Ovarian Cancer Treatment – How Is It Treated In 2021?

Ovaries are two organs found in females. They are located in the pelvic cavity around the hips of the woman. Ovaries[1] are responsible for making female hormones and producing eggs that travel through the fallopian tubes and ultimately to the uterus. While traveling through the fallopian tube, the egg can be fertilized by sperm. If the egg is not fertilized or it does not implant along the uterine wall, it will be shed through menstrual bleeding. 

This cycle is hormonally regulated and is normally consistent for most women. Menstruation begins during puberty.

Treatment Overview

Ovarian cancer can involve the ovaries themselves, or relating tissue[2] in the fallopian tubes and the peritoneum. Ovarian cancer can result from many different types of tumors. Success in treating ovarian cancer depends upon how early the cancer is identified, with success being more likely with early detection. Therefore, recognizing the symptoms is crucial, though difficult, as symptoms can be mild. 

Symptoms[3] may include pain in the back or abdomen, change in bowel or urinary patterns, abnormal vaginal bleeding, postmenopausal vaginal bleeding, bloating, problems with eating, a feeling of fullness that comes on quickly while eating, and a feeling of pressure in the pelvis. Be cognizant of your body and your normal habits. It is important to be able to recognize menstrual irregularities and report them to your doctors. 

The National Cancer Institute says that CA-125 may be an effective diagnostic tool for ovarian cancer[4]. CA-125 is a tumor marker and is used to monitor the response to treatment. The idea is that this antigen would be elevated if cancer was present. This is a test that your doctor could order. 

According to the CDC[5], ovarian cancer is the most deadly form of cancer relating to the female reproductive system. It causes the most cancer deaths of the reproductive system in women. It is estimated that the 5-year relative survival percentage in patients diagnosed with invasive ovarian cancer is 46.9 percent[6]

The following statistics[7] are for the year 2017 in the U.S. This information is as reported by the CDC and the NCI. 

The rate of new cases of women with ovarian cancer was 10 per 100,000. Relatively speaking, this is not a common form of cancer. A total of 20,452 new cases were reported. 6.6 per 100,000 women with ovarian cancer died. This means that a total of 14,193 ovarian cancer patients died in 2017.  

Cancer therapy drugs function on the body in many different ways for each ovarian cancer patient. Most often, a treatment plan for ovarian cancer consists of a combination of surgery and chemotherapy[8]. Ultimately, the doctor would decide upon the treatment options and manage any possible side effects while in communication with the patient. Severe side effects are common with chemotherapy. 

Ovarian epithelial cancer[9] is the most common type of ovarian cancer. Fallopian tube cancer and primary peritoneal cancer are much like ovarian epithelial cancer because they affect the same type of tissue. They are treated in the same way and are even staged in the same way (as you will see). The therapy for ovarian epithelial cancer will be the focus of this article over other types of ovarian cancer (such as ovarian germ cell tumors and ovarian low malignant potential tumors). 

Targeted therapy[10] is also a common treatment a doctor may prescribe for ovarian epithelial cancer patients. This is a good method of treatment, if effective, because it does not cause the same type of damage to other tissues in the body (such as with chemotherapy and radiation therapy). Targeted therapy can consist of infusing monoclonal antibodies into the bloodstream which are designed to target specific cancer cells or other cells in the body that could help stop the cancerous cells from growing. These antibodies could also carry other substances (such as toxins or drugs) that may kill cancerous cells.

There are four stages of ovarian epithelial cancer. Stage one consists of cancer in both or one of the ovaries or fallopian tubes. Stage II consists of cancer that is found in the same areas as stage I and it has spread to other parts of the pelvic area, including the uterus. Stage II also refers to spread found in the organs of the peritoneal cavity (more specifically, stage IIB). Stage III refers to ovarian epithelial cancer that meets the aforementioned characteristics of stages I and II with spread into other abdominal areas or neighboring lymph nodes. 

Finally, Stage IV refers to cancer that has gone to other areas of the body beyond the abdomen. Treatment is defined as either being for early cancers or advanced cancers. Early cancers refer to cases in stage I. Advanced cancers refer to cancers in stages II to IV. 

Ovarian cancer treatment by stage

Surgical treatment for ovarian epithelial cancer stage I can include removal of the uterus and, possibly, the cervix. It may include bilateral removal of the ovaries and fallopian tubes. Lastly, surgery for this stage of cancer could encompass the removal of the omentum. If the woman wishes to have children, unilateral removal of the ovary and fallopian tubes may be considered. In both cases, chemotherapy may be initiated afterward. 

Stage II ovarian cancer treatment and stage III ovarian cancer treatment are seen as advanced cancers. Stage IV cancers are also seen as advanced. Categorically, these advanced cancer treatments are grouped together. Treatments include the surgeries seen in stage I cancer treatment. These surgeries are followed with some form of chemotherapy and possibly a combination of chemotherapy and targeted therapy. 

