Treatment of Ovarian Cancer

Treatment options for ovarian cancer are dependent on many different factors. You and your doctor need to consider the type of ovarian cancer, the stage at diagnosis and the aggressiveness of the disease. A variety of options are available including surgery, chemotherapy, targeted therapy, and radiation therapy, some of which may be used in combination. Each patient’s disease is unique and therefore, medical management should be personalized for each patient. Below is a basic explanation of treatment options that your doctor may recommend.

Treatment of ovarian cancer by stage:

Stage I – limited to the ovary.  Ovarian cancer treatment starts with surgery (for staging and to remove the cancer). The uterus, both fallopian tubes and both ovaries are often all removed. Unilateral salpingo-oophorectomy may be performed in young women, if fertility preservation is desired, and if the cancer is very early stage.

Stage II – limited to the ovary and surrounding tissues. Ovarian cancer treatment also starts with surgery for staging (determining how widespread the cancer is), removal of the uterus, both fallopian tubes and both ovaries (hysterectomy and bilateral salpingo-oophorectomy or BSO), and cytoreduction (removing as much of the cancer as possible).  Treatment usually also includes chemotherapy.

Stage III ovarian cancer is treated similarly to stage II cancer. As much of the cancer as possible is removed, and staging performed to examine how far the cancer has spread. Surgery may include removal of the uterus, both fallopian tubes, both ovaries, omentum, and other tissues to which the cancer may have spread (such as the intestines).  Following surgery, chemotherapy is usually given (adjuvant chemotherapy). In some cases, chemotherapy is given before surgery takes place (neoadjuvant chemotherapy).

Stage IV ovarian cancer has spread to other sites in the body outside of the abdominal cavity. This stage of disease may be treated in a similar fashion to stage III disease with surgery and/or chemotherapy.

(cancer.org)

Surgical Therapy

Surgery is used to physically remove the cancer (or as much of the cancer as possible) from the body and determine how widespread the cancer is. Nearly all women with ovarian cancer will be required to have some type of surgery in their treatment process. Surgery has two main objectives:

  1. Staging: Confirms the diagnosis and establishes how far the cancer has spread.
  2. Cytoreduction: Removes as much of the cancer as possible.

Ovarian Cancer Surgery

Hysterectomy– removal of uterus

Bilateral salpingo-oophorectomy– removal of both fallopian tubes and both ovaries

Women with ovarian cancer will usually have a hysterectomy and bilateral salpingo-oophorectomy, along with staging procedures. In certain circumstances, for example in young women, who desire fertility preservation and in whom the cancer appears to be very early stage, the affected ovary and fallopian tube may be removed, in addition to sampling of other tissues to ensure no additional spread has occurred. (www.cancer.org and www.oncolink.com)

Pharmacological therapy – administered by Gynecologic Oncologist or Medical Oncologist

Chemotherapy

Chemotherapy treatment is the use of cytotoxic drugs to destroy cancer cells. Chemotherapy for ovarian cancer is often a combination of 2 or more drugs given cyclically (every 3-4 weeks). Pairing medicines together is often more effective than using a single agent. There is a large variety of chemotherapy drugs available to treat ovarian cancer and chemotherapy can be given either intravenously (IV) or intraperitoneally (IP). Occasionally the tumor will be very large and chemotherapy will be prescribed before the surgery to shrink the tumor; this is referred to as neoadjuvant therapy. Neoadjuvant therapy makes it easier to remove as much of the tumor as possible during surgery. After surgery you may be prescribed “adjuvant” chemotherapy to destroy remaining cancer cells that are still present in the body. (http://www.cancerresearchuk.org/about-cancer/type/ovarian-cancer/treatment/surgery-for-ovarian-cancer) and (www.cancer.org)

Common chemotherapy drugs:

  • Cisplatin (brand name: Platinol®)
  • Carboplatin (brand name: Paraplatin®)
  • Paclitaxel (brand name: Taxol®)
  • Docetaxel (brand name: Taxotere®)

