How Ovarian Cancer is Treated

Surgery, Chemotherapy, Radiation, and Clinical Trials

surgery is one of the treatment options for ovarian cancer
Credit: Photo©Andrei Malov




The treatment options for ovarian cancer depend on the stage of the disease as well as other factors, and may include surgery, chemotherapy, targeted therapies, or clinical trials. Except in very early stage tumors, a combination of these therapies is usually used. Treatments may also vary if your cancer is a recurrence of an earlier cancer, or if you are pregnant.

Your Cancer Treatment Team

Your first step in choosing the best treatment options is to understand your cancer care team.

It's important to understand which provider will play the role of managing your care, and who should you call with questions.

Most often, ovarian cancer is first diagnosed, or at least suspected, by an obstetrician-gynecologist (OB/GYN) or another primary care physician. When choosing treatment options, however, it's recommended that people consult with a gynecologic oncologist before pursuing any treatments. Studies have found that when ovarian cancer surgery is performed by a gynecologic oncologist, outcomes tend to be much better than when surgeries are performed by physicians of other specialties.

Other members of your health care team may include your primary care physician, an oncology social worker or counselor, a pathologist (who looks at any tissue removed during surgery), and possibly a palliative care physician (a palliative care team cares for people with any stage of cancer and focuses on relieving the symptoms related to cancer).


For those who are young and are interested in preserving their fertility if possible (especially those with germ cell and stromal cell tumors), talking with a physician who specializes in fertility preservation should take place before treatment begins.

Treatment Options

There are two basic types of treatments for ovarian cancer:

  • Local treatments: Treatments such as surgery and radiation therapy are local treatments. They treat a cancer where it originated but do not address any cancer cells which have spread beyond the initial site of the cancer.
  • Systemic treatments: When cancer spreads beyond its original location, systemic treatments such as chemotherapy, targeted therapies, or hormonal therapy (with non-epithelial tumors) are usually needed. These treatments address cancer cells no matter where they are located in your body.

Most people with epithelial ovarian cancer will have a combination of these treatments. Occasionally, such as with germ cell and stromal cell tumors, or early stage (such as stage IA) epithelial tumors, surgery alone, without chemotherapy, may be effective.


Surgery is the mainstay of treatment for many people with ovarian cancer, but can vary both by the type of ovarian cancer and the stage.

Surgery for Germ Cell and Stomal Cell Tumors 

Germ cell and stromal cell tumors are often found in the early stages. Many people with these tumors are young, and surgery to remove only the affected ovary (an oophorectomy) can sometimes result in the preservation of the other ovary and uterus. Surgery alone may also be effective in very early epithelial tumors.

Surgery for Epithelial Ovarian Cancer

Most (around 80 percent) of epithelial ovarian cancers are found in the later stages of the disease (stage III and stage IV). The idea of having surgery for stage 4 cancer might seem foreign to those who are familiar with other types of cancer. For example, with cancers such as breast cancer and lung cancer, surgery for stage 4 disease doesn't improve life expectancy. Surgery does extend life, however, for those with stage 4 ovarian cancer, and improves the later benefit from chemotherapy.

As noted earlier but well worth repeating, outcomes of these surgeries are often better when performed by a gynecologic oncologist who is very familiar with the meticulous methods these surgeries require.

Surgery for advanced epithelial ovarian cancer is referred to as cytoreductive surgery or debulking surgery. "Cyto" is the root word for cell, and "reductive" means to reduce, so the goal of this surgery is to reduce the number of cancer cells present, rather than eliminate all cancer.

There are three possible outcomes of this surgery:

  • Complete: All visible cancer is removed.
  • Optimal: Cancer remains, but all areas are less than 1 cm in diameter (often referred to as miliary disease).
  • Sub-optimal: Nodules that are larger than 1 cm in diameter remain.

Many people would think that a complete cytoreduction in which all cancer cells are removed would be more effective, but this is not the case. Cytoreductive surgery is a long and arduous surgery, and the risks of a longer surgery often outweigh the benefits. Therefore an "optimal" cytoreduction is usually the goal of surgery.

The Procedure (Cytoreduction Surgery)

In addition to removing both ovaries and fallopian tubes (a bilateral salpingo-oophorectomy) and uterus (hysterectomy), additional tissue is often removed or biopsied as well.

The omentum, or layer of fatty tissue which overlies the ovaries and pelvis is frequently removed (omentectomy). "Washings" are also done. This is a procedure in which saline is injected into the abdomen and pelvis and then withdrawn in order to look for the presence of cancer cells that are "loose" in the abdomen and pelvis.

