Treatment

When all the necessary results of examinations are available and there is a suspicion of ovarian cancer, treatment can be discussed. Examinations do not give a 100% guarantee, but only substantiate the alleged diagnosis. Confidence in the diagnosis can only be given by an operation with a histological examination.

Treatment of ovarian cancer consists of various parts of surgical treatment and chemotherapy.

Operation

During the operation, the so-called laparotomy (abdominal incision) is performed: intraoperatively, the diagnosis is first clarified, which means that during the operation a piece of tissue is taken and sent to the pathological laboratory. Pathologists histologically examine a sample of the material during the operation and report whether there really is ovarian cancer. Only with a confirmed diagnosis, i.e. when it is a proven ovarian cancer, will an operation be performed, as presented below.

The goal of the operation is to completely remove the tumor from the abdominal cavity. Both ovaries, uterus, greater omentum, parts of the peritoneum and, in certain situations, also lymph nodes located near large blood vessels are removed.

If the cancer is too widespread, it may be necessary in rare cases to remove nearby organs such as the bladder, part of the intestine, and the vagina (major pelvic surgery). An operation of this kind is crucial: With this operation, it is sometimes necessary to create artificial excretory tracts: for example, a colostomy to expel feces and/or a urostomy to expel urine. The vagina can be formed by grafting skin or musculocutaneous tissue from other parts of the body. The clitoris and labia are not affected during the operation.

Due to irritation or damage to the nerves during the operation, there may be a violation of the emptying of the bladder or intestines. This is rare and improvement is most often spontaneous, but the process can take weeks or months. In cases where it is necessary to remove part of the intestine, sometimes there is a need for a temporary (for several months) or permanent imposition of an artificial exit of the intestine to the outside (anus preternaturalis or colostomy). As a rule, the intestines can be restored later by surgery. Other consequences of the operation may be adhesions in the surgical area, which may cause discomfort or pain. In young women who are not yet in menopause, menopause occurs after removal of the ovaries. The result can be typical menopausal disorders. They manifest as hot flashes, sleep disturbances, and mood swings. These symptoms can be relieved by taking medication. In some cases, with small tumors and in the early stages, it is possible to perform organ-preserving operations with the possibility of pregnancy in the future.

Chemotherapy

After the operation is performed and the final histological results are available, the planned chemotherapy is discussed with the patient.

Most ovarian cancers require chemotherapy. It is aimed at destroying possibly still remaining cancer cells throughout the body with the help of medicines that suppress cell growth (cytostatics). Cytostatics work very well against rapidly growing cells. Rapid growth is a feature that is especially characteristic of cancer cells. Which chemotherapy will be considered depends on the general condition of the patient and on possible comorbidities. Standard therapy consists of combination therapy with two drugs (carboplatin and paclitaxel) given 6 times every 3 weeks.

Side effects are mostly eliminated by medication and, as a rule, disappear when the administration of cytostatics is stopped; for example, immediately after the end of chemotherapy, hair growth resumes.

Antibody treatment

Modern research shows that the addition of an active substance to the above chemotherapy bevacizumab prolong the period before the recurrence of the disease. Bevacizumab is "targeted therapy". Cancer cells need new blood vessels to grow (angiogenesis). Bevacizumab prevents the formation of these vessels. This so-called anti-angiogenesis reduces the blood supply to the tumor, which in turn affects the ability of the tumor to grow and spread. In advanced cases of ovarian cancer, antibody therapy with the drug bevacizumab paid by health insurance.

relapse

Relapses can occur with ovarian cancer and after complete surgical removal of the tumor and chemotherapy. Depending on when and in what form the recurrence occurs, a second operation and/or chemotherapy may be required. In such an advanced and recurrent disease, the primary goal is to limit the tumor, alleviate the patient's condition, and prolong life expectancy. Complete recovery after a relapse is possible only in rare cases.