Other Drugs include:

  • Nab-paclitaxel (brand name: Abraxane®)
  • Altretamine (brand name: Hexalen®)
  • Capecitabine (brand name: Xeloda®)
  • Cyclophosphamide (brand name: Cytoxan®)
  • Etoposide (brand names: Etopophos®, Toposar®)
  • Gemcitabine (brand name: Gemzar®)
  • Ifosfamide (brand name: Ifex®)
  • Irinotecan (brand name: Camptosar®)
  • Liposomal doxorubicin (brand name: Doxil®)
  • Melphalan (brand name: Alkeran®)
  • Pemetrexed (brand name: Alimta®)
  • Topotecan (brand name: Hycamtin®)
  • Vinorelbine (brand name: Navelbine®)

Common side effects:

  • Nausea and vomiting
  • Loss of appetite
  • Loss of hair
  • Increased chance of infection
  • Bleeding or bruising after minor cuts or injuries
  • Fatigue
  • Hand and foot rashes
  • Mouth sores
  • Low blood counts

Targeted Therapy

Targeted therapy uses a class of drugs that destroy cancer cells while minimizing damage to normal, heathy cells. This is achieved by designing drugs that affect critical functions required for tumor cells to survive. Many of these drugs target the same mutations that cause a cell to become cancerous. Mutational analysis is often required to determine if a targeted therapy is appropriate. Fewer side effects are associated with targeted therapies compared to chemotherapy.

Common targeted therapy drugs:

Bevacizumab (Avastin®)

Olaparib (Lynparza™)

 

Who Qualifies

For some cancers the majority of patients will have an appropriate target for a specific targeted therapy. For other cancers, patients must receive a tumor tissue test to determine eligibility for a targeted therapy. If a patient’s tumor tissue displays specific gene mutations that are targets for targeted therapy they would be a candidate of targeted therapy. (cancer.org) At times a blood sample may be used to determine if a patient qualifies for a targeted therapy.

Side effects

Although targeted therapy doesn’t affect the body the same way that standard chemotherapy does patients still may experience side effects. There is a large variety of targeted therapy drugs and the side effect of each varies depending on what each drug targets. Some drugs target substances that are found more prevalently on cancer cells, but are also found on healthy cells. Side effects occur when targeted therapy drugs affect healthy cells.

Some targeted therapy drugs cause more side effects than others. When drugs attack more than one target there is a greater chance of experiencing side effects. Not every person will get every side effect. Some patients get few side effects if any. Talk with your doctor about which side effects you are at risk for with your specific treatment regimen.

Common Side effects:

  • Skin problems
  • High blood pressure
  • Problems with bleeding or blood clotting
  • Problems with wound healing
  • Heart damage
  • Autoimmune reactions
  • Low blood cell counts

Other side effects may include:

  • Nausea and vomiting
  • Diarrhea or constipation
  • Mouth sores
  • Shortness of breath or trouble breathing
  • Cough
  • Feeling tired all the time
  • Headache
  • Swelling in the hands and feet
  • Damage to organs such as the thyroid gland, liver, or kidneys
  • Allergic reactions
  • Increased risks of certain infections
  • Muscle and joint pain
  • Blood cancer (rare)

(cancer.org)

Companion Diagnostics:

Companion diagnostics are medical tests that make personalized medicine possible. Designed to be paired with a specific drug, companion diagnostics help healthcare professionals determine which patients could be helped by that drug and which patients would not benefit, or could even be harmed.

“To learn which patients would benefit from a particular drug therapy or, conversely, which patients should not receive the medication, the Food and Drug Administration works with drug and device manufacturers that are developing certain tests called companion diagnostics.” (http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/InVitroDiagnostics/ucm407297.htm)

How to test

Companion diagnostics are often done by a blood sample to determine if a patient has a disease or infection. Companion diagnostic tests may also involve tumor testing. Tumor or somatic testing looks only at the cells of a tumor.

