"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).
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.
In one study published in the New England Journal of Medicine, IP plus IV chemotherapy enabled women to live 16 months longer than IV chemotherapy alone. "That's huge," says Matulonis. "That trial has the longest survival that's ever been published in advanced ovarian cancer."
The main drawback to IP chemotherapy is that it also adds an increased risk of side effects (including pain and infection in the catheter). Sometimes these side effects can be severe enough to cause women to stop the treatment and switch to IV chemotherapy alone.
Although the ovarian cancer chemotherapy options are limited, new drugs are being investigated in combination with chemotherapy. One of the most promising drugs is Avastin, an antiangiogenesis inhibitor. Avastin works by stopping new blood vessel growth, essentially cutting off the nutrient supply to the tumor.
Questions to Ask Your Doctor
Remember that you are also an important participant in your own ovarian cancer treatment. Before your chemotherapy begins, make sure you understand all of your options and the possible outcomes.
You can understand more about your chemotherapy treatment by asking your doctor the following questions:
- Which type of chemotherapy treatment will give me the best results?
- Should I get IV or IP chemotherapy? (It's important for your doctor to determine this before your surgery, so that he or she can place the port during the procedure if you're going to have IP chemotherapy.)
- What kind of chemotherapy drugs will be used? (Although the chemotherapy options are fairly standard for ovarian cancer, there may be some choice involved.)
- When will my treatment start?
- How many cycles will I have?
- How much will my treatment cost?
- Will my insurance cover the cost of treatment?
- What risks or side effects can I expect from my treatment?
- What can I do to prevent or reduce those side effects?
- When should I contact you about side effects that I may experience?
- Am I eligible to participate in a clinical trial of new drug regimens?
When you meet with your doctor, be sure to discuss any other health problems you're experiencing. Chemotherapy drugs can sometimes worsen nausea, hearing problems, nerve damage, or other conditions you already have.
What Can I Expect After Chemotherapy Treatment?
Surgery plus chemotherapy drugs can get rid of ovarian cancer, but often they can't keep it away forever. "They're usually effective in treating the cancer so it will go away for a while, but in most cases the cancer ends up coming back," says Schmeler. Often, the cancer will return within one to two years after treatment is finished. If your cancer does return, you'll likely be treated with another round of chemotherapy.