• Ovarian Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Treat Ovarian Cancer

    One in 73 women will be diagnosed with ovarian cancer during her lifetime. Because there are no screening tests for the disease, and symptoms are often subtle, most ovarian cancer cases are diagnosed at a more advanced or complex stage. Because of the complexities of ovarian cancer subtypes, it is imperative that your treatment is conducted at a cancer center with an experienced team, like the Gynecologic Cancer Treatment Center at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). Our team of gynecologic experts — highly skilled at treating routine and advanced cases of ovarian cancer — is one of the most experienced in the United States.

    As an ovarian cancer patient, you can feel confident in the treatment at DF/BWCC, as our specialists focus exclusively on gynecologic cancers. If you need surgery, you will see a surgeon who specializes in gynecologic procedures. If your treatment includes chemotherapy, you will work with a medical oncologist who treats only gynecologic patients. If you require radiation therapy, which is uncommon for ovarian cancer treatment, you will work with a radiation oncologist who specializes in gynecologic cancers.

    For referring physicians

    Because the patient's primary care physician or community specialist is an integral part of the patient's care team, we are committed to collaborating with you in the care of your patient.

    If you are a referring physician and have a patient with ovarian cancer, we look forward to working with you.

    Find out more about how to refer a patient to DF/BWCC.

    Personalized, multidisciplinary approach

    Dr. Ursula Matulonis with team membersDr. Ursula Matulonis, Medical Director of Gynecologic Oncology, leads a team meeting to discuss patient cases. 

    Our multidisciplinary team includes experienced surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, and social workers who treat, counsel, and care for each patient with dedication and compassion.

    Beginning with your first appointment, our nurses will walk you through the entire treatment process, making sure you know what to expect and where to find helpful resources, such as counseling, nutrition advice, or palliative care.

    Each patient can request access, or may be referred, to a social worker who is embedded in the gynecologic oncology program and who can provide extra support and guidance. Your medical team will meet regularly to review your health and treatment options and ensure you receive the best possible care. We create a unique, personalized plan for every patient, and consider all aspects of your health history and future when making our recommendations.

    Ovarian cancer treatment by stage

    • If you are diagnosed with stage I or stage II ovarian cancer, removal of the cancerous tumor and diseased organs may be adequate treatment. During surgery, your doctor may perform biopsies to check for spread to your lymph nodes or surrounding tissues. Chemotherapy may be suggested for high-risk stage I patients, as well as stage II patients.
    • If you are diagnosed with stage III or stage IV ovarian cancer, surgery may be performed prior to chemotherapy in order to remove the tumor, both ovaries, and affected organs and lymph nodes throughout the body. After surgery, the majority of patients will start a personalized chemotherapy plan, including one or more chemotherapy drugs. Sometimes, once a diagnosis of ovarian cancer has been made by a needle biopsy, chemotherapy for a few cycles is given first in order to make surgery more successful and less complicated. Then, chemotherapy is completed after surgery. We encourage ovarian cancer patients to pursue targeted or biologic therapies via a clinical trial if the clinical trial makes sense for the patient and her care.

    Surgery

    Our surgical team is recognized internationally as one of the best for the treatment of gynecologic cancers, and consistently ranks as one of the top in the country for surgical care. Because we perform over 1,500 gynecologic surgeries each year, our patients can be reassured they will receive the highest level of surgical care from one of the most experienced teams available.

    Surgery is the main treatment for ovarian cancer, recommended primarily when the vast majority of the cancer or affected tissue can be removed successfully. Some early-stage ovarian patients may undergo minimally-invasive procedures to remove ovarian tumors and/or preserve fertility. Other ovarian cancer surgical procedures may include:

    • Removal of the uterus and the cervix (hysterectomy)
    • Removal of the ovaries or fallopian tubes (unilateral or bilateral salpingo-oophorectomy)
    • Taking a small sample of your pelvic, omentum, or abdominal lymph nodes or tissue (biopsy) to examine for cancerous cells under a microscope
    • An incision in the abdomen to remove cancerous tissue, and if necessary, fluid from the abdominal region (laparotomy)
    Michael Muto, MD, and Colleen Feltmate, MDMichael Muto, MD, and Colleen Feltmate, MD, experts in robotic hysterectomy 

    Gynecological oncologists at Dana-Farber/Brigham and Women's Cancer Center use the most advanced technology available to perform surgery with exacting precision. Our skilled surgeons regularly perform leading-edge, Minimally-invasive surgeries, such as:

    • Laparoscopy: A procedure performed through small incisions in the abdomen, making more extensive surgeries unnecessary
    • Robot-assisted hysterectomy: The benefits of robot-assisted radical hysterectomy are multiple: the procedure provides a safer, less invasive approach to the hysterectomy procedure and offers patients better outcomes, shorter hospital stays, faster recoveries, and enhanced safety. This procedure — which Dana-Farber/Brigham and Women's Cancer Center was the first New England hospital to offer — allows our experts to carefully perform complex robotic surgeries in place of more invasive procedures.

    Ovarian cancer in younger women

    Ovarian cancer in young women is less common. However, if you are a young woman with ovarian cancer and would still like to have children, our doctors will discuss your best options to preserve your fertility. If the cancer is at an early stage (stage I or II), one ovary (unilateral oophorectomy) and one fallopian tube (unilateral salpingectomy) may be removed (when possible) to preserve reproductive functions. In later stages where the cancer has spread, broader surgery may be necessary. At any stage, we suggest discussing your fertility options and concerns with the dedicated fertility and reproductive specialists at DF/BWCC. For example, you may consider egg harvesting or embryo (egg) freezing until treatment concludes.

