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NCCN Guidelines for Patients



Ovarian Cancer, Version 1.2017


Treatment guide

Stage I ovarian cancer

Guide 5

shows the options that are recommended

after surgery for stage I ovarian cancer. Most women

with ovarian cancer will receive chemotherapy

after primary treatment with surgery. This is called

adjuvant treatment. Your doctor may also refer to this

as primary chemotherapy.

Which option is recommended after surgery depends

on the cancer stage and the cancer grade. The

cancer stage is a rating of how much the cancer

has grown and spread. The cancer grade describes

how fast the cancer will likely grow based on how

much the cancer cells look like normal cells. Grade 1

cancer tends to grow more slowly, grade 3 tends to

grow more quickly, and grade 2 is in between.

Treatment options

For stage IA or IB ovarian cancer, the options depend

on the cancer grade. For grade 1, observation with

follow-up tests is recommended. Observation is a

period of testing to watch for cancer growth after

treatment. For grade 2, observation with follow-up

tests is still an option. A second option is to receive

chemotherapy given in a vein. This is called IV

chemotherapy. For all other stage I ovarian cancers,

IV chemotherapy is the only recommended option.

The number of chemotherapy cycles recommended

depends on whether or not surgical staging was

completed. It may have been completed during the

initial surgery or a second surgery. If so, 3 to 6 cycles

of chemotherapy should be given. If surgical staging

was not completed, then at least 6 cycles should be


Guide 5 also shows the chemotherapy regimens that

are recommended for stage I ovarian cancer. Which

drug or regimen is best for you depends on a number

of factors. This includes your age, overall health, and

performance status—a rating of how well you are

able to do daily activities.

Another key factor is your risk for peripheral

neuropathy—a nerve problem that causes pain,

tingling, and numbness typically in the hands and


Neuropathy is a common side effect of paclitaxel and

to a less degree carboplatin. If you have a high risk

for nerve problems, then docetaxel and carboplatin

may be a better option for you. Some patients may

not be able to tolerate the severe side effects of

chemotherapy. This includes patients who are older

than 65, have other health problems, or have trouble

doing daily activities. For these patients, paclitaxel

and carboplatin given once a week may be a good

option. Giving these drugs once a week may cause

fewer side effects than when they are given once

every three weeks. It may be better tolerated by

certain patients.

Testing during chemotherapy treatment

During treatment, your doctor will give tests to check

how well the chemotherapy is working and to assess

for side effects. A physical and pelvic exam may be

done at least every 2 to 3 cycles. You may also have

other tests as needed. This may include imaging

tests, CBC, blood chemistry profile, and tests of CA-

125 or other tumor markers.

Next steps

See Guide 10 on page 58 for follow-up tests that

are recommended during observation and after

completing chemotherapy treatment.