NCCN Guidelines for Patients® | Ovarian Cancer
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52

NCCN Guidelines for Patients

®

:

Ovarian Cancer, Version 1.2017

5

Treatment guide

Stages II, III, and IV ovarian cancer

The goal is to not leave behind any tumors that are

1 cm or larger. Surgical staging isn’t needed because

the cancer has spread outside the pelvis.

If the cancer has grown into a lot of tissue, it

might not be possible to safely remove it all with

initial surgery. Your doctors may decide to give

chemotherapy first to try to shrink the cancer before

surgery. This is called preoperative or neoadjuvant

chemotherapy. (See Guide 2 on page 38 for

chemotherapy recommendations.) It is important

that a gynecologic oncologist is involved in this

assessment and treatment decision. You will likely

have a biopsy (core biopsy preferred) to confirm

ovarian cancer before starting chemotherapy

treatment.

After a few cycles of chemotherapy, your doctor will

check the status of the cancer. If your doctor thinks

all the cancer can be safely removed, then you will

have surgery as described above. You will likely then

receive additional chemotherapy after an interval

surgery.

Next steps

After primary treatment for newly diagnosed stage II,

III, and IV ovarian cancer, see Guide 8 on page 54

for treatments that are recommended next.

Guide 7

shows the primary treatment options for

stage II, III, and IV ovarian cancers confirmed by a

prior surgery or biopsy. 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.

Surgery is often used as primary treatment for

ovarian cancer. But, there is more than one option

and more than one type of surgery to choose from.

Which option is best for you depends on a few key

factors.

If the remaining cancer can likely be removed, then

tumor reductive surgery is recommended. Your

doctor will remove as much as the cancer as he or

she possibly can. This is called tumor reduction or a

“debulking” procedure.

If all the remaining cancer likely can’t be removed,

then chemotherapy may be given in a vein to try

to shrink the cancer before surgery. This is called

neoadjuvant treatment. After a few cycles of

chemotherapy, your doctors will check the status of

the cancer. If your doctors think all the cancer can

be safely removed, then you will have completion

surgery as described above. Completion surgery

after 3 cycles of chemotherapy is preferred. But,

surgery may be performed after 4 to 6 cycles based

on your doctor’s judgment.