"You have ovarian cancer." These four words are among the most difficult a woman can ever hear. Yet more than 21,000 women hear them each year.
Being told that you have ovarian cancer is made even more difficult by the prognosis. With no real method to screen for ovarian cancer, by the time most women learn they have the disease, the disease is already in its advanced stages (stages III or IV).
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Incidence and Mortality
Estimated new cases and deaths from ovarian cancer in the United States in 2011:
New cases: 21,990.
Since the disease is often discovered when it is so advanced, treatment usually begins with surgery to remove as much of the cancer as possible. During the surgery, a comprehensive staging of the cancer is done, and in many cases a total abdominal hysterectomy is performed. Ovarian cancer cells aren't easy to remove, though, because they are quick to spread into the abdomen and start hiding.
"Because you have this scattering of tumor cells that emanate from the ovary and have complete access to the entire abdominal cavity, it is impossible to remove every cancer cell," explains Ursula A. Matulonis, MD, director and program leader of Medical Gynecologic Oncology at the Dana-Farber Cancer Institute and assistant professor of Medicine at Harvard Medical School. "You end up removing just a piece of it. And you have millions of cells left behind."
To eliminate the cells that remain, chemotherapy -- drugs that kill cancer cells -- is an essential second step in treatment. Occasionally, chemotherapy can also be given before surgery. This treatment, called neo-adjuvant chemotherapy, helps shrink the tumor and make it easier to remove.
Chemotherapy Treatment for Ovarian Cancer
The chemotherapy drugs used to treat ovarian cancer are fairly standard. Typically doctors combine a platinum-based drug such as carboplatin (Paraplatin) or cisplatin with a taxane such as paclitaxel (Taxol) or docetaxel (Taxotere).
Two different methods are used to administer the drugs. One method is to give them through a vein (intravenously or IV). Chemotherapy is administered in cycles of treatment days and rest. That means you'll get the drug treatment, and then you'll have a rest period. The number of treatment days varies with the drug given. Women with ovarian cancer typically get six cycles of chemotherapy.
The other option is to deliver the chemotherapy directly into the abdominal cavity using a thin tube or catheter. This process is known as intraperitoneal (IP) chemotherapy. The advantage to IP chemotherapy is that it bathes the cancer cells directly in the cancer-killing drugs.
Doctors will often place the tube for IP chemotherapy during the initial surgery to remove the cancer. The tube is attached to a port, which makes it easy to deliver the drugs into the abdomen each time treatment is given.
Often, women who receive IP chemotherapy get IV chemotherapy too, because studies have shown that the combination significantly improves survival.