Current Practice
Testing may include pelvic examination, transvaginal or transabdominal ultrasound, color flow Doppler imaging, and CA-125 levels. Diagnosis is confirmed by biopsy.
Treatment decisions are based on stage of disease. Phases of care may be divided as surgical care, chemotherapy-related care, and care for the woman with advanced disease. With advanced disease, supportive care may include treatment and symptom management of ascites, intestinal obstruction, nutrition problems, lower body lymphedema, and pleural effusion.
Surgery
Surgery is the mainstay of ovarian cancer treatment. Its purpose is to provide definitive diagnosis, stage disease and remove as much tumor as possible. A vertical midline incision is used to perform an abdominal hysterectomy, bilateral salpingo-oophorectomy, scraping of the under surfaces of the diaphragm, omentectomy and peritoneal cytology, multiple peritoneal biopsies, and pelvic and para-aortic lymph node sampling. Tumor debulking is extremely important for improving a patient's response to chemotherapy and relieving symptoms. Optimal debulking leaves no tumor larger than 1 cm. Second-look surgery provides prognostic information, does not improve outcomes, remains controversial and is recommended only in the context of a clinical trial.2
Radiation Therapy
Abdominal and/or pelvic radiation or intraperitoneal radiation may be used for local control.
Chemotherapy
Intravenous taxanes and cisplatin or a carboplatin-based combination is usually prescribed before or after surgery. The intraperitoneal route may be used with intravenous chemotherapy, but usually not alone. Maintenance or consolidation chemotherapy must be considered because of the high relapse rate (up to 80%). Once relapse occurs, the disease is no longer curable. Specific and detailed treatment algorithms are available for professionals and patients from the National Comprehensive Cancer Network.3