Lymph nodes in the abdomen and pelvis are often biopsied or removed (lymph node dissection). In addition, samples may be taken from the surface of many pelvic and abdominal organs, such as the bladder, intestines, liver, spleen, stomach, gallbladder, or pancreas. With serous epithelial tumors, the appendix is usually removed.

When samples are taken from the intestines, the two ends on either side of the region removed are reattached when possible. If not, the end of the intestine before the surgical site is sewn to the skin so that the bowel can be drained to the outside (creation of a stoma). 

All of this surgery may be done right away, or instead, after chemotherapy is given or after a recurrence of the cancer.

Side Effects

The most common side effects of surgery are bleeding, infections, and reactions to anesthesia. Since cytoreduction surgery tends to be a lengthy operation, it's recommended that those at risk have a thorough heart and lung evaluation prior to surgery.


With ovarian cancer, it's almost impossible to remove all of the cancer, and even when surgery removes all visible cancer cells (such as with earlier stages), the recurrence rate is very high at around 80 percent. This means that even if visible cancer is not seen, microscopic areas of cancer are left behind. Therefore, chemotherapy is usually given for all but the very earliest stages of epithelial ovarian cancer. Chemotherapy is often used for higher stages of germ cell tumors as well.

Drugs Used

For the initial diagnosis of ovarian cancer (either after or sometimes before chemotherapy) the drugs commonly used include a combination of:

  • Platinum drugs: Paraplatin (carboplatin) or Platinol (cisplatin).
  • Taxanes: Taxol (paclitaxel) or Taxotere (docetaxel).

There are many other drugs which may be used as well, including drugs such as Doxil (liposomal doxorubicin), Gemzar (gemcitabine), and many more. 

With germ cell tumors, chemotherapy often includes a combination of Platinol (cisplatin), VP-16 (etoposide), and bleomycin.

Methods of Administration

Chemotherapy may be given either in one of two ways:

  • Intravenously (IV): IV chemotherapy is usually given every 3 weeks to 4 weeks and is repeated for 3 to 6 cycles. This can be given through a catheter placed in your arm (such as with an IV for fluids in the hospital) or through a chemotherapy port or PICC line.
  • Intraperitoneal chemotherapy: In this procedure, chemotherapy is given through a needle inserted directly into the abdominal cavity.

Researchers now believe that intraperitoneal chemotherapy is vastly underused for ovarian cancer. According to a 2018 study published in The New England Journal of Medicine, hyperthermic intraperitoneal chemotherapy increased survival when used along with interval cytoreductive surgery. In a 2016 review of studies, researchers found that intraperitoneal chemotherapy increases survival with ovarian cancer more than IV chemotherapy. In this study, it was noted that intraperitoneal chemotherapy caused more digestive tract side effects, fever, pain, and infection, but was less likely that IV chemotherapy to cause hearing loss (ototoxicity). 

Intraperitoneal chemotherapy is not tolerated as well as IV chemotherapy and cannot be used if there is kidney dysfunction or a lot of scar tissue in the abdomen, so is usually reserved for women with stage IV disease and those who had a sub-optimal cytoreduction. 

Side Effects

Chemotherapy drugs interfere with cell division at different points in the cycle, and are effective in killing off rapidly growing cells such as cancer cells. Unfortunately, there are normal cells in the body which divide rapidly as well, and this gives rise to the commonly known side effects of chemotherapy such as hair loss (hair follicles divide rapidly), nausea (cells in the digestive tract divide rapidly), and bone marrow (the cells which become white blood cells, red blood cells, and platelets divide rapidly). The most common side effects of chemotherapy drugs used for ovarian cancer include:

  • Nausea and vomiting: The treatment of chemotherapy-induced nausea and vomiting has improved dramatically in recent years, and preventive medications now often allow people to go through chemotherapy with little or no vomiting.
  • Bone marrow suppression, leading to a low level of white blood cells, red blood cells, and platelets. It is the low level of a type of white blood cell called neutrophils, that predisposes people to infections during chemotherapy.
  • Fatigue
  • Hair loss

There are also some long-term side effects of chemotherapy, with the drugs given for ovarian cancer often causing peripheral neuropathy (tingling, pain, and numbness in the hands and feet), and hearing loss (ototoxicity). There is also a small risk of developing secondary cancers down the line.

The side effects and complication of chemotherapy, however, are usually far outweighed by the survival benefits of these treatments.

