Treatment and prognosis of ovarian cancer

Treatment and prognosis of ovarian cancer

Therapy for ovarian cancer depends on the stage of the disease and the microscopic structure (histology) of the tumour tissue. Usually, however, the first step in treatment is surgery, removing as much of the tumour mass as possible. This is often followed by chemotherapy to kill any remaining cancer cells and prevent them from coming back (recurrence).

The prognosis of ovarian cancer depends on various factors, such as the characteristics of the tumour. In general, if ovarian cancer is discovered in time, the chances of recovery are relatively good. However, the prognosis is somewhat unfavourable in the advanced stage of the disease.

Surgery: the basis of treatment for ovarian cancer

The most crucial element in the treatment of ovarian cancer is the surgical removal of as much tumour tissue as possible. In most cases, this can already be done during the diagnostic operation that has to be carried out to confirm the diagnosis of ovarian cancer.

First, a tissue sample is taken, which a pathologist examines during the operation. If this confirms the diagnosis of ovarian cancer, both ovaries, fallopian tubes and the uterus are usually removed.

In addition, lymph nodes are usually removed from the pelvis and abdomen. To clarify how far the tumour has spread (staging), tissue samples are taken from the peritoneum and all conspicuous areas.

 

The extent of surgery is dependent on the tumour stage.

How radical the operation has to be depends on the stage of the disease. For example, in the early stages of ovarian cancer, it is possible to perform fertility-preserving surgery.

The prerequisite for this is that the tumour has a low degree of degeneration (grading) and is also locally limited to one ovary (stage IA). It is then possible to preserve the healthy ovary and uterus so the patient can become pregnant later. In certain particular forms of ovarian cancer (germ cell tumours and sex cord-stromal tumours), it is more often possible to preserve fertility.

 In the case of advanced ovarian cancer, however, it may be necessary to remove parts of other organs such as the liver, spleen, pancreas or intestines in addition to the ovaries and uterus if these are affected by the cancer.

Ovarian cancer: chemotherapy often makes sense

In most cases of ovarian cancer, chemotherapy is given after surgery (adjuvant), even if the tumour has been completely removed. This is intended to destroy any remaining cancer cells and thus prevent a recurrence.

In stage IA and certain forms of ovarian cancer (e.g. so-called borderline tumours), no chemotherapy is usually necessary. In all other cases, an active ingredient combination of a so-called taxane and a platinum-containing chemotherapeutic agent, usually administered six times at intervals of three weeks, is used.

 

Repeat chemotherapy for recurrence.

Suppose there is a recurrence after treatment of ovarian cancer. In that case, the time interval to chemotherapy is relevant: If a recurrence occurs within six months after completion of platinum-based chemotherapy, this means that the tumour is not responding, or only slightly, to active substances containing platinum (platinum-resistant ). Accordingly, the recurrence is treated with another non-platinum chemotherapeutic agent.

If, on the other hand, the ovarian cancer recurs later than after six months, it has initially responded to the first chemotherapy. It can again be treated with a platinum-containing drug combination (platinum-sensitive). Whether another operation makes sense in the event of a recurrence must be decided on a case-by-case basis for each patient.

Antibody therapy in exceptional cases

In the advanced stage and the event of recurrences, the active substance bevacizumab (Avastin ®) can be used in addition to chemotherapy. This antibody is directed against a growth factor in the blood vessels and thus inhibits the formation of new blood vessels.

Since the tumour needs nutrients and oxygen from the blood to grow and depends on forming new blood vessels, bevacizumab can inhibit tumour growth and prevent spread (metastases).

Palliative therapy for a better quality of life

If the ovarian cancer is already so advanced that there is no chance of recovery, the doctors will start a so-called palliative therapy. This means that the goal of therapy is not healing but extending life expectancy and the best possible quality of life.

In the case of ovarian cancer, this is usually the case when the tumour has spread outside the abdomen or comes back despite surgery and multiple chemotherapy. However, there are no universal guidelines for end-stage therapy. Instead, it must be decided individually which treatment will benefit the ovarian cancer patient the most.

 

Irradiation of metastases in ovarian cancer

Radiation therapy does not play a significant role in the treatment of curable ovarian cancer since the tumours themselves usually do not respond to it. In the final stage, however, irradiation of metastases – for example, in the bones – can lead to significant pain relief and, thus, to a better quality of life.

In addition, the treatment of symptoms is an integral part of palliative therapy. There are a large number of medications that can usually be used to treat symptoms such as nausea, pain and shortness of breath.

Alternative treatment: efficacy questionable

So-called unconventional healing methods – for example, mistletoe therapy or other herbal therapies – are widespread in alternative medicine. However, there is no scientific evidence that alternative treatments for ovarian cancer are effective.

Therefore, alternative medical treatment should not be carried out instead of the medically recommended therapy. However, herbal preparations or homoeopathy can, under certain circumstances, help alleviate symptoms and thus be a helpful addition to conventional medical treatment.

Prognosis dependent on stage

As with most diseases, the chances of recovery from ovarian cancer are better the earlier the diagnosis is made. The following factors can influence the prognosis:

  • Tumour stage:  The size and spatial spread of the tumour, as well as the presence and location of metastases, largely determine the chances of recovery.
  • Residual tumour after the operation: The amount of tumour tissue that could be removed is given based on classification into R0 (tumour was removed entirely), R1 (microscopically visible tumour residues) and R2 (tumour residues visible to the naked eye).
  • Microscopic structure: The different sub-forms of ovarian cancer, such as ovarian carcinoma, borderline tumours or germ cell tumours, have different chances of recovery.
  • Grading: The tumour’s aggressiveness is related to the degree of degeneration.
  • Age and general condition of the patient: Severe previous illnesses can, for example, be a limitation for an operation or aggressive chemotherapy.

Since ovarian cancer is often diagnosed late compared to other cancers due to the lack of early signs, the prognosis is generally considered to be somewhat unfavourable.

 

Estimation of the chance of survival is only possible to a limited extent.

One way to express the approximate chance of survival in numbers is the so-called five-year survival rate. It indicates what percentage of patients are still alive five years after diagnosis.

If the tumour is locally limited to one or both ovaries (stage I), the five-year survival rate is 80 to 95 per cent. This means that 80 to 95 out of 100 patients are still alive five years after diagnosis. However, suppose there are metastases outside the abdomen (stage IV), or the residual tumour is visible to the naked eye after the operation (R2). In that case, the five-year survival rate is only 10 to 20 per cent.

Life expectancy varies from person to person.

However, the meaningfulness of such numbers is somewhat limited since it is not taken into account, for example, whether the ovarian cancer itself or another cause led to death. In addition, the course of the disease is individually different for each patient. A general prediction of life expectancy in ovarian cancer is, therefore, not possible using either statistics or prognostic factors.

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