Chemotherapy in Ovarian cancer is generally given to patients with advanced disease or recurrent cancer or in early cancer if they are high-grade variety. Our Oncologists treat ovarian cancer with a comprehensive and personalized approach, which may include using various chemotherapy drug combinations. We also choose methods that are designed to deliver high doses of chemotherapy to tumours, while reducing damage to the rest of your body. To treat ovarian cancer, chemotherapy is typically given Orally, Intravenously, or directly into the abdomen through a catheter directly targeting the ovaries and abdominal area with a higher concentration of chemotherapy drugs, while limiting the amount that reaches the rest of the body, in a chemotherapy technique known as intraperitoneal chemotherapy.

Chemotherapy can be given prior to surgery to shrink cancer, especially if it has spread to the lining [peritoneum] and caused ascites. This approach is called Neo-adjuvant therapy [NACT]. Therapy given after surgery to reduce the risk of relapse is called adjuvant therapy. They are usually given at an interval of three weeks and six cycles in total, regimen’s and interval change depending on the type of ovarian cancer.

HIPEC: Hyperthermic Intra Peritoneal Chemotherapy, is a form of surgical treatment, wherein after extensive surgery [Cytoreductive surgery or CRS] to remove the uterus, tubes and ovaries and any affected organs- peritoneum or intestine, a heated solution of chemotherapy is used to wash out the belly to destroy any remaining cancer cells and this significantly decreases the risk of cancer coming back. This is a core area of expertise at Apollo Proton Cancer Centre and we have a special protocol and a team of surgeons for this advanced therapy.

PIPAC: Pressurised Intra Peritoneal Aerosol Chemotherapy, is a form of treatment wherein cancers which have spread extensively to the peritoneum and the covering of the intestines, which cannot be fully removed during surgery, are treated with a chemotherapy aerosol under pressure, this enables the drug to penetrate deeply into the cancer cells and gives relief of symptoms such as ascites and blockage of the intestine. PIPAC is used for patients where the cancer is more extensive than what can be removed by CRS. PIPAC is performed as a laparoscopic procedure and is repeated after every 2-3 courses of conventional chemotherapy given intravenously. This is usually done in a palliative setting.

PARP inhibitors are a form of targeted therapy used to treat ovarian cancer. Designed to block the enzyme poly ADP-ribose polymerase (PARP) from identifying damaged DNA inside cancer cells, PARP inhibitors may stop cancer cells from repairing themselves.

Surgery is done to remove an ovarian mass and make a diagnosis or for suspicion of ovarian cancer or possible ovarian cancer that has spread to other parts of the tummy. It includes removal of the mass, ovary, or both ovaries with or without hysterectomy (womb, fallopian tubes and cervix). The mass can sometimes be sent for rapid diagnosis to pathology lab (frozen section) to establish a diagnosis to see if it is looking cancerous. If suspicion of cancer then the fatty curtain called the omentum in the tummy will be removed and lymph glands (Pelvic and Para-aortic lymph nodes) will be sampled (to see microscopic spread). Some women may need more extensive surgery than others and this will be discussed with you.

The surgery is done by keyhole operation if there is a small size mass with no spread or by a vertical cut on the tummy if is big or has spread. The operation aims to safely remove the mass, tumour, or cyst, to establish a diagnosis, to remove all tumour possible if it has spread to other organs with no visible tumour left after the operation.

Extensive operation is needed if there is spread outside the cyst or mass which includes removal of omentum, peritoneum (cling film lining the tummy and organs), lymph glands, may have to operate close to, or on the bowel. If the area of bowel affected by cancer must be removed, the remaining sections of the unaffected bowel are joined together if possible. If this is not possible, the bowel will be diverted to open on the surface of the tummy. This is known as a ‘stoma’ and allows the bowel contents to be collected in a bag attached to your tummy. The bag can be removed and emptied. If the doctor thinks there is a possibility of bowel surgery this will be discussed with you. It sometimes involves resection of other involved organs intending to extend your life with not much of a compromise on your quality of life.

Chemotherapy is sometimes used before surgery if there is an extensive disease or after the operation. The intention to use it before is to reduce the volume of cancer and make it feasible to have a less extensive operation with an intention not to leave cancer after the operation. In our institution, we nearly achieve in 90% of the patients. We perform this operation as a team involving other specialists as and when needed. Patients live longer who had no cancer left after surgery.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Cytoreductive Surgery (CRS) defined as the removal of macroscopic abdominal and peritoneal disease, combined with hyperthermic perioperative chemotherapy (HIPEC) is the treatment indicated for ovarian cancer with peritoneal metastases.(Cancers spread to other organs and lining of the abdomen) Chemotherapy is given into the abdomen during surgery is called intraoperative chemotherapy.

