What stage of ovarian cancer requires chemotherapy?

The decision to use chemotherapy in ovarian cancer is based on the cell type (type of ovarian cancer) and the stage of the disease, among other factors.

Ovarian cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) system, which takes into account the extent of the disease within the pelvis and abdomen. The lower the stage, the less the cancer has spread.

The stages of ovarian cancer are generally categorised as follows:

Stage I: Cancer is confined to the ovaries.

Stage II: Cancer involves one or both ovaries with pelvic extension.

Stage III: Cancer involves one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal lymph nodes.

Stage IV: Cancer has spread to distant organs.

The decision to use chemotherapy often depends on the stage of ovarian cancer:

illustration of a patient receiving chemotherapyStage I: For early-stage ovarian cancer (confined to the ovaries), the primary treatment is often surgery to remove the ovaries, fallopian tubes and the uterus plus omentum (fat pad arising from the stomach) and enlarged lymph nodes.  In some cases, chemotherapy may be recommended if the tumour is high-grade, has ruptured during surgery or if the risk of recurrence is high.

In patients with stage I ovarian cancer, we expect a good prognosis. In those cases, the risk of not giving chemotherapy (risk of relapse) need to be weighed very carefully against the risks of chemotherapy (short- and long-term side effects). Ideally we recommend chemotherapy to patients whose survival will be improved by chemotherapy and hope that they tolerate the treatment well without any major poor long-lasting adverse effects.

Stages II, III, and IV: In advanced stages (II, III, and IV), where the cancer has spread beyond the ovaries, a combination of surgery and chemotherapy is commonly recommended. The goal of postoperative chemotherapy (given after surgery to remove any very small tumour left behind after surgery) in these stages is to eliminate or reduce cancer cells that may not be visible for a naked eye throughout the abdominal cavity and, if applicable, to address any cancer spread to distant organs.

Neoadjuvant chemotherapy is given before surgery to shrink the tumours so that they become easier to remove afterwards.

Chemotherapy is also the treatment of choice if ovarian cancer has recurred. The role of surgical removal of recurrence in ovarian cancer is very limited and I offer it only to very selected patients who will benefit from a surgical procedure.

It's important to note that the decision on whether to use chemotherapy and the specific treatment plan is highly individualised and depends on factors such as the patient's overall health, the type and grade of the cancer, and the extent of disease. A thorough discussion with a gynaecologic oncologist is essential for understanding the specific treatment approach recommended for a particular case.

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