    Surgery takes place in the operating suites at Brigham and Women's Hospital, whose gynecology program is widely recognized as one of the best in the country. Post-surgical care and other inpatient care are provided by the DF/BWCC team at Brigham and Women's Hospital.

    hysterectomyHysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision. 

    Read our post-operative guidelines for gynecologic surgery.

    Find out more about your hospital stay at Brigham and Women's Hospital.

    Chemotherapy

    Medical oncologists are medical doctors who study and treat cancers. Medical oncologists at DF/BWCC offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Chemotherapy is provided at Dana-Farber's Yawkey Center for Cancer Care, one of the most advanced outpatient cancer centers in the country — designed by patients, for patients.

    Chemotherapy for ovarian cancer may be administered at any stage, but it is usually given at the later stages of the disease. In general, chemotherapy drugs are administered after surgery to eliminate remaining cancer cells, or to keep them from returning. However, there are times when chemotherapy will be given before surgery to make the tumor easier to remove.

    • One type of chemotherapy used to treat regions of the female body is intraperitoneal (IP) chemotherapy. In this process, chemotherapy drugs are injected directly through a thin tube that is placed during the initial surgery into the peritoneal cavity (the space that contains the organs of the abdomen). This type of chemotherapy is primarily given to stage III ovarian cancer patients in conjunction with chemotherapy drugs given intravenously.

    Throughout your treatment, your medical oncologist will work closely with your team of nurses, nutritionists, and social workers to minimize the toxicities and side effects of chemotherapy, maintain your quality of life, and optimize your results. We encourage you to be actively involved in the decision-making process when it comes to choices about chemotherapy treatment.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to eliminate cancer cells or stop cancer growth. Radiation therapy for ovarian cancer is given by our experienced team of radiation oncologists. They are pioneers in the field, regularly setting standards nationwide for treatment and safety.

    Radiation therapy is used to treat select cases of ovarian cancer. While most ovarian cancer patients are not treated with radiation therapy, it may be used for patients with certain types of ovarian cancer, those who have isolated and/or minimal recurrence, or to control symptoms such as pain. In rare or recurrent cases, these radiation treatments may be performed:

    • 3D imaging radiation therapy called intensity-modulated radiation therapy (IMRT). IMRT uses computer images to find and target the cancerous tumor. Radiation is externally delivered and aimed at the tumor, firing thin radiation beams from different angles. This reduces the damage to the surrounding healthy tissue.
    • In brachytherapy or interstitial brachytherapy, radioactive material is directly implanted in or near the tumor via a tiny needle, wire, or other device. Our radiation oncologists at DF/BWCC are among a limited few in the nation to deliver this type of radiation with image-guided techniques. Occasionally, cylinder brachytherapy, a type of radiation therapy delivered to the vagina, will be performed on patients after surgery.

    Revolutionary imaging therapies

    For rare cases of ovarian cancer that require complex imaging treatment, you will be cared for in an innovative operating and research environment developed at Brigham and Women's Hospital (BWH) in 2011. Called the Advanced Multimodality Image Guided Operating (AMIGO) Suite, our team of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses, and technologists use the latest imaging tools to develop and deliver the safest, state-of-the-art therapies. The AMIGO suite is unique, as it combines PET/CT, MRI, and OR technologies in one operating room. BWH is one of the few hospitals in the United States to operate an AMIGO suite.

    Clinical trials for ovarian cancer

    DF/BWCC offers one of the largest and most active clinical trial programs available, including clinical trials for women with ovarian cancer. The clinical trials conducted at DF/BWCC have had a meaningful impact on the type of care administered worldwide.

    Clinical trials are available for nearly every stage of ovarian cancer. However, for women with advanced or recurrent cases of ovarian cancer, taking part in a clinical trial may be the best treatment option. If you qualify for a clinical trial, your doctor will carefully discuss all options and the best time to begin a trial.

    Clinical trials are part of the cancer research process; they are safe and regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Not only can trials lead to new discoveries and improve cancer care, but they can have meaningful anti-cancer benefits.

    Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer (immunotherapy or biotherapy). Trials also include targeted therapy or therapies using drugs to identify and attack the specific ovarian cancer cells.

    Find out more about clinical trials at DF/BWCC. Detailed information about clinical trials is available from the NCI website. For nationally run clinical trials, please visit ClinicalTrials.gov.

    Clinical trial studies are underway at DF/BWCC using new drugs called PARP (poly-ADP-ribose polymerase) inhibitors, some of the more promising drugs for women with ovarian cancer, especially recurrent cases. PARP inhibitors are agents that do not allow the repair of DNA to occur. They are particularly successful in women with a subtype of ovarian cancer called high-grade serous cancer and those women with BRCA mutations (germline mutations inherited from the parents). PARP inhibitors are now being combined with other targeted biological therapies to improve the use of single agent PARP inhibitors. For some women with high-grade serous tumors and BRCA mutations, the response rates from PARP inhibitors have been higher than would be expected from traditional chemotherapy. Various PARP inhibitors are available on clinical studies.

    Read about research findings for high-grade serous ovarian cancer.

    Questions to ask your doctor about clinical trials

    If your doctor suggests a clinical trial as part of your cancer treatment, you may have questions before you get started. Review some commonly asked questions about clinical trials and discuss them with your doctor.

    Next: Our Ovarian Cancer Specialists 

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