Ovarian Cancer Treatment

To better understand the surgery your doctor recommends, including details about the procedure, as well as risks and recovery, The National Cancer Institute recommends asking your doctor the following questions:

• What kind of surgery do you recommend for me? Will both ovaries need to be removed? Will lymph nodes or other tissues be removed? Why?
• How soon will I know the results of the pathology report? Who will explain them to me?
• How will I feel after surgery?
• If I have pain, how will it be controlled?
• How long will I be in the hospital?
• What are some of the possible long-term effects of the surgery?
• How might the surgery affect my sex life?
• How much will the surgery cost? Will my health insurance cover it?

Patients who have been through similar surgeries often have the most helpful advice. We asked participants in OCRA’s Woman to Woman Peer Mentor Program and Staying Connected Support Series what they wish they knew before surgery. Here are their tips:

• You may have a numb abdomen post-surgery and feel a little discomfort on the first day.
• Hospitals are busy and noisy, with lots of bedside visits, but try and rest as much as possible.
• Some people need a lot of help the first days after surgery, while others may be able to get around on their own. Consider planning for a family member or friend to stay with you in the first days after surgery.
• Ask your doctor if an abdominal binder would be helpful.
• At discharge, plan to wear larger elastic-waist pants with a button-up shirt or a waist-free dress. Placing a pillow under your seatbelt can make the ride home more comfortable.
• Stay ahead of the pain by taking your medications on time.
• Keep a log of when you take your medication, and when your next dose is scheduled. Also keep a log of any symptoms you might be experiencing.
• Light meals, like smoothies and soup, can be helpful and nourishing.
• Surgery can shut down the bowels, and it can take time for things to return to normal.
• Walk, walk, walk as much as you are able to.

Some chemotherapy is given through a vein (intravenous), some may be given directly into your abdominal cavity (intraperitoneal), and some is given by mouth (PO). Your doctor may discuss the option of having an IV catheter inserted surgically under the skin of your upper chest wall (called a Port) which can eliminate the need for multiple needlesticks to start IVs for each infusion. Ports can also be used for blood draws for laboratory tests that are needed during treatment. A chemotherapy nurse will assist in providing your treatment and can also help treat side effects during the infusion. Every patient has a different response to chemotherapy, and side effects will depend on factors like the type and length of treatment you are undergoing.

There are several chemotherapy drugs used in varying combinations that you will hear as “standard” chemotherapy for common ovarian cancers. There are also newer drugs, used alone or in combinations with standard therapy, that are being studied via clinical trial, to determine if they produce the same or better results as the current standard treatment. Ask your doctor about your treatment, and why your team is recommending a specific treatment for you.

Platinum-Based Drugs (Cisplatin, Carboplatin)
Platinum-based drugs, such as cisplatin (trade name Platinol) and carboplatin (trade name Paraplatin) have the chemical element platinum as part of their molecular structure. These drugs form highly reactive platinum complexes that damage DNA, causing tumor cells to die. Examples of platinum-based chemotherapy are carboplatin, cisplatin, and oxaliplatin.

Taxanes (Paclitaxel)
Taxanes include paclitaxel (trade name Taxol) or docetaxel (trade name Taxotere) and are a type of drug originally extracted from the Pacific yew tree, but now are chemically synthesized. Taxanes prevent cancer cells from being able to divide and grow.

Maintenance Therapy
Your doctor may recommend maintenance therapy options after you have completed your debulking surgery and chemotherapy. Maintenance therapy means ongoing treatment with a drug that may reduce the risk of cancer returning to extend disease-free intervals. Maintenance therapy may be an oral therapy with agents called PARP inhibitors such as Olaparib, Niraparib, or Rucaparib. Bevacizumab is a different type of drug given IV that may also be used for maintenance.

The National Comprehensive Cancer Network (NCCN) recommends the following treatment for common ovarian cancers. The below information appears in The National Comprehensive Cancer Network (NCCN) 2024 Patient Guidelines.

Stage 1

Chemotherapy is recommended after surgery for most newly diagnosed stage 1 cancers. Observation may be an option for a stage 1A or 1B, low-grade tumor. Ask your doctor if this applies to your cancer.

At this time, the preferred chemotherapy regimen is paclitaxel with carboplatin, given every 3 weeks. If you can’t have this regimen, there are other recommended options.

Six cycles of chemotherapy may be recommended for high-grade serous tumors. Between 3 and 6 cycles are recommended for some other stage 1 tumors. The specific number of cycles needed depends on the tumor type and other factors.

