Women diagnosed with ovarian cancer have a variety of treatment options, including surgery, chemotherapy, hormone therapy, targeted therapy, immunotherapy and radiation. Most often, patients receive combinations of these treatments.
When a woman is first diagnosed with ovarian cancer, the treatment program corresponds to the cancer’s stage. More advanced cancers generally require more aggressive treatments.
In addition, Tumor Blueprints – diagnostic tests that identify the molecular characteristics of each patient’s tumor – can help clinicians prioritize treatments by consolidating information from the tumor’s molecular profile. NCCN guidelines recommend that all patients with recurrent cancer obtain tumor testing for genomic alterations in BRCA 1/2 and other genomic change scores, such as mutation burden or microsatellite status.
Here are the most common treatment options:
- Surgery is conducted to diagnose (confirm that it is cancer), stage (determine how far it has spread) and remove as much tumor as possible. This is called debulking the tumor. In most cases, surgeons remove the uterus, ovaries and fallopian tubes and take samples (or biopsies) from the surface of other tissues inside the pelvic and abdominal cavities. Unfortunately, surgery rarely gets all of the cancer, which means patients must have additional treatments.
- Chemotherapy damages tumor DNA to foster cell death or interferes with other important cellular mechanisms. Tumor cells are particularly susceptible to this damage since they divide more often than most normal cells. Unfortunately, the DNA in normal cells can also be damaged. Chemotherapy is a systemic treatment, which means it is infused through the blood and goes throughout the body. Most ovarian cancers are treated with a platinum compound to damage DNA, such as carboplatin, and a taxane to interfere with cell division, such as paclitaxel (Taxol).
- Radiation therapy (also called radiotherapy) uses high doses of radiation to kill cancer cells. Radiation is more targeted than chemotherapy, which can be an advantage or a disadvantage. Though it may do less systemic damage, it could also miss some of the cancer. It is most often used palliatively to shrink tumors when they are causing painful symptoms.
- Because hormones can stimulate growth in some ovarian cancers, there are a number of therapies designed to prevent tumors from being triggered by them. For example, tamoxifen, which is more often used to treat breast cancer, can be used to block estrogen activity in tumor cells. Other drugs, like letrozole (Femara) reduce estrogen production.
- Targeted therapies work by hitting specific biological mechanisms that help tumors survive and grow. Bevacizumab (Avastin) targets a protein called VEGF, which stimulates the production of blood vessels to help feed growing tumors. PARP inhibitors, such as olaparib (Lynparza), interfere with DNA repair mechanisms. The goal is to allow DNA damage to accumulate in tumor cells until they die.