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51

NCCN Guidelines for Patients

®

:

Ovarian Cancer, Version 1.2017

5

Treatment guide

Stages II, III, and IV ovarian cancer

Stages II, III, and IV ovarian cancer

Guide 6

shows the primary treatment options for

newly diagnosed stage II, III, and IV ovarian cancer.

For ovarian cancer confirmed by a prior surgery, see

Guide 7. Primary treatment is the main treatment

given to rid the body of cancer. The primary

treatment options depend on the cancer stage. The

cancer stage is a rating of how far the cancer has

grown and spread.

Stage II ovarian cancer is when cancer has spread to

nearby organs in the pelvis such as the other ovary,

the fallopian tubes, and the uterus. Stage III ovarian

cancer has spread outside the pelvis to tissues in

the abdomen. Stage IV ovarian cancer has spread

outside the abdomen to distant sites.

Primary treatment

Surgery is often used as primary treatment for

ovarian cancer. The type and extent of surgery

depends on the cancer stage. For more details about

each type of surgery, see page 35.

For stage II ovarian cancer, you will have surgery to

remove both ovaries, both fallopian tubes, the uterus,

and all cancer that can be seen. Surgical staging

procedures should also be done. This is to check for

cancer cells that have spread outside the pelvis and

can only be seen with a microscope. During surgical

staging, biopsy samples will be taken from nearby

organs and tissues where ovarian cancer often

spreads. The omentum and nearby lymph nodes will

also be removed.

For stage III or IV ovarian cancer, the treatment

options depend on how much tissue the cancer has

grown into. If the cancer hasn’t grown into a lot of

tissue and can be safely removed, then surgery is

recommended. In this case, surgery will remove both

ovaries, both fallopian tubes, the uterus, and all or as

much cancer as possible. Surgery may also remove

all or part of organs or tissues the cancer has spread

to. This is called debulking surgery or cytoreductive

surgery. It aims to reduce the amount of cancer in

your body as much as possible.

Guide 6. Primary treatment for newly diagnosed ovarian cancer

Cancer stage

Primary treatment options

Stage II, III, or IV

(surgery may be an option)

Cancer has spread to nearby organs

and tissues in the pelvis, outside the

pelvis, or outside the abdomen

ª

• Surgery to remove both ovaries, both fallopian tubes, and

the uterus + surgical staging + debulking as needed

Stage III or IV

(surgery may not be an option,

disease is large)

Cancer has spread outside the pelvis

to the tissue lining the abdomen and/or

to nearby lymph nodes, or cancer has

spread to organs outside the abdomen

ª

• Seek an expert opinion from a gynecologist oncologist

• Biopsy to confirm type of ovarian cancer

• Start chemotherapy to shrink the cancer (neoadjuvant

treatment), then surgery as described above