HIPEC is used to treat cancers that have spread to the lining of the abdominal cavity, such as those of the appendix, colon, stomach and ovaries. HIPEC is an alternative and innovative method of delivering chemotherapy, which is commonly used to treat many types of cancer. Unlike traditional chemotherapy that is delivered intravenously (through a needle into your vein), HIPEC delivers chemotherapy directly into the abdomen making it a good option for cancers that originated in or have spread to the abdominal cavity.

Patients who have ovarian or advanced peritoneal metastases from ovarian cancer may profit from this strategy but additional evidence should be generated from ongoing collaborative studies at experienced treatment centers.

Recent studies on HIPEC in Ovarian cancer have shown promising results. There are several studies published supporting HIPEC in Ovarian cancer with increased survival. It is a part of national guidance in treating ovarian cancer in some of the countries. We are doing it as a part of a trail and this will contribute to the current evidence.

CRS can take several hours (sometimes up to 10-12 hours). If the surgeons can remove the entire tumour less than a centimeter is left you will be given HIPEC. Heated chemotherapy is put directly in your abdomen while you are in the theatre and left in for 90 minutes. We know that even after the surgeon has removed the entire tumour that can be seen, there may still be tumour cells that are not visible and chemotherapy is used to destroy these. The chemotherapy is heated because heat damages tumour cells more than normal cells and improves the effect of the drug. Circulating the fluid around your abdomen allows it to be filtered which also increases the effectiveness of the treatment. HIPEC destroys cancer cells that are too small to be seen with the naked eye.

Most of the side effects are from having the operation rather than directly having the chemotherapy. There can be a small chance that there could be an inflammation of the pancreas (pancreatitis), bowel leak, or low white cell count. We will carefully watch for all these and treat them as needed.

The role of radiotherapy in ovarian cancer is limited to the treatment of isolated pelvic disease not amenable to surgery in patients who have already received a number of courses of radiotherapy.

In this clinical situation, it is important to limit the dose to the intestines that lie in the vicinity of the tumour. Since in ovarian cancer, intestinal loops can get stuck to each other, the tumour and its adjacent organs they prone to injury. At Apollo Proton Cancer Centre, radiotherapy for ovarian cancer ensures the least possible dose to surrounding organs using sophisticated techniques like helical tomotherapy and proton therapy.

The latter is administered on the Proteus Plus treatment unit using the sophisticated pencil beam scanning technology. This technology that allows the doctor to treat the tumour accurately, layer by layer, is combined with accurate positioning of the patient using an on-board CT scan to further improve the protection of normal tissues lying close to the tumour.

Find out about follow up appointments and tests after treatment for ovarian cancer from your team. Depends on type and stage of treatment.

Find out about the latest research, clinical trials from our team and how you can take part.

Survival depends on many different factors. It depends on your individual condition, type of cancer, stage at presentation, treatment and level of fitness. So no one can tell you exactly how long you will live.

These are general statistics based on large groups of patients. Remember, they can’t tell you what will happen in your individual case.

Your doctor can give you more information about your own outlook (prognosis).

Stage 1

About 90 out of 100 (about 90%) will survive their cancer for 5 years or more after they are diagnosed.

Stage 2

More than 40 out of 100 (more than 40%) will survive their cancer for 5 years or more after being diagnosed.

Stage 3

Almost 20-45 out of every 100 women (almost 20% – 45 %) will survive their cancer for 5 years or more after they are diagnosed.

Stage 4

Around 5 out of every 100 women (around 5% i.e- 30 %) will survive their cancer for 5 years or more after they are diagnosed.

Your outcome depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread.

The type and grade of ovarian cancer affects your likely survival. Grade means how abnormal the cells look under the microscope.

Your likely survival is also affected by whether the surgeon can remove all the tumor during initial surgery. In our hospital we are able to achieve this in around 90 % of the patients which is among the best numbers in the world.

Your general health and fitness may also affect survival. Doctors have a way of grading how well you are. This is called performance status. Women who have a good performance status have a better outlook.

Age also affects outcome and survival is better for younger women.

There is recent evidence that giving heated chemotherapy (HIPEC – Hyper thermic intra peritoneal chemotherapy) in to the abdomen at the time of surgery for the removal of tumor improves survival. We are offering this facility in our hospital. We are one among the few centers offering this service.

About these statistics

The terms 1-year survival and 5-year survival don’t mean that you will only live for 1 or 5 years. They relate to the number of people who are still alive 1 year or 5 years after their diagnosis of cancer.

Some people live much longer than 5 years.