Ovarian Cancer Treatment by Stage

Treatment for ovarian cancer is usually based on the type of ovarian cancer and the stage of the cancer. The stage of the cancer is based on the size of the tumor and the spread of cancer. The stage helps to guide the type and extent of treatment. For example, early-stage ovarian cancer would be treated in a different way than more advanced cancer.

For ovarian cancer, early-stage typically means stage I, when the cancer is confined to the ovary. Ovarian cancer in stages beyond stage 1 is usually considered advanced ovarian cancer.

Treatment for stage I ovarian cancer

Once you are diagnosed with ovarian cancer, your treatment team will next determine the clinical stage of your cancer. This is done before surgery. If you wish to have biological children in the future, this is the time to discuss your fertility-sparing options with your doctor.

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Staging will give your doctor an idea on the extent of the cancer based on tests like imaging and blood work. Surgery will help give your doctors a definitive stage of your cancer.1

Surgery is the recommended first-line treatment for people with stage I ovarian cancer. The type of surgery will depend on the sub-stage of the cancer and whether you want the option of becoming pregnant in the future. The most common surgery for stage I ovarian cancer is called a TAH-BSO procedure. The procedure includes 2 surgeries:1

  • Removal of the uterus (total abdominal hysterectomy)
  • Removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy)

In fertility-sparing surgery, one or both ovaries and fallopian tubes are removed, but the uterus is not. This will allow you to try to become pregnant in the future with assisted reproduction techniques.1

During surgery, surgical staging is completed. The surgeon will measure the tumor and look for any spread by removing the omentum (layer of fatty tissue that covers the abdominal organs) and nearby lymph nodes. They will also take biopsies of nearby areas.1

After surgery, many people with stage 1 ovarian cancer will need chemotherapy. Your chemotherapy options will depend on the exact stage of your cancer, the tumor grade and cancer type, and your overall health.1

The chemotherapy is usually intravenous (given through an IV), platinum-based chemotherapy. The number of cycles and course of treatment depends on features of your cancer and your overall health.1

Symptom control and emotional support are essential during treatment. They are just as important as your medical treatment. Supportive care can help relieve symptoms and improve quality of life and overall well-being. Talk with your doctor or treatment team about the resources and support available to you.

Treatment for stage II to stage IV ovarian cancer

After clinical (pre-surgery) staging, treatment will be planned but not certain until the surgery is done and surgical staging is performed. Pre-surgery tests like imaging and blood work will also help doctors decide whether surgery should be the first treatment.1

Some people with advanced ovarian cancer may need to have chemotherapy first to shrink the tumor to make surgery possible. Other people may not be good candidates for surgery.1

Surgery

Like in stage I, surgery is typically the first-line treatment for stages II to IV ovarian cancer. Surgery involves removing the uterus, both ovaries, and both fallopian tubes.1

Surgical staging will also be done, with the surgeon taking biopsies from the lymph nodes and areas in the abdomen. If cancer has spread, the organs, parts of the organs, and other tissues that contain cancerous cells may also be removed during surgery.1

Chemotherapy

After surgery, platinum-based chemotherapy is usually recommended for those with stages II to IV ovarian cancer. While most of the chemotherapy is given intravenously, some can be given as intraperitoneal chemotherapy (IP). This is chemotherapy that is given directly into the abdominal cavity. Your doctor will talk with you about whether you are a candidate for IP chemotherapy and what it will mean for your treatment.1

After chemotherapy, some people may need more surgery to remove any remaining cancer. This is called completion surgery.1

Additional treatments

After surgery and chemotherapy, treatment depends on the kind of chemotherapy given and whether specific targeted therapy drugs were used along with it. Further treatment is also determined by treatment response. Treatment responses include:1

  • Complete remission – There are no signs of cancer on imaging tests, a physical exam, or CA-125 blood tests after treatment
  • Partial remission – Tests show a decrease in the amount of cancer, tumor size, or CA-125 levels
  • Stable disease – Cancer did not get better or worse during treatment
  • Progression – The cancer continued to grow during or following treatment

If you had chemotherapy along with Avastin® (bevacizumab), your options after chemotherapy might include:1

  • Those with complete or partial remission
    • Maintenance therapy with bevacizumab
    • Maintenance therapy with Lynparza® (olaparib) if you have a BRCA1 or 2 mutation
  • Those with stable disease
    • Maintenance therapy with bevacizumab
  • Those with cancer progression
    • Start treatment for persistent disease, which can involve a clinical trial, supportive care, or recurrence therapy

If you had chemotherapy without bevacizumab, your options after chemotherapy might include:1

  • Those with complete remission
    • Join a clinical trial
    • No treatment, continue to watch and wait while continuing to be monitored by your doctor
    • Maintenance therapy with olaparib if you have a BRCA1 or 2 mutation
  • Those with partial remission
    • Maintenance therapy with olaparib if you have a BRCA1 or 2 mutation
    • Start treatment for persistent disease through a clinical trial, supportive care, or recurrence therapy
  • Those with progression
    • Clinical trial
    • Supportive care
    • Recurrence therapy

Finding emotional support

Emotional support and symptom relief are an important part of treatment. Stress reduction, symptom management, and any other kind of support are key to your treatment plan. Talk with your doctors about any type of help or support you might need and the options that are available to you.

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Written by: Jaime Rochelle Herndon | Last reviewed: May 2021