Treatment

Ovarian Cancer Treatment

There are different types of treatment for patients with ovarian cancer, depending on the type of cancer, stage of the cancer, whether you are a candidate for surgery, and your childbearing status. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principle investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for epithelial ovarian cancer include surgery, radiation therapy, chemotherapy, hormonal therapy and biologic therapy. Clinical trials are testing many other approaches, some of which are becoming standard of care.

Surgery

Ovary removal (Unilateral or bilateral salpingo-oophorectomy): This surgery removes one or both ovaries and fallopian tubes.

Total hysterectomy: The surgeon removes the uterus and the cervix. It may be done through the vagina, through an abdominal incision, or laparoscopically through several small incisions. In some cases, a radical hysterectomy is indicated, which would include removal of the uterus, cervix, fallopian tubes and ovaries and nearby lymph nodes. Some patients may be recommended to receive radiation therapy or hormone therapy to kill any remaining cancer cells.

Omentectomy: In this surgery, when a peritoneal tumor is detected, surgeons remove the omentum, the tissue in the peritoneal cavity that contains blood vessels, nerves, lymph vessels and lymph nodes.

Cytoreductive surgery: In addition to removing the uterus and/or fallopian tubes and ovaries, an additional surgical procedure Siteman has pioneered and refined uses aggressive surgical techniques to achieve full visible cancer removal. The procedure, called tumor debulking, or cytoreductive surgery, has been shown to improve survival. In this approach, as much of the tumor as possible is removed, either after chemotherapy or followed by chemotherapy or radiation. Following the course of chemotherapy, the doctor my do another abdominal incision to find out if cancer cells are remaining after treatment. At that time, lymph nodes or other abdominal tissue may be biopsied to test microscopically for tumor cells.

Learn more about surgery at the Siteman Cancer Center.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be systemic or regional.

Regional intraperitoneal (IP) chemotherapy is a new technique sometimes used to treat ovarian or primary peritoneal cancer. It is underutilized because it requires a higher level of expertise and more intensive monitoring. Those patients who are eligible and can tolerate it have a significantly improved survival. In IP chemotherapy, the anticancer drugs are carried directly into the peritoneal cavity through a thin tube. More than one anticancer agent, called combination chemotherapy, may be used. Siteman is a leader in the development of IP chemotherapy, improving the safety profile of this life-prolonging therapy.

Vaccine and Immune Therapy

Vaccines are currently being tested in trials for the treatment of ovarian cancer to allow your immune system to fight the cancer without the harsh side effects of traditional chemotherapy.

Radiation Therapy

Radiation oncology has active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. No one should be over or undertreated. Siteman is a leader in using shorter radiation durations than the national average with the same outcomes.

Patients also can take part in studies with the Radiation Therapy Oncology Group, a group dedicated to radiation therapy trials, and receive new cancer therapies offered through clinical studies initiated by Siteman researchers and physicians.

MR-guided adaptive radiation therapy: Siteman cancer center is the only center in the world performing MR-guided adaptive radiation therapy. By using an MRI to guide the radiation therapy, Siteman radiation oncologists can adjust, or adapt, the radiation to the patient every day.

Stereotactic body radiation therapy uses special equipment to position a patient and deliver radiation directly to the tumors. The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps prevent damage to normal tissue. This type of radiation therapy is being studied in clinical trials.

Brachytherapy: This type of localized radiation allows a high-dose concentration of radiation immediately surrounding the radioactive source, with rapid fall-off of radiation exposer to adjacent tissues. In gynecologic cancers, the radiation source can be put inside an existing body cavity or directly into tissue. Siteman Cancer Center has the largest Brachytherapy Center in the United States and sees more than 1,200 patients for gynecologic cancer as well as thousands more for other types of cancer.

Radiation oncologists here are the only ones in the country to offer Image-Guided Adaptive Brachytherapy (IGABT) and have set the protocols and standards of care for this highly specialized and target-specific treatment that allows for adapting both the dose and parameters of radiation beams. The team also is the only one in the region specializing in combined brachytherapy and Intensity-Modulated Radiation Therapy (IMRT).

Targeted Therapy

Targeted therapy uses drugs to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy in which the antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given intravenously alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody that may be used with chemotherapy to treat ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer that has recurred.

PARP inhibitors are targeted therapy drugs that block DNA repair and may cause cancer cells to die. PARP inhibitor therapy is being studied in treating ovarian epithelial cancer that remains after chemotherapy.

Targeted treatments are enhanced by the Washington University Genomics and Pathology Service (GPS), which offers genomic testing and next generation sequencing that can identify optimal patient treatment strategies for your specific cancer type and subtype.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.