Targeted Therapies

Targeted therapies are treatments that interfere with specific steps in the growth of a cancer. Since they are directed specifically at cancer cells they sometimes (but not always) have fewer side effects than seen with chemotherapy. Therapies that may be used with ovarian cancer include:

Angiogenesis inhibitors: Cancers need to create new blood vessels in order to grow and spread. Angiogenesis inhibitors inhibit this process, essentially starving the tumor of a new blood supply. Avastin (bevacizumab) can sometimes slow the growth of ovarian cancer but can have serious side effects such as bleeding, blood clots, and a perforated bowel.

PARP Inhibitors: The first PARP inhibitor was approved for ovarian cancer in 2015. Unlike chemotherapy these medications may be given in pill form rather than IV. PARP inhibitors work by blocking a metabolic pathway that causes cells with a BRCA gene mutation to die. Drugs available include:

  • Lynparza (olaparib)
  • Rubraca (rucapraib)
  • Zejula (niraparib)

These medications are most often used for women who have BRCA mutations, but both Lynparza and Zejula can be used for women without BRCA mutations to treat ovarian cancer recurrences after chemotherapy. Side effects may include joint and muscle pain, nausea, and anemia among others, but tend to be tolerated better than chemotherapy. There is also a small risk (as with chemotherapy) of secondary cancers such as leukemia.

Other Treatments

Other types of treatment may be used with different types of ovarian cancer or for widespread disease. Hormonal therapy drugs are more commonly used for breast cancer. But drugs such as ovarian suppression drugs, tamoxifen, and aromatase inhibitors may be used for stromal cell tumors, and uncommonly, epithelial cell tumors. Radiation therapy isn't commonly used for ovarian cancer, but may be utilized when there are extensive metastases in the abdomen.

Clinical Trials

There are many clinical trials in progress looking at combinations of the above therapies, as well as newer treatments, both for the initial diagnosis of ovarian cancer, and for recurrences. The National Cancer Institute recommends talking to your doctor about clinical trials that may be appropriate for you. You can also research these trials on your own, or request help through one of the free clinical trial matching services.

Treatments are improving rapidly, and sometimes the only way to use a newer treatment option is by taking part in one of these medical research studies. Yet we know that less than 5 percent of people who are eligible for these new treatments participate. There are many myths about clinical trials, but the truth is, that every treatment we now have for cancer was once first studied in a clinical trial.

Alternative Medicine 

Complementary and alternative medicine (CAM), also called integrative medicine, includes a wide variety of supplements and practices, from acupuncture to herbs. Thus far we don't have any studies that show a benefit of these therapies for "treating" ovarian cancer, and they could actually be detrimental if a person were to forego conventional methods of treating the disease.

That said, some of these integrative therapies can help with the symptoms of cancer and cancer treatments, improving quality of life during treatment. For this reason, many cancer centers now offer various alternative therapies for cancer. Studies which have shown some benefit in at least a few research studies include acupuncture, meditationyoga, music therapy, and even pet therapy

Many people ask about using antioxidants during cancer treatment, and it is extremely important to talk to your oncologist about any dietary supplements you wish to take before you take them. Some vitamin and mineral supplements may interfere with cancer treatment. This makes sense if you think about how treatments such as chemotherapy and radiation therapy work. These treatments work by causing oxidative damage to the genetic material in cancer cells. In theory, taking antioxidant preparations could "protect" your cancer cells. That said, most oncologists believe that eating a healthy diet rich in foods high in antioxidants is not a problem during treatment.

All vitamins or dietary supplements are metabolized by either the liver or kidneys and could theoretically slow down or speed up the metabolism of chemotherapy drugs. Special caution is in order with some supplements such as vitamin E and Ginko buloba as they can increase bleeding during and after surgery. Some supplements may also increase the risk of abnormal heart rhythms or seizures related to anesthesia.

There is some interest in turmeric, or curcumin, a common ingredient in curry and mustards that give these foods their yellow color. In Japan, people consume a lot of Ukon tea which is high in turmeric and the incidence of ovarian cancer is very low. Looking at this from another direction (since there are many other factors that could cause a lower incidence in Japan other than turmeric), studies done in the lab have found that turmeric stimulated programmed cell death (apoptosis) in ovarian cancer cells but not normal cells. In another study, it was found that ovarian cancer cells grown in a dish were less likely to become resistant to chemotherapy if "fed" turmeric.

It's not known whether these lab studies would translate to studies in humans, but if you are someone who enjoys curry, you may wish to enjoy a curry dinner once in awhile. Researchers have made it clear that this research is in the early stages and it is far too early to recommend turmeric or curcumin to people with ovarian cancer.

