Facts on File Encyclopedia of Health and Medicine

Treatment Options and Outlook
The treatment of first choice for nearly all ovarian
cancers is surgery to remove the ovary that con-
tains the tumor. In all ovarian cancers except LMP,
surgery also includes removal of the rest of the
pelvic reproductive organs—both ovaries, both
FALLOPIAN TUBES, uterus, and CERVIX—as well as the
omentum (a layer of fatty tissue that covers the
interior of the peritoneum) and nearby LY M P H
nodes (lymphadenectomy). Because ovarian can-
cer tends to spread in layers of cells that cover the
pelvic or abdominal structures, the surgeon
removes as much of it as possible through a proce-

dure called debulking. Debulking may also involve

removing segments of the SMALL INTESTINE.

Most women also receive adjuvant therapy

(follow-up treatment) with CHEMOTHERAPY, RADIA-

TION THERAPY, or both. Treatment with a single

chemotherapy agent is often sufficient to treat

early stage 1 ovarian cancer, though many oncolo-

gists prefer combination chemotherapy or radia-

tion therapy with single-agent chemotherapy

after. Multiple cycles of combination chemother-

apy are the current standard of treatment for stage

2 through stage 4/recurrent ovarian cancer. Some

chemotherapy agents are available in oral forms

ovarian cancer 311

BASIC STAGING OF OVARIAN CANCER

Stage Meaning Treatment Options
low malignan t tumor is borderline cancerous and slow surgery to remove the involved ovary (unilateral
potential (LMP) growing OOPHORECTOMY)

stage 1 cancer remains confined to a local tumor in surgery (bilateral salpingo-oophorectomy, total
one ovary HYSTERECTOMY, omentectomy, and lymphadenectomy)
intraperitoneal CHEMOTHERAPY, RADIATION THERAPYwith
follow-up single DRUGchemotherapy, or combination
(multiple drug) chemotherapy

stage 2 cancer involves both OVARIESor has spread to surgery (bilateral salpingo-oophorectomy, total
the FALLOPIAN TUBES, UTERUS, or tissue within hysterectomy, omentectomy, and LYMPH NODEdissection)
the pelvis combination chemotherapy, four to six cycles

stage 3 cancer has spread to other organs in the surgery (bilateral salpingo-oophorectomy, total
abdomen, the peritoneum, and abdominal hysterectomy, omentectomy, and lymph node dissection)
LYMPHnodes and debulking surgery
combination chemotherapy, four to six cycles

stage 4 cancer has spread to distant organs debulking surgery
combination chemotherapy, multiple cycles
“second look” surgery to remove remaining cancerous
tissue

stage 4/recurrent cancer has returned after treatment combination chemotherapy
IMMUNOTHERAPY
clinical trial of appropriate investigational new
treatments
high-DOSEchemotherapy with autologous bone marrow
therapy (STEM CELLsupport)
palliative surgery for symptom relief