Patients with advanced cancers can be given chemotherapy alone or preceding surgery in combination with targeted therapy. Intraperitoneal chemotherapy could be given to patients postsurgically who received some form of chemotherapy prior to surgery. 

Chemotherapy

Chemotherapy for ovarian epithelial cancer is varied and dependent upon the analysis of the type of cancerous cells. Chemotherapy refers to the use of drugs to either destroy cancer cells or halt their division. Chemotherapy is commonly administered intravenously. Chemotherapy can be systemically or regionally applied, depending upon the decision of the health care team and the patient. The NCI defines intraperitoneal chemotherapy as a regional intervention in which drugs are introduced into the peritoneal cavity through a tube. 

Oral and injected chemotherapy are systemic in their effect because the agent enters the bloodstream. Regional chemotherapy consists of agents that are introduced directly into a body cavity, an organ, or the cerebrospinal fluid. Chemotherapy treatments can be combined with other forms of chemotherapy as ordered by the doctor. Side effects that can severely lower the patient’s quality of life are common with chemotherapy and must be managed by the patient and the doctor. 

Surgery

Ovarian cancer surgery to remove organs is varied, as seen in the surgical treatments listed above. Surgical options are selected at the discretion of the doctor with the approval of the patient. The aim of surgery to remove ovarian cancer is to cut out as much cancer as possible.

Medication

There are many ovarian epithelial cancer medications approved by the FDA[11] that your physician could utilize. This section will touch on some of what your doctor may order. 

Chemotherapy can be combined with targeted therapy drugs like bevacizumab. Its brand names are Zirebev, Mvasi, and Avastin. It works by possibly stopping the formation of new blood vessels that the tumor needs to develop. This may be used for recurrent cases of ovarian epithelial cancer. It is known as both a monoclonal antibody and an “antiangiogenesis agent.” The treatment plan should be formulated by the physician in tandem with the patient. 

Chemotherapy can also be coupled with a poly (ADP-ribose) polymerase inhibitor[12], which is a type of targeted therapy. These are known as PARP inhibitors. Some PARP inhibitors are olaparib, rucaparib, and niraparib. According to the NCI, PARP inhibitors may work by stopping the enzyme known as PARP. The NCI says PARP is needed to repair DNA cells that have been damaged. If PARP is inhibited, it might stop cancer cells from repairing their DNA, leading to their destruction (as cited by the NCI). 

Melphalan is another drug treatment that is FDA approved for ovarian epithelial cancer, according to the NCI. It is in a group of medications known as “alkylating agents[13].” Alkeran is a brand name for this drug. It is taken by mouth. Melphalan works[14] by stopping or reducing the growth of cancer cells. Serious side effects from melphalan include rash, hives, dysphagia, and jaundice. Get in touch with your doctor if you experience the aforementioned. Other possible side effects include appetite loss, weight loss, nausea, vomiting, and joint pain. If these side effects persist or are severe you should ask your doctor.

Natural treatment options

Ovarian cancer natural treatments appear to be preventative in focus. The NCI says that there is a link between being overweight or obese and developing ovarian cancer[15] Obesity is also linked to an increased probability of death due to ovarian cancer. Therefore, diet and exercise are important. Preventative care team professionals and the doctor may take this into account when formulating a care plan with an at-risk patient. 

The NCI also identifies breastfeeding as a potentially protective factor against the development of ovarian cancer. The NCI says that women who breastfeed for 8 to 10 months benefit from the greatest decrease in risk from ovarian cancer.

Clinical Trials

Three recent clinical trials highlighted in an NCI article[16] from 2019 shows that PARP inhibitors may be effective for advanced ovarian cancers that are newly diagnosed. PARP inhibitors may be used for recurrent ovarian cancer treatment. Clinical trial will be needed in order to form more definitive conclusions and to ensure proper comparisons to the general population. The three PARP inhibitors tested were niraparib, olaparib, and veliparib. The clinical trials for both the veliparib and olaparib had approximately 20 percent of their respective participants drop off the drug due to side effects. 

A study published in July of this year[17] found that a microRNA may be the initiating cause of deadly ovarian cancer in women. The microRNA is identified as miR-181A. This microRNA could act as a signal in the blood for early detection of ovarian cancer. Currently, ovarian cancer is not detected until it is in its more advanced stages, severely decreasing the ovarian cancer treatment success rate. 

The investigators believe that elevated levels of miR-181A suppressed levels of a critical protein. This allowed cancer cells to continue to exist because this protein is crucial in the destruction of damaged DNA. One of the defining features of ovarian tumors is their ability to exist with extensive DNA damage. More studies are needed to be able to draw definitive conclusions from these findings.

Conclusion

Consider the symptoms of ovarian cancer and note changes in your body. Enrolling in clinical trials is advised for many patients diagnosed with ovarian cancer. Talk with your doctor regarding this possibility in your treatment plan. All treatment options should be discussed with your doctors first. 