Another nutrient that people with advanced cancer may wish to discuss with their oncologist is omega-3-fatty acids. 

Cancer cachexia is a condition that includes weight loss, loss of muscle mass, and loss of appetite. Found in around 80 percent of people with advanced cancer, cachexia is thought to be the direct cause of death in 20 percent of people with stage 4 cancer. A frustrating condition to treat with few options that work, studies suggest that omega-3-fatty acids may help in retaining muscle mass. Like other supplements, however, it's important to have a careful discussion with your oncologist about any supplement you are considering taking.

Treatment for Recurrence

Unfortunately, around 80 percent of ovarian cancers which are treated with the therapies above will recur. The treatment approach for a recurrence depends on the timing of the recurrence after the original treatment, and is broken down into three categories:

  • Recurrence immediately after treatment: When ovarian cancer returns right after treatment it is considered "platinum refractory" or resistant to platinum chemotherapy. Options include repeating chemotherapy with same drugs (although this usually results in a poor response), using a different chemotherapy regimen (there are several different options), or considering a clinical trial. 
  • Recurrence within 6 months of treatment: When ovarian cancer doesn't recur immediately but does so within 6 months it is considered platinum resistant. Options at this point might be a different chemotherapy drug or regimen or a clinical trial. Surgery is not usually recommended.
  • Recurrence 6 months or more after treatment has been completed: If the original chemotherapy included the use of a platinum chemotherapy drug (Platinol or Paraplatin) the tumor is considered "platinum sensitive." Treatments recommendations vary but may include cytoreduction surgery plus treatment with the original chemotherapy drugs.

Treatment in Pregnancy

Most ovarian cancers that occur during pregnancy are germ cell tumors or stromal cells tumors. These tumors often involve only one ovary, and surgery to remove the ovary is possible during pregnancy, though waiting until second trimester is preferred.

For those with epithelial ovarian cancers and more advanced stage stromal cell or germ cell tumors, cytoreduction surgery is possible. It's ideal to wait until after first trimester, but may be considered earlier. Chemotherapy, though it may surprise many, is relatively safe after the first trimester, and can usually be started at around 16 weeks. For epithelial ovarian cancers, a combination of Paraplatin (carboplatin) and Taxol (paclitaxel) is usually used, with a combination of Platinol (cisplatin), Velban (vinblastine), and bleomycin used for non-epithelial tumors.

Making Decisions 

Studies have found repeatedly that outcomes are better when ovarian cancer surgery is performed by a gynecologic oncologist rather than a general surgeon or an obstetrician/gynecologist, and this is worth repeating again. The surgical procedure for all but the earliest stages of ovarian cancer is complex and meticulous. Even when seeing a gynecologic oncologist, many people find it helpful (and often reassuring) to get a second opinion. If you are considering a second opinion, you may wish to consider one of the larger National Cancer Institute-designated cancer centers which often have surgeons who specialize in one particular type of surgery.

When you learn you have ovarian cancer you are immersed in a foreign world that nobody every wanted to visit. It's helpful to learn as much as you can about your cancer and the treatment choices offered. In addition to researching your cancer, reaching out to the ovarian cancer community online can be priceless. Not only do these connections provide support, but many people who are living with ovarian cancer are up-to-date on the very latest treatments. If you are interested in connecting with others via social media, the hashtag #ovariancancer will help you find the right people. Most importantly, learn how to advocate for yourself as a cancer patient.   

Reach out to your family and friends as well. Many women are accustomed to being the "strong one" and it can be a challenge to accept help. Learn how to accept help now. Be ready for your relationships to change. Close friends may become distant (not everyone can handle metastatic cancer), and distant acquaintances may become close friends. When you choose a treatment plan, everyone will have an opinion and emotions can run hot. Remember that this is your decision and yours alone. Accept input from your loved ones, but make the choices that honor you and your needs alone. 


van Driel, W., Koole, S., Sikorska, K. et al. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. The New England Journal of Medicine. 2018. 378(3):230-240.

Fruscio, R., de Haan, J., Van Calsteren, K. et al. Best Practices and Research. Clinical Obstetrics and Gynaecology. 2017. 41:108-117.

Jaaback, K., Johnson, N., and T. Lawrie. Intraperitoneal Chemotherapy for the Initial Management of Primary Epithelial Ovarian Cancer. Cochrane Database of Systematic Reviews. 2016. (1):CD005340.

National Cancer Institute. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ)—Health Professional Version. Updated 01/19/18.