Ovarian Cancer

Treatment decisions for ovarian cancer

Treatment of ovarian cancer is influenced by many factors - age, general health, type and size of tumour, what it looks like under the microscope and whether it has spread beyond the ovary. Doctors usually recommend whatever treatment they believe would give the patient the best possible result. However, all treatments involve a trade-off between benefits and side effects and very few doctors know much about their patients' priorities. When choices are to be made many doctors now recognise that patients want to be involved.

At the time of diagnosis most women know little about ovarian cancer or the treatment options and tend to rely on their doctors to recommend the treatment that offers the best possible chance of cure. As they learnt more about their disease and the treatment options, some women became fully involved in treatment decisions, or even took control. 

Women who remembered being involved in decisions talked about consent to surgery, whether to take part in a clinical trial (see 'Clinical trials'), choices about the order of the surgery and chemotherapy, whether and which type of chemotherapy to have, whether to use a cold cap to minimise hair loss and, in a few cases, whether to have radiotherapy. 

Some women were asked for written consent before surgery to removal of certain organs if during the operation they were found to be affected by cancer. A woman of child-bearing age was asked to agree to her other ovary being removed if necessary, a move that would make her infertile. Others agreed to a possible hysterectomy in addition to removal of their affected ovaries. One woman doubted that there was no disadvantage to having a hysterectomy and checked what she had been told with a medical friend. A woman who initially had one ovary and her tumour removed was later offered a hysterectomy.

Others were asked to consent to a colostomy in case part of the bowel had to be removed. One woman decided against this because she would feel she'd had enough if it had spread to her bowel. Sometimes women asked if they could have more than one surgical procedure done at once: a couple of women who were to have surgical biopsies had asked their surgeons to take out anything that they found to be affected at the same time.

One woman was offered chemotherapy followed by surgery but asked to have the surgery first because she believed her post-operative recovery would be slower after chemotherapy had weakened her immune system. Women whose surgery brings on an early menopause are usually offered the choice of hormone replacement therapy (HRT) (see 'Menopause'). 

A few women had to decide whether or not to have chemotherapy as well as surgery. A woman who initially had not wanted it described how her oncologist gently convinced her that it would be a good idea. A woman who didn't want the steroids that are often given with chemotherapy was persuaded to accept a lower dose than usual. One woman had to choose because her surgeon and oncologist disagreed on the need for chemotherapy. Another said she was almost relieved when the decision was taken out of her hands when the laboratory results from her operation showed tumour cells in her abdomen. