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Surgery is the preferred treatment and is frequently necessary for diagnosis. Studies have shown that surgery performed by a specialist in gynecologic oncology usually result in an improved outlook. Improved survival is attributed to more accurate staging of the disease and a higher rate of aggressive surgical excision of tumor in the abdomen by gynecologic oncologists as opposed to general gynecologists and general surgeons.
The type of surgery depends upon how widespread the cancer is when diagnosed (the cancer stage), as well as the type and grade of cancer. The surgeon may remove one (unilateral oophorectomy) or both ovaries (bilateral oophorectomy), the fallopian tubes (salpingectomy), and the uterus (hysterectomy). For some very early tumors (stage 1, low grade or low-risk disease), only the involved ovary and fallopian tube will be removed (called a "unilateral salpingo-oophorectomy," USO), especially in young females who wish to preserve their fertility. In advanced disease as much tumor as possible is removed (debulking surgery). In cases where this type of surgery is successful, the prognosis is improved compared to patients where large tumour masses (more than 1 cm in diameter) are left behind.
Chemotherapy is used as after surgery to treat any residual disease. At present many oncologists are still recommending systemic chemotherapy including a platinum derivative with a taxane as a preferred method of treating advanced ovarian cancer. However, randomized, multicenter clinical trials are beginning to clearly show that Intra-peritoneal chemotherapy produces longer survival times. As this therapy may not always be available in local hospitals, women should consult doctors based in nationally recognized centers as soon after diagnosis as possible in order to select the most effective treatment plan. Chemotherapy can also be used to treat women who have a recurrence.
Three large randomized studies of the Gynecologic Oncology Group have suggested that chemotherapy regimens delivered partly via direct infusion into the abdominal cavity (intraperitoneal or "IP") improve median survival time over regimens that are only given intravenously (in the vein or "IV"). Reported toxicities are generally higher and the advantages of IP chemotherapy are still debated among specialists.
Radiation therapy is not effective for advanced stages because when vital organs are in the radiation field, a high dose cannot be safely delivered.
Pre-clinical chemosensitivity and chemoresistance testing is being done by laboratories in the USA, Europe, and Asia.
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