Epithelial ovarian cancer is the umbrella term for a number of subtypes of ovarian cancer (what the cancer cells look like under the microscope), including high grade serous, endometrioid, clear cell, low-grade serous and borderline serous ovarian cancer. The subtype (also known as pathology) of ovarian cancer can be important in determining the type of treatment you may receive (chemotherapy/hormonal/radiation) and can also help determine if any genetic testing may be appropriate for you and your family.

Women who may have personal and/or family histories of high-grade serous ovarian/fallopian tube/peritoneal cancer, premenopausal breast cancer, pancreatic cancer, early onset prostate cancer and/or male breast cancer are risk factors. Individuals from certain ethnic groups (i.e. Ashkenazi Jewish) can mean you are at increased risk for developing the high-grade serous type of ovarian cancer.

On the other hand, personal and/or family histories of clear cell/endometrioid ovarian cancer, colon and endometrial cancer are risk factors.

Ovarian cancer of the mucinous, germ cell or stromal cell subtypes, do not appear to be linked to known inherited cancer syndromes.

Chemotherapy
Neo-adjuvant Chemotherapy

Occasionally, cancers will be advanced at initial diagnosis and your gynecologic oncologist may feel that surgery is unlikely to be as effective as desired, or that immediate surgery will be too difficult for you to tolerate. In this situation, chemotherapy treatments can be given to shrink the tumor. Once there has been shrinkage and your physical condition is improving, surgery is performed usually followed by more chemotherapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for ovarian cancer is usually given intravenously (injected into a vein). You may be treated in the doctor’s office or the outpatient part of a hospital.

The drugs travel through the bloodstream to reach all parts of the body. This is why chemotherapy can be effective in treating ovarian cancer that has spread beyond the ovaries. However, the same drugs that kill cancer cells may also damage healthy cells. Chemotherapy is usually given in cycles. Periods of chemotherapy treatment are alternated with rest periods when no chemotherapy is given. Most women with ovarian cancer receive chemotherapy for about 6 months following their surgery.

There is another way to deliver chemotherapy, called intra-peritoneal (IP) chemotherapy. With IP chemotherapy, the medications are injected directly into the abdominal cavity in hopes of delivering a large dose directly to the tumor location. Intra-peritoneal chemotherapy is recommended for women with Stage III ovarian cancer in whom all of the tumor spots bigger than 1 centimeter were removed with surgery. Recent studies have shown that while IP chemotherapy has more short-term toxicity, it is associated with a longer survival rate. It is important for you to talk with your team about the pros and cons of this approach.

Side Effects of Chemotherapy

Each person responds to chemotherapy differently. Some people may have very few side effects while others experience several. Most side effects are temporary. They include:

Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy x-rays, or other types of radiation, to kill cancer cells or stop them from growing. Radiation therapy is not usually part of the first treatment plan for women with ovarian cancer, but may be used if the tumor returns.

Side Effects of Radiation

The side effects of radiation therapy depend on the dose used and the part of the body being treated. Common side effects include:

Most of these side effects are temporary. Be sure to talk with your treatment team members about any side effects you experience. They can help you find ways to manage them.

Hormone Therapy
A few types of ovarian cancer need hormones to grow. In these cases, hormone therapy may be a treatment option. Hormone therapy removes female hormones or blocks their action as a way of preventing ovarian cancer cells from getting or using the hormones they may need to grow. Hormone therapy is usually taken as a pill, but can be given as a shot.

Side Effects of Hormone Therapy

The side effects depend on the type of hormones being used. Some women retain fluid and have a change in appetite, or have hot flashes.

Targeted Therapies
There are many new treatments that are targeting specific mechanisms of tumor growth. For example, there are drugs that can block new blood vessel formation or target specific tumor enzymes to inhibit tumor growth. Many of these new agents are being investigated in clinical trials. Because these drugs block pathways that are more active in tumor cells, they are not as damaging to normal cells. For patients this often means fewer serious side effects. Sometimes these targeted therapies are combined with chemotherapy to try to make the chemotherapy more effective.