Keep in mind that ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer affect the same type of tissue. Due to this, they are treated and staged in the same way, and are often grouped together when addressing ovarian epithelial cancer. 

Radiation therapy and immunotherapy are developing treatments for ovarian cancer. Like chemotherapy, radiation therapy can cause pain for the patient and severely lower their quality of life.

Frequently Asked Questions

What is the most common type of ovarian cancer?

Ovarian epithelial cancer.

How many stages of ovarian epithelial cancer are there?

There are four stages of ovarian epithelial cancer.

Is breastfeeding a protective factor against the development of ovarian cancer?

According to the NCI, breastfeeding is linked to lower risks of ovarian cancer.

Is intraperitoneal chemotherapy a systemic or regional intervention?

Intraperitoneal chemotherapy is a regional chemotherapy.

How many ovaries do females have?

Females have two ovaries.

What are the symptoms of ovarian cancer?

Symptoms include pain in the back or abdomen, change in bowel or urinary patterns, abnormal vaginal bleeding, postmenopausal vaginal bleeding, bloating, problems with eating, a feeling of fullness that comes on quickly while eating, and a feeling of pressure in the pelvis.

What are the brand names for bevacizumab?

The brand names for bevacizumab are Zirebev, Mvasi, and Avastin.

What are some examples of drugs that are PARP inhibitors?

Olaparib, rucaparib, veliparib, and niraparib are examples of drug treatment that are PARP inhibitors.

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  1. Anon, (2021). Female Reproductive System – Reproductive Health. [online] Available at: https://www.cdc.gov/niosh/topics/repro/femalereproductivesystem.html [Accessed 7 Jan. 2021].
  2. ‌Anon, (2021). Basic Information About Ovarian Cancer. [online] Available at: https://www.cdc.gov/cancer/ovarian/basic_info/index.htm [Accessed 7 Jan. 2021].
  3. ‌Anon, (2021). What Are the Symptoms of Ovarian Cancer? [online] Available at: https://www.cdc.gov/cancer/ovarian/basic_info/symptoms.htm [Accessed 7 Jan. 2021].
  4. ‌National Cancer Institute. (2020). NCI Dictionary of Cancer Terms. [online] Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ca-125 [Accessed 7 Jan. 2021].
  5. ‌Anon, (2021). Ovarian Cancer Statistics. [online] Available at: https://www.cdc.gov/cancer/ovarian/statistics/index.htm [Accessed 7 Jan. 2021].
  6. ‌Cdc.gov. (2013). USCS Data Visualizations. [online] Available at: https://gis.cdc.gov/Cancer/USCS/DataViz.html [Accessed 7 Jan. 2021].
  7. ‌Cdc.gov. (2013). USCS Data Visualizations. [online] Available at: https://gis.cdc.gov/Cancer/USCS/DataViz.html [Accessed 7 Jan. 2021].
  8. ‌Anon, (2021). How Is Ovarian Cancer Treated? [online] Available at: https://www.cdc.gov/cancer/ovarian/basic_info/treatment.htm [Accessed 7 Jan. 2021].
  9. ‌National Cancer Institute. (2020). Ovarian, Fallopian Tube, and Primary Peritoneal Cancer—Patient Version. [online] Available at: https://www.cancer.gov/types/ovarian [Accessed 7 Jan. 2021].
  10. ‌National Cancer Institute. (2020). Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)–Patient Version. [online] Available at: https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq#_156 [Accessed 7 Jan. 2021].
  11. ‌National Cancer Institute. (2021). Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer. [online] Available at: https://www.cancer.gov/about-cancer/treatment/drugs/ovarian [Accessed 7 Jan. 2021].
  12. National Cancer Institute. (2020). NCI Dictionary of Cancer Terms. [online] Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/poly-adp-ribose-polymerase-inhibitor [Accessed 7 Jan. 2021].
  13. ‌Medlineplus.gov. (2020). Melphalan: MedlinePlus Drug Information. [online] Available at: https://medlineplus.gov/druginfo/meds/a682220.html [Accessed 7 Jan. 2021].
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  15. ‌National Cancer Institute. (2020). Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention (PDQ®)–Patient Version. [online] Available at: https://www.cancer.gov/types/ovarian/patient/ovarian-prevention-pdq#_11 [Accessed 7 Jan. 2021].
  16. ‌National Cancer Institute. (2019). PARP Inhibitors as Initial Treatment for Ovarian Cancer. [online] Available at: https://www.cancer.gov/news-events/cancer-currents-blog/2019/parp-inhibitors-ovarian-cancer-initial-treatment [Accessed 7 Jan. 2021].
  17. Knarr, M., Avelar, R.A., Sekhar, S.C., Kwiatkowski, L.J., Dziubinski, M.L., McAnulty, J., Skala, S., Avril, S., Drapkin, R. and DiFeo, A. (2020). miR-181a initiates and perpetuates oncogenic transformation through the regulation of innate immune signaling. Nature Communications, [online] 11(1). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320168/ [Accessed 7 Jan. 2021].
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