Stages 2, 3, and 4

For common tumor types, chemotherapy is recommended after surgery for all newly diagnosed stage 2, 3, and 4 ovarian cancers.

At this time, the preferred chemotherapy regimen is paclitaxel with carboplatin, given every 3 weeks. Six cycles are given for stage 2, 3, and 4 cancers. If you can’t have this regimen, there are other recommended options.

A drug called bevacizumab (Avastin) may be added to your chemotherapy. It stops the growth of new blood vessels that feed the tumor.

If chemotherapy works well, the next step may include maintenance therapy.

Most chemotherapy kills rapidly-growing cells, sometimes including healthy ones, leading to common side effects such as low blood counts, fatigue, nausea, hair loss, neuropathy, mouth sores, and increased infection risk. Side effects of antibody drug conjugates (ADCs) can include ocular toxicity and pneumonitis. Chemotherapy side effects vary based on the medication, dosage, and other factors.

Some people may have hypersensitivity reactions. Ask your doctor about expected and rare side effects to stay informed and vigilant.
 For more information about the different standard chemotherapy treatment options, please visit pages 30-32 of National Comprehensive Cancer Network Patient Guidelines 2023.

For more information about clinical trials near you, visit OCRA’s Clinical Trial Navigator.

Before starting chemotherapy, here are some questions the National Cancer Institute suggests you might want to ask your doctor:

• When will treatment start? When will it end? How often will I have treatment?
• Which drugs will I have?
• How do the drugs work?
• Do you recommend intravenous or intraperitoneal chemotherapy for me? Why?
• What are the expected benefits of treatment?
• Will I have a port placed for my treatment?
• What are the risks of treatment? What side effects might I have?
• How can I prevent or treat these side effects?
• How much will chemotherapy cost? Will my health insurance pay for all of the treatment?

Participants in OCRA’s Woman to Woman Peer Mentor Program and Staying Connected Support Series share helpful tips below about dealing with chemotherapy treatment. Always ask your health team before using any medications or homeopathic therapies.

• Don’t be afraid to ask for help. You do not need to suffer to be successful in treatment.
• If you experience new symptoms and side effects, talk to your doctor.
• Using plastic utensils can mitigate the metallic taste some people get throughout treatment.
• It can be empowering to cut your hair short early.
• Remember to drink water or juice to stay hydrated throughout treatment.
• Walking and light exercise can make a positive difference.
• Chew ice chips to prevent mouth sores.
• Using ice on your hands and feet may help reduce neuropathy.
• Acupuncture can be helpful for nausea, pain, sleeping issues, and digestion issues.
• Ask for a prescription to help cover the cost of wigs.
• A heating pad and Epsom salt baths can help with bone pain.
• Meet others through OCRA’s Staying Connected Support Series who share their own experiences, insights, and support.
• Connect 1:1 with the Oncology Social Work team through OCRA’s Patient Support Line for information, support, and resource navigation.

PARP inhibitors are oral drugs that block the activity of a protein called poly adenosine diphosphate-ribose polymerase, or PARP. In some cancer cells, blocking PARP can keep the cells from dividing and replicating.

To function and reproduce correctly, the cells in your body are constantly copying and proofreading their DNA. When cells detect errors or breaks in the DNA, they activate repair machinery to fix these errors before copying again. There are a few different types of DNA repair machinery. In around half of all ovarian cancers — including those with mutations in the BRCA genes — cancer cells are defective in one type of repair mechanism. But PARP fixes damaged DNA using a different mechanism.

This means that PARP inhibitors, by blocking PARP, can keep cancer cells from having any kind of DNA repair mechanism and thus from copying and multiplying. Healthy cells, however, are largely unaffected by these drugs because they have a backup repair mechanism that works.

PARP inhibitors are currently approved to treat ovarian cancer patients with a BRCA mutation or positive HRD (homologous recombination deficient) test whose tumor shrank or disappeared after frontline treatment.

The drugs are approved as a maintenance treatment — this means they are given to patients with ovarian cancer after chemotherapy has decreased the size of their tumor. Studies have shown that this can delay  recurrence of ovarian cancer.

PARP inhibitors are generally prescribed as tablets or capsules, taken twice a day. How long a patient takes them for depends on their exact type of ovarian cancer.

