Treatment and prognosis of ovarian cancer

The therapy for ovarian cancer depends on the stage of the disease and the microscopic structure (histology) of the tumor tissue. However, as a rule, the first step of the treatment is an operation that initially removes as much tumor mass as possible. This is often followed by chemotherapy to kill any remaining cancer cells and to prevent a relapse (recurrence).

The prognosis of ovarian cancer depends on various factors, such as the tumor properties. In general, if ovarian cancer is discovered in time, the chances of recovery are relatively good. In the advanced stage of the disease, however, the prognosis is rather unfavorable.

Operation: Basis of treatment

The most important element of the treatment of ovarian cancer is the surgical removal of as much tumor tissue as possible. This can usually be done during the diagnostic operation that needs to be done to help diagnose ovarian cancer.

First, a tissue sample is taken, which is examined during the operation by a pathologist. If this confirms the diagnosis of ovarian cancer, both ovaries, fallopian tubes and the uterus are usually removed.

In addition, lymph nodes are usually removed from the pelvis and abdomen. In order to clarify how far the tumor has spread (staging), tissue samples are also taken from the peritoneum and from all conspicuous areas.

Extent of surgery depending on tumor stage

How radically the surgery has to be done depends on the stage of the disease. For example, in the early stages of ovarian cancer, it is possible to perform fertility-preserving surgery.

The prerequisite for this is that the tumor has a low degree of degeneration (Grading) and is also locally limited to one ovary (stage IA). It is then possible to maintain the healthy ovary and the uterus so that the patient can later become pregnant. Certain types of ovarian cancer (germ cell tumors and germinal motility tumors) are more likely to maintain fertility.

In advanced ovarian cancer, however, it may be necessary to remove parts of other organs such as the liver, spleen, pancreas, or intestine, as well as the ovaries and uterus, if they are cancerous.

Chemotherapy often makes sense

In most cases of ovarian cancer, adjuvant chemotherapy is performed after surgery, even if the tumor has been completely removed. This should destroy any remaining cancer cells and thus prevent recurrence.

In stage IA as well as in certain forms of ovarian cancer (for example, in so-called borderline tumors) chemotherapy is usually not necessary. In all other cases, an active ingredient combination of a so-called taxane and a platinum-containing chemotherapeutic agent is used, which is usually administered six times at intervals of three weeks.

Re-chemotherapy for recurrence

If there is a recurrence after the treatment of ovarian cancer, the interval to chemotherapy is relevant: If a relapse occurs within six months after completion of the platinum-based chemotherapy, this means that the tumor responds poorly or not to drugs with platinum (platinum-resistant ). Accordingly, the relapse is treated with another chemotherapy drug without platinum.

However, if the ovarian cancer occurs again later than after six months, it has initially responded to the first chemotherapy and can in turn be treated with a platinum-containing active ingredient combination (platinum-sensitive). Whether a new operation in case of recurrence makes sense, must be decided in each case for each patient.

Antibody therapy in special cases

In advanced stages, as well as relapses, bevacizumab (Avastin ®) may be used in addition to chemotherapy. It is an antibody that is directed against a growth factor of the vessels and thus inhibits neovascularization.

Since the tumor requires nutrients and oxygen from the blood to grow and is therefore dependent on the formation of new vessels, bevacizumab can thus inhibit tumor growth and prevent stray (metastases).

Palliative therapy for a better quality of life

If the ovarian cancer is already so advanced that there are no chances of recovery, the doctors will start a so-called palliative therapy. This means that the goal of the therapy is not the cure, but the extension of life expectancy and the best possible quality of life.

In ovarian cancer, this is usually the case when the tumor has spread outside the abdomen or comes back despite surgery and multiple chemotherapy. However, there are no general guidelines for end-stage therapy. Rather, it must be decided individually which treatment benefits the ovarian cancer patient the most.

Irradiation of metastases

In the treatment of curable ovarian cancer, radiotherapy does not play a major role, as the tumors themselves usually do not respond. In the final stage, however, irradiation of metastases - for example in the bones - can lead to significant pain relief and thus to a better quality of life.

In addition, the treatment of symptoms is an important part of palliative therapy: There are a variety of medications that can treat complaints such as nausea, pain and shortness of breath usually good.

Alternative treatment: efficacy questionable

So-called unconventional healing methods - for example mistletoe therapy or other herbal therapies - are widely used in alternative medicine. However, there is no scientific evidence that alternative treatments for ovarian cancer are effective.

Therefore, alternative medical treatment should not be performed in lieu of the medically recommended therapy. However, herbal supplements or homeopathy may under certain circumstances contribute to the alleviation of symptoms and thus be a useful supplement to traditional medical treatment.

Prognosis depending on the stage

As with most diseases, the chances of a cure for ovarian cancer are better the earlier the diagnosis is made. The following factors can influence the forecast:

  • Tumor stage: The size and spatial spread of the tumor as well as the presence and localization of metastases significantly determine the chances of recovery.
  • Post-operative tumor remainder: R0 (complete removal of the tumor), R1 (microscopic visible tumor remnants), and R2 (visible tumor remnants) indicate how much tumor tissue could be removed.
  • Microscopic structure: The various subtypes of ovarian cancer such as ovarian cancer, borderline tumors or germ cell tumors have different chances of recovery.
  • Grading: The aggressiveness of the tumor is related to the degree of degeneration.
  • Age and general condition of the patient: For example, severe pre-existing conditions may be a limitation for surgery or aggressive chemotherapy.

Since ovarian cancer is often diagnosed late because of lack of early-stage signs compared to other cancers, the prognosis is generally considered to be rather unfavorable.

Estimation of the chance of survival limited

One way to express the approximate chance of survival in numbers is the so-called five-year survival rate. It indicates the percentage of patients still alive five years after the diagnosis.

If the tumor is localized to one or both ovaries (stage I), the five-year survival rate is 80 to 95 percent. This means that 80 to 95 out of 100 patients still live five years after the diagnosis. However, if there are metastases outside the abdomen (stage IV) or if the residual tumor is visible to the naked eye after surgery (R2), the five-year survival rate is only about 10 to 20 percent.

Life expectancy individually different

However, the significance of such numbers is rather limited, for example, does not take into account whether the ovarian cancer itself or another cause has led to death. In addition, the course of the disease is individually different for each patient. A generalized prediction of ovarian cancer life expectancy is therefore not possible using either statistics or prognostic factors.

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