Treatment of Stage III Ovarian Cancer

This content has been reviewed and approved by

Maurie Markman, MD
Vice President, Clinical Research
MD Anderson Cancer Center
University of Texas
 

Patients diagnosed with stage III ovarian cancer have cancer that has spread from the ovaries and pelvic organs into the upper abdomen or lymph nodes. Stage III ovarian cancer has not spread to sites outside the abdomen or inside the liver.

A variety of factors will ultimately influence your decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase your chance of cure, or prolong your survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of stage III ovarian cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this website is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Currently, the standard treatment for stage III ovarian cancer consists of both surgery and chemotherapy.

Surgical Debulking

During debulking surgery, physicians attempt to remove as much of the ovarian cancer as possible. Debulking is believed to be beneficial because it reduces the number of cancer cells that ultimately need to be destroyed by chemotherapy and therefore decreases the likelihood of the cancer developing a resistance to chemotherapy.

Initial debulking surgery in ovarian cancer is currently considered the standard of care because clinical studies have shown that "optimally" debulked patients live longer and have a more prolonged time to cancer recurrence than "suboptimally" debulked patients.

Following surgical debulking, all patients with stage III ovarian cancer are offered additional treatment. Nearly all patients with stage III disease have small amounts of undetectable cancer that have spread outside the ovary and were not removed by surgery. Other patients cannot be optimally debulked with initial surgery. An effective treatment is needed to eliminate the remaining cancer to improve the survival rate achieved with surgical removal of the cancer. Currently, this treatment is chemotherapy.

Chemotherapy for Stage III Ovarian Cancer

It is important to understand that many patients with ovarian cancer already have small amounts of cancer that were not removed with surgery or have spread away from the ovaries. These cancer cells cannot be detected with any of the currently available tests and are referred to as micrometastases. The presence of micrometastases causes cancer recurrence following treatment with surgery alone.

An effective treatment is needed to cleanse the body of micrometastases to improve a patient's duration of survival and potential for cure.

Regardless of the timing or the necessity of performing interval debulking surgery, combination chemotherapy using one or more anticancer drugs is considered "standard" treatment for patients with stage III ovarian cancer.

Clinical trials have demonstrated that for patients with advanced stage ovarian cancer, treatment with combination chemotherapy regimens containing a platinum compound Platinol® (cisplatin) or Paraplatin® (carboplatin) prolongs the duration of survival and prevents more recurrences of cancer compared to treatment with surgery and nonplatinum compounds. Current first-line chemotherapy typically consists of a taxane (Taxol® or OnxolTM [paclitaxel] or Taxotere® [docetaxel]) and a platinum compound administered every 3 weeks for six cycles.

Clinical Trial Participation

Because many patients still experience recurrence of their cancer following standard therapy, some patients and their doctors consider participation in clinical trials evaluating new treatment approaches as their initial option.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients.

Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. If you are interested in participating in a clinical trial, you should discuss the risks and benefits of clinical trials with your physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news to learn about new treatments and the results of clinical trials.

Before deciding to receive adjuvant chemotherapy treatment or to participate in a clinical trial, women should ensure they understand the answer to three questions:

1. What is my prognosis (risk of cancer recurrence) without chemotherapy treatment?
2. How will my prognosis be improved with treatment?
3. What are the risks of treatment?

Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.

 

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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