Studies have established that PARP inhibitors are safe but, like all drugs, they can have side effects. The most common side effects of PARP inhibitors include:

• An increased risk of infection and bleeding problems
• Fatigue
• Nausea
• Diarrhea or indigestion
• Taste changes
• Headaches and dizziness
• Liver and kidney problems

A very rare side effect of PARP inhibitor use is the development of blood cell abnormalities called myelodysplastic syndrome or a type of leukemia.

Targeted therapy for ovarian cancer is a class of drugs that is designed to identify and attack specific vulnerabilities in cancer cells.

Antibody-drug conjugates, also known as ADCs, have shown promise in the treatment of ovarian cancer. They allow for targeted drug delivery to the tumor cell and thus may have less toxicity than standard chemotherapy.There are multiple ongoing trials of ADCs in ovarian cancer.


Angiogenesis inhibitors have proven effective against some epithelial ovarian cancers, working by cutting off the blood supply to tumors. Bevacizumab is an angiogenesis inhibitor that is approved for treatment.

Immunotherapy is an innovative approach that harnesses the power of the body’s own immune system to fight the cancer. This has been very effective in other kinds of cancer, and is an active area of promising research in ovarian cancer. One type of immune therapy called checkpoint inhibitors, is approved for any solid tumor with a particular mutational profile, including some ovarian cancers. Checkpoint inhibitors work by telling the immune system to continue fighting tumor cells when immune “checkpoints” would typically shut down an anti-tumor immune response. Pembrolizumab is a checkpoint inhibitor. Researchers, including many OCRA grantees, are determined to understand why ovarian cancer evades immune response and are actively testing new immunotherapies.

If you are interested in receiving up-and-coming treatments, a clinical trial may be right for you. Clinical trials help accelerate breakthroughs while giving participants the opportunity to receive new and promising treatments that are not yet publicly available. Participants in cancer clinical trials never receive just a placebo — though there may be a placebo component to the trial, all patients receive either standard of care or the therapy being tested.

You can use OCRA’s Clinical Trial Navigator to search available clinical trials online or to speak to a clinical trial navigator over the phone.

Radiation therapy uses high-energy x-rays or other radiation types to eliminate or stop cancer cells. Radiation is helpful to target a specific site of disease, such as a brain metastasis or a tumor in the spine. Because ovarian cancer most commonly recurs at multiple sites in the abdominal cavity, chemotherapy is often preferred for treatment.

Radiation treatment is an outpatient procedure typically lasting 15 to 30 minutes. Before your first visit, a simulation session is conducted to determine the exact treatment area, with marks made on your body to guide the therapy. During treatments, you’ll lie on a table as a linear accelerator delivers radiation to the targeted area. It’s important to remain still but breathe normally. Protective shields may be used. You can communicate with the therapist via intercom. Radiation does not make you radioactive, so it’s safe to be around others post-treatment.

The “success rate” for ovarian cancer is often discussed using the 5-year relative survival rate, which compares survival times in women with the same type and stage of ovarian cancer. It’s crucial to understand that this is a statistic, not a prediction for any individual.

Ovarian cancer is a serious disease that requires prompt and specialized care from a gynecologic oncologist. Its seriousness stems primarily from the fact that it is often diagnosed at a later stage, after it has already spread within the pelvic and abdominal cavity. This makes it more challenging to treat than cancers that are typically caught earlier.

However, it is important to balance this seriousness with a message of hope. The landscape of ovarian cancer treatment has changed dramatically over the past decade. The development of PARP inhibitors, targeted therapies, and a deeper understanding of the disease’s genetic drivers have led to longer remission periods and better outcomes for many women.

Unfortunately, the majority of ovarian cancers (more than 60%) are diagnosed at an advanced stage (Stage III or IV). This happens because these cancers typically spread beyond the ovary before they are big enough to cause symptoms. Early symptoms are also often subtle and easily attributed to other common conditions, such as digestive issues. Furthermore, there is currently no standard, reliable screening test for ovarian cancer in the general population, which makes early detection difficult.

This is a very difficult question, and it’s impossible to provide a specific timeframe. “Life expectancy” is a statistical average and can’t predict an individual’s journey. It varies significantly based on many factors, including the cancer’s subtype, where it has spread, the patient’s response to previous and current treatments, and their overall health and resilience.

For patients with advanced or recurrent cancer, the focus of care often shifts to balancing length of life with quality of life. Palliative care and supportive therapies play a crucial role in managing symptoms and ensuring the patient remains as comfortable and active as possible. It is a deeply personal journey, and discussions about prognosis should be had directly with your medical team, who can provide context based on your specific situation.