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NCCN Guidelines for Patients



Ovarian Cancer, Version 1.2017


Treatment guide

Stages II, III, and IV ovarian cancer

Treatment options

For stage II or III ovarian cancer, the treatment

options depend on how much cancer is left after

surgery. If no tumors 1 cm or larger remain, then

you have two options to choose from. One option is

to receive chemotherapy given in the abdomen and

some in the vein. The second option is to receive all

your chemotherapy given in a vein. If any remaining

tumors are 1 cm or larger, then you will receive

chemotherapy given in a vein. For stage IV ovarian

cancer, you will receive chemotherapy given in a


Chemotherapy given in the abdomen is called IP

chemotherapy. Chemotherapy given in a vein is

called IV chemotherapy. It is important to discuss the

differences between IP and IV chemotherapy with

your doctor.

Even if you had some chemotherapy before

surgery, you will likely have more chemotherapy

after surgery. A total of 6 to 8 chemotherapy cycles

is recommended for stage II, III, and IV ovarian

cancer. If you had 3 cycles before surgery, at least

three more cycles of chemotherapy after surgery is


Guide 8 also lists the chemotherapy regimens that

are recommended for stage II, III, and IV 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.

It is important that your kidneys are working well

if you may receive a combination of IV and IP

chemotherapy. Your doctor may give a blood test

to check for chemicals that your kidneys filter out of

your blood. High levels of certain chemicals may be

a sign that your kidneys aren’t working well. If you

have trouble doing daily activities, have a high risk

for neuropathy, or your kidneys aren’t working well,

then IP chemotherapy may not be a good treatment

option for you.

Testing during chemotherapy treatment

During treatment, your doctor will give tests to see

how well the chemotherapy is working and to check

for side effects. A physical and pelvic exam should 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.

Your doctor will also give some tests after

chemotherapy treatment is finished to check how

well it worked. An outcome or improvement related to

treatment is called a treatment response. Once the

treatment response is known, more treatment options

may be considered.