Ovarian Cancer Companion Diagnostics

  • BRACAnalysis CDx®: in vitro diagnostic device to observe the BRCA1 and BRCA2 genes. Determines eligibility for Lynparza™. Learn more.

(http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/InVitroDiagnostics/ucm301431.htm)

Radiation Therapy – delivered by a Radiation Oncologist

 

Radiation therapy is not part of the standard treatment of ovarian cancer but in some cases may be considered for treating locally recurrent disease and for symptom control. Radiation therapy (RT), or radiotherapy, is the use of ionizing radiation to eliminate cancer by damaging the DNA of the cancer cells. External beam radiation therapy is the most common form of radiotherapy. High-energy machines using rays or particles focus radiation specifically at the site of the cancer.

Common side effects of Radiation Therapy

  • Fatigue
  • Mild skin reactions
  • Upset stomach
  • Loose bowel movements

Cancer Caregiver:

A caregiver is anyone who provides physical, emotional, spiritual, financial, or logistical support to anyone suffering from a disabling or life threatening illness. Caring for a loved one with cancer is the role of caregivers but it is also important that caregivers take care of themselves. Finding a balance between helping your loved one and helping yourself is imperative for all caregivers.

Every caregiver is at a different point in their journey. Understanding the important role caregivers hold helps them be effective at embracing their new life. Caregivers may face many obstacles while adapting to their new role, but there are resources to help them along the way. Some online resources include the American Cancer Society (cancer.org), the National Cancer Institute (cancer.gov), Cancer Support Community (cancersupportcommunity.org), OncoLink (oncolink.com), and Breastcancer.org.

Some tips that may help include:

Find support from others in similar positions: Communicating with other caregivers may help you relieve stress and become a better caregiver.

Educate yourself on their specific situation: Learning about what your loved one is going through will enable you to help them in many different ways.

Embrace new life changes: It is normal to feel like things are different and that they may never be how they once were. It is important to embrace your new situation and learn to adapt to the changes in life. Learning to balance what you have control of and what is out of your control may help remove some of the stress from your life.

Take time outs: It is ok to take time for yourself. Rejuvenating yourself is imperative to becoming the best caregiver you can be.

Remain connected with community, friends, and family: Becoming a caregiver should not involve you abandoning your old life. Being around people that love and care about you can recharge you and uplift your spirit. The level of involvement you have with friends and family may vary, but keeping them close can help give you strength and a positive attitude.

Allow help from others: Accepting help from others will take strain off of you and allow others to feel a part of caring for someone in need. People around you may want to help but don’t know how. If they ask to help, learn to say yes.

Maintain yourself physically, mentally, and emotionally: Taking care of yourself allows you to be a better resource to those in need. It is easy to overlook your personal wellbeing while taking on the role of a caregiver, but allowing time to keep yourself healthy will make you a more effective helper.

Find ways to relieve stress: It is important to plan stress relieving activities into busy schedules. Learning different ways that allow your body to relax can enhance the way your mind and body function.

Understand your limits: You can’t do everything, and that is ok. It is easy to get caught up feeling like you need to take care of every single responsibility. Ask for help when you need it, take a break when it’s hard, and try not to overwork yourself.

(Cancer.org)

(10 tips for caregivers: www.cancersupportcommunity.org)

Sources: Cancer.org, radiologyinfo.org, NCCN guidelines, FDA.gov, cancer.gov, cancerresearchuk.org, oncolink.com, cancersupportcommunity.org

Platinol, Paraplatin, Taxol, Taxotere, Abraxane, Hexalen, Xeloda, Cytoxan, Etopophos, Toposar, Gemzar, Ifex, Camptosar, Doxil, Alkeran, Alimta, Hycamtin, Navelbine, Avastin, Lynparza, and BRACAnalysis CDx are either trademarks or registered trademarks of their respective owners.

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