectomy) Lymph nodes may also be removed.
• Explore the abdomen for additional cancer and evaluate the extent of the disease.
• Drain any fluid build-up in the abdominal area.
• Retrieve small samples of abnormal tissue to perform a biopsy.
• Determine if you might benefit from debulking (removal of as much of the tumour as possible) and chemotherapy.

B) Debulking (Cytoreduction) for Stage IV Ovarian Cancer:

If your cancer has spread beyond the pelvis, and depending on how much the cancer has spread, your surgeon may need to take out parts of the omentum, the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen), and segments of the bowel, the spleen, and parts of the liver.

In many cases, we recommend a minimally invasive laparoscopy procedure that's done through smaller incisions. To perform laparoscopy, we insert a small video camera into the abdominal area through an endoscope (a device with a light at the end), and the surgical team guides the camera within the body.

If your cancer comes back (recurs), you may benefit from a second debulking operation, depending on how long the disease has been in remission and in what locations the cancer has returned.

C) Fertility Preserving Surgery:

For certain younger women, we may consider an approach that preserves fertility by finding ways to keep a normal ovary intact, as well as the uterus. As long as the cancer is at a very early stage it's sometimes possible to remove only the affected ovary (called unilateral oophorectomy) and fallopian tube, omentum, and lymph nodes preserving other pelvic organs necessary for fertility.

To destroy any tumour cells that might be left behind after surgery for ovarian cancer, many women receive one form or another of chemotherapy, which works by interrupting the growth of cancer cells.

There are several ways to receive chemotherapy medicines for ovarian, fallopian tube, or peritoneal cancer:

• By mouth (oral chemotherapy)
• By injection into a vein

We tailor the type of chemotherapy we recommend to each woman based on such factors as the type and stage of her cancer. We also make adjustments along the way as we assess whether the tumour is responding. Today we also have options that include targeted drugs, which are often effective in identifying and attacking cancer cells while basically sparing normal cells.

While each type of targeted therapy works differently, all attack the inner workings of cancer cells - the so-called programming that makes them different from normal, healthy cells.

Targeted therapies for ovarian cancer include:

• Poly (ADP-ribose) polymerase (PARP) inhibitors, which are enzymes that function as key regulators of cell survival and cell death. Drugs that inhibit PARP-1 help fight cancers caused by mutations in BRCA1 and BRCA2. In December 2014, the PARP inhibitor Alaparib was approved for women with BRCA mutations who have experienced a recurrence of ovarian cancer.
• Bevacizumab (Avastin), a targeted therapy that has been studied frequently in ovarian cancer, and targets the blood vessels that supply the tumour and aid in growth.