Depending on the stage of diagnosis, and the general health condition of the patient;  treatment of ovarian cancer varies.

During the early stages of the tumor as well as when the patient is fit; the initial treatment of choice is surgery. Surgery benefits in the removal of visible conditions. It also confirms the diagnosis and disease extent. After cytoreductive surgery; adjuvant chemotherapy is usually done.

In order to decrease or downsize the tumor for patients whose disease is not operable upfront; doctors recommend neoadjuvant chemotherapy (before surgery). After neoadjuvant chemotherapy; surgery is performed which is followed by cycles of chemotherapy.

Doctors recommend chemotherapy to patients who are healthy enough for surgery. Also, doctors may operate at a later stage or may opt for chemotherapy alone.

Treatment of stage 1 and 2 ovarian cancer

The primary mode for the treatment of stage I ovarian cancer is surgery. Stage 1 usually involves incidentally detected. The surgeon removes the tumor along with the uterus, ovaries, fallopian tubes, and the omentum with multiple peritoneal biopsies is done using Staging laparotomy. Post-surgery treatments depend on the substrate and stage of cancer.

Stage

Treatment

Stage 1a and 1b

Treatment depends on how cancer cells look under a microscope in a biopsy.

Grade 1(low-grade tumors/ borderline)

  • Fertility-preserving hysterectomy is best for women diagnosed with stage 1 cancer and have not yet had children.

  • It involves removal of one ovary and the fallopian tubes and preservation of the healthy ovary.

Grade 2 (high-grade tumors )

  • Patients closely examined with CA 125 after the surgery.

  • 3 to 6 cycles of chemotherapy done after this.

Grade 3 (high-grade tumors )

  • Treatment usually given is chemotherapy.

  • 3 to 6 cycles of chemotherapy done after this.


Stage 1c

  • Removal of cancer is the standard option of treatment.

  • 3 to 6 cycles of chemotherapy done after this.



Treatment of stage 3 ovarian cancer

Treatment for stage 3 cancer involves surgery with the procedures of staging and debulking. The stage of cancer is identified and debunked that provides for the removal of the uterus, fallopian tubes, ovaries and the omentum. It removes most of the tumor. The organs that are also affected apart from the above organs such as the liver or intestine are also removed. The goal of this mode of treatment is to leave no visible tumor or tumor bigger than 1cm as the smaller the remaining tumor behind in the patient's body.

Interval Cytoreduction

During this treatment; chemotherapy is done before the surgery.

Upfront surgery (Staging laparotomy and debulking)

Spread of cancer is minimal and the patient is in good condition.

Adjuvant therapy

Chemotherapy starts when the patient is given time to recover post-surgery that goes about a year done through intravenous therapy. Another option is Intra-abdominal (HIPEC or EPIC) if surgery removes the whole tumor. The treatment might not work if there are traces of cells still remaining in the patient's body.

A series of blood tests are performed after surgery and chemo.  Doctors may also recommend a PET scan, a CT scan, or an MRI.

Treatment of stage 4 ovarian cancer

The treatment for stage 4 cancer is similar to the one given during stage 3 ovarian cancer. But the treatment for stage 4 ovarian cancer is hard as it has already spread to distant sites and organs like the liver, bones, or lungs. Thus the goal of the treatment is to help the patient feel better and live longer as curing cancer at this stage is difficult.

Surgery

Surgery involves removal of the tumor before chemotherapy.

Adjuvant therapy

Time for recovery is given to the patient post which chemotherapy is carried out for about a year.

Interval Cytoreduction

This treatment option is for women who are not healthy enough for surgery. First chemotherapy is advised to such patients. If the tumor shrinks in size after the primary three cycles, the operation is done, and then another three cycles of chemo are done.

Palliative care

The goal of this therapy is to improve the patient’s comfort by offering help from various symptoms of ovarian cancer and not fighting against cancer. Local anesthesia is given to the patient to numb the region and then the abdominal fluid is drawn from the body through a needle. Such treatments cause relief to the women and may even help some live longer.

Ovarian Cancer Surgery

Surgery for ovarian cancer has three main categories:

Staging Laparotomy

The goal of this treatment is to determine the spread of cancer and to obtain accurate surgical staging and diagnosis.

In this process; a vertical incision is done in the abdomen which is large enough to allow the surgeon to look at the site of cancer. It is also followed by the removal of the uterus (a hysterectomy). Bilateral salpingo-oophorectomy or BSO involves the removal of the uterus along with ovaries and fallopian tubes. The removal of the omentum is done in omentectomy.

If there is fluid in the pelvic or abdominal cavity; it is first extracted; sent to check for cancer cells and the area is then washed with saline water.

Interval Cytoreduction

It is done in women who respond well to chemotherapy. It includes laparotomy and laparoscopy.

Debulking

Involves removal of cancer cells from the body as soon as possible. This surgical method is adopted when cancer has spread throughout the abdomen at the time of the surgery. The goal of this treatment is to leave behind no traces of cancer cells in the patient’s body.

Cytoreductive Surgery (CRS) with HIPEC

It is performed in very advanced recurrent ovary cases with the help of a machine.  First, the maximum removal of disease is done followed by the installation of hot water along with chemotherapy drugs inside the abdominal cavity (HIPEC).

Liposomal Doxorubicin (Trade name: Doxil) Drug For Ovarian Cancer Treatment

An anti-cancer drug used in the treatment of chemotherapy is Liposomal doxorubicin which is encapsulated in a closed lipid sphere known as the liposome. It is classified as an anthracycline antibiotic and used to treat breast cancer, ovarian cancer, and other solid tumors.

Availability, Dosage, and Administration of Liposomal Doxorubicin

Liposomal doxorubicin is injected through injection by using the intravenous method. It is known to be an irritant as it causes inflammation in the vein.

Availability

Liposomal doxorubicin injection is available in single-use vial of 20 mg/10 ml and 50 mg/25 ml

Dosage

50 mg/m2 IV every 4 weeks

Side Effects

Side effects are not shown in many people. Even when they occur; they are predictable in terms of their onset and duration. They are almost always reversible and will go after the treatment is complete. Depending upon the dosage of the drug that has been given; side effects vary. The most common side effects are:

  • Infusion-related reactions( shortness of breath, flushing, headache, face swelling, tightness in the chest and throat and low blood pressure.)
  • Low blood count
  • Mouth sores
  • Hand and foot syndrome
  • Nausea and vomiting
  • Hair loss
  • Constipation
  • Diarrhea
  • Poor appetite
  • Discoloration of urine
  • Darkening of nail beds

Precautions

  • Inform your doctor about other medications that you might be taking before starting treatment with Liposomal Doxorubicin.
  • Without informing your doctor; do not take any kind of vaccination or immunization
  • Inform your doctor before starting the liposomal Doxorubicin treatment if you are pregnant
  • If you are pregnant; inform your doctor before starting the liposomal Doxorubicin treatment
  • While on liposomal Doxorubicin treatment; do not conceive a child. This applies to both men and women.
  • Avoid sun exposure while on treatment
  • Patients with an allergic reaction to the drug in the past; cannot receive it again.