About your illness: ovarian cancer

Diagnosis and initial treatment

Ovarian cancer is a common illness, affecting about 6,000 women each year in Britain.

Because it is a kind of cancer that is very difficult to diagnose, the cancer may have already spread beyond the ovary by the time it is discovered. To remove the cancer, surgery will generally be recommended. At an exploratory operation, or laparotomy, the surgeon will see where the cancer is located, and will usually proceed to remove as much tumour as possible. In this process, it is often necessary to perform a hysterectomy (removal of the womb) and an oopherectomy (removal of the ovaries).

The aim of surgery is to remove as much disease as possible. In some cases it is possible to remove all the disease, but residual "seedlings" of cancer cells are unavoidably left behind in the majority of patients. The amount of cancer left after surgery varies from person to person. Sometimes only a few cells are left; in other people larger amounts may remain. Before surgery your doctors may have performed a scan to assess the situation. A further scan may be performed after surgery so that your progress on treatment can be monitored.

What happens after surgery?

After surgery the majority of patients are given chemotherapy drugs, to kill as many of the remaining cancer cells as possible. This kind of treatment should be given under the supervision of an oncology clinic where you can receive specialist care and detailed information about all aspects of the treatment.

What will chemotherapy do for me?

In most patients, chemotherapy is able to kill off the majority of cancer cells. This results in the shrinkage of the cancerous lumps, improvement in your symptoms, and a positive effect on the progression of your illness. When all of this happens – and the cancer has shrunk up like this – it is said to be in "remission".

Sometimes, all the detectable cancer disappears. This is called complete remission. In other cases – and for no known reason – most of the cancer disappears, but a small amount remains and can still be seen on scans or through blood tests. This is known as partial remission.

In a minority of cases, the cancer cells resist the effects of chemotherapy drugs, and the disease does not improve. If this happens, other drugs which work in different ways may be used to try to control the cancer.

A word about remission and relapse

Although ovarian cancer is frequently controlled with chemotherapy (that is, put into remission), and you feel fit and well, the disease often returns. This is known as relapse, or recurrence of the cancer. It is difficult to predict how long the benefits of your treatment will last, as it varies in each individual case. Some treatments may work for only a few months, while other women have such a good response to chemotherapy that they remain in remission for five years and beyond – and they are cured.

If your ovarian cancer returns after initial ("first-line") chemotherapy, it is often appropriate to use more (and different) "second-line" drugs to achieve another remission. Some women may go on to receive third-line or even fourth-line chemotherapy to control the cancer. Your own consultant will discuss these kinds of options with you, when and if it is necessary.