Early ovarian cancer Ovarian cancer stages 2 4 Multidisciplinary team Giving your consent The benefits and disadvantages of treatment Second opinion

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1 Treatment overview for ovarian cancer This information is an extract from the booklet Understanding cancer of the ovary. You may find the full booklet helpful. We can send you a free copy see page 6. Overview Contents Overview Early ovarian cancer Ovarian cancer stages 2 4 Multidisciplinary team Giving your consent The benefits and disadvantages of treatment Second opinion The main treatments for ovarian cancer are surgery and chemotherapy (the use of anti-cancer drugs to destroy cancer cells). Occasionally other treatments are used, such as radiotherapy (the use of high-energy rays to destroy cancel cells) or targeted therapies (the use of drugs to stop or shrink cancer cells). Decisions about the best treatment for you are made by a team of experts called a multidisciplinary team (see page 3). The treatment plan they advise is based on: the type of ovarian cancer you have its stage (the size of the tumour and whether it has begun to spread) and its grade (how fast growing it is) where it is your general health your personal preferences. Your cancer doctor and nurse can help you if you need to make decisions about treatment. They will also make sure your preferences are taken into account. Questions about cancer? Ask Macmillan Page 1 of 6

2 Early ovarian cancer Women with borderline tumours or women with certain stage 1 ovarian cancers can often be cured with surgery. Because they are not a true cancer, borderline ovarian tumours are treated with an operation alone. Occasionally, cells from these tumours spread and grow somewhere else, such as on the peritoneum. These are called non-invasive implants. They don t usually cause problems and often don t need to be treated. Instead the doctor may monitor them at regular check-ups. Ovacome (visit ovacome.org.uk or call ) has more detailed information about borderline ovarian tumours. If you have early-stage ovarian cancer (not a borderline tumour), in certain situations your doctor may recommend chemotherapy after surgery. This is to reduce the risk of the cancer coming back. It includes stage 1 cancers that are: high-grade The cancer cells look very different from normal cells and may grow more quickly clear cell cancer stage 1c The cancer is in one or both ovaries, and the tissue surrounding the ovary (capsule) has broken before/ during surgery or there are cancer cells in the fluid taken from the abdomen during surgery. It s not common for ovarian cancer to be diagnosed at stage 1. Ovarian cancer stages 2 4 You usually have a combination of surgery and chemotherapy or chemotherapy on its own. The aim of treatment may be to cure the cancer or to keep it under control for as long as possible. Your cancer doctor and specialist nurse can explain more about this. Page 2 of 6 Questions about cancer? Ask Macmillan

3 You have surgery to remove as much of the cancer as possible. Doctors sometimes call this debulking. After this you have chemotherapy, either to: treat cancer cells that cannot be seen during surgery they can only be seen under a microscope shrink any remaining cancer that couldn t be removed during the operation. If an operation isn t likely to remove most or all of the cancer, you may be given some chemotherapy first. This is done to shrink the cancer so that surgery is more successful. After the operation, you have some more chemotherapy. Sometimes chemotherapy is the main treatment. This is usually when an operation isn t possible because of where the cancer is or if you aren t well enough for a major operation. The aim is to shrink the cancer, help to control it and relieve symptoms. When ovarian cancer is not at an early stage it s more likely to come back (recurrence). If this happens it can usually be treated again with more chemotherapy and sometimes more surgery. Some women have several courses of chemotherapy, when they need it. This keeps the cancer under control for many years. Newer treatments are also being developed. Your cancer doctor may talk to you about taking part in research, such as in a clinical trial. Sometimes, if the cancer is very advanced, women may decide not to have or continue with cancer treatments. Your cancer doctor and nurse will support you and prescribe drugs and treatments to control and reduce your symptoms. This is known as supportive care (palliative care). You may see a specialist palliative care doctor or nurse for expert help with your symptoms. Multidisciplinary team Women with ovarian cancer should be treated by a specialist gynaecological cancer team. These teams are based in larger cancer centres, so you may have to travel for your treatment. Questions about cancer? Ask Macmillan Page 3 of 6

4 A team of specialists will meet to discuss and decide on the best treatment for you. This multidisciplinary team (MDT) will include: a surgeon who specialises in gynaecological cancers (a gynaecological oncologist) a cancer doctor (oncologist) who specialises in cancer treatments for gynaecological cancers a gynae-oncology nurse specialist a radiologist (a doctor who analyses x-rays and scans) pathologists (who advise on the type and extent of the cancer). It may also include other healthcare professionals, such as a dietitian, physiotherapist, occupational therapist, radiographer, psychologist or counsellor. Your cancer doctor and nurse specialist will advise you about the best treatment for your particular situation. It s important to ask them any questions you have. Giving your consent Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about: the type and extent of the treatment its advantages and disadvantages any significant risks or side effects any other treatments that may be available. If you don t understand what you ve been told, let the staff know straight away so they can explain again. Some cancer treatments are complex, so it s not unusual to need repeated explanations. It s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment. Page 4 of 6 Questions about cancer? Ask Macmillan

5 People sometimes feel that hospital staff are too busy to answer their questions, but it s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions. You can always ask for more time if you feel that you can t make a decision when your treatment is first explained to you. You are also free to choose not to have the treatment. The staff can explain what may happen if you don t have it. It s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice. The benefits and disadvantages of treatment You may feel worried about having cancer treatment because of the possible side effects that can happen. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the possible benefits will depend on your individual situation. If the cancer is advanced and has spread to other parts of the body, treatment may only be able to control it, improving symptoms and quality of life. However, for some people in this situation the treatment will have no effect on the cancer and they will get the side effects without any of the benefit. If you ve been offered treatment that aims to cure the cancer, deciding whether to accept it may not be difficult. However, if a cure is not possible and the purpose of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have treatment to control the cancer, there are drugs and other treatments that can help to relieve the symptoms caused by cancer. Treatment given in this situation is known as supportive or palliative care. Questions about cancer? Ask Macmillan Page 5 of 6

6 Second opinion Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion. More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding cancer of the ovary, or any other cancer information, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN MAY 2015 Planned review in 2017 Page 6 of 6 Questions about cancer? Ask Macmillan