One in 70 women will be diagnosed with ovarian cancer during her lifetime. Because there are no screening tests for ovarian cancer, and symptoms are often subtle, most ovarian cancer cases are diagnosed at a more advanced 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 team at Dana-Farber Brigham Cancer Center. 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.
Dr. Ursula Matulonis, Chief of Gynecologic Oncology, leads a team meeting to discuss patient cases.
Our multidisciplinary team includes experienced surgical, medical, and radiation oncologists, radiologists, pathologists, researchers, nurses, nutritionists, and social workers who care for each patient with dedication and compassion.
Beginning with your first appointment, our team 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 has access to a social worker for extra support and guidance if needed. Your medical team will work together to ensure you receive the best care available. We create a unique, personalized plan for every patient, and consider all aspects of your health when making our recommendations.
Ovarian Cancer Treatment by Stage
If you are diagnosed with stage I 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 II, 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 biopsy, a few cycles of chemotherapy are given first in order to make surgery more successful and less complicated. Chemotherapy is then completed after surgery. We encourage ovarian cancer patients to pursue targeted or biologic therapies. These therapies can be pursued via a clinical trial, or, in some circumstances, are the standard of care.
Surgery
Gynecologic surgeons Michael Muto, MD, and Colleen Feltmate, MD
The quality of a patient's surgery remains one of the most important factors in ovarian cancer care. 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 omentum, pelvic or abdominal lymph nodes and/or additional biopsies to examine for cancerous cells under a microscope and remove cancerous tissue
An incision in the abdomen to remove cancerous tissue, and if necessary, fluid from the abdominal region (laparotomy)
Surgical Treatment for Ovarian Cancer
Michael J. Worley, Division of Gynecologic Oncology at Brigham and Women’s Hospital, describes surgical treatment options for ovarian cancer.
Ovarian Cancer in Younger Patients
If you are diagnosed 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 Dana-Farber Brigham Cancer Center. 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 Dana-Farber Brigham Cancer Center team either at Brigham and Women's Hospital or at Dana-Farber's Inpatient Hospital located within Brigham and Women's Hospital.
Hysterectomy. 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.
After surgery, your surgical samples are carefully examined by pathology experts in the Women's and Perinatal Pathology Division. Their evaluation will be shared with all members of the gynecologic oncology program, including your treatment team, in a weekly tumor board meeting where further treatment (if necessary) and management of your tumor will be decided.
Medical oncologists at Dana-Farber Brigham Cancer Center offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Chemotherapy (drugs that eliminate cancer cells or stop them from dividing) 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.
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.
Intraperitoneal (IP) Chemotherapy
Dana-Farber Brigham Cancer Center offers an advanced treatment for ovarian cancer that has already spread within the abdominal cavity. While the combination of intravenous chemotherapy and surgery is the best treatment approach for many patients, studies have suggested that certain patients may benefit from receiving intraperitoneal (IP) chemotherapy after their initial surgery. IP chemotherapy delivers chemotherapy directly to cancer cells in the abdomen, so it is well-suited to the treatment of ovarian cancer.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
In addition to traditional IP chemotherapy, Dana-Farber Brigham Cancer Center offers hyperthermic intraperitoneal chemotherapy (HIPEC). In contrast to standard IP chemotherapy that is given after surgery, HIPEC involves a single use of heated chemotherapy in the abdomen, which is given at the time of surgery. Heating the chemotherapy improves absorption and directly destroys cancer cells. At the completion of the surgery, the chemotherapy is removed from the abdomen. Recent studies have shown that adding HIPEC to select patients’ treatment improves survival significantly and doesn’t increase side effects or complications. HIPEC is for select patients with advanced stage ovarian cancer and we encourage patients to discuss treatment options with their cancer team.
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 Dana-Farber Brigham Cancer Center 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
All bladder cancer patients requiring radiation therapy 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.
Dana-Farber Brigham Cancer Center offers one of the largest and most active clinical trial programs available, including clinical trials for patients with ovarian cancer. The clinical trials conducted at Dana-Farber Brigham Cancer Center have had a meaningful impact on the type of care administered worldwide.
Clinical trials are available for nearly every stage of ovarian cancer. 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 regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Not only can trials have meaningful anti-cancer benefits, but they can lead to new discoveries and improve cancer care.
Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer. Trials can also include targeted therapies that attack specific vulnerabilities in cancer cells.
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.
Our diagnostic team provides second opinions, including for challenging or difficult cases. We are happy to consult with you, your primary care physician, or other specialists.
Can't travel to Boston? Our Online Second Opinion service lets patients from all over the world receive expert second opinions from Dana-Farber oncologists.
Because primary care physicians and community specialists are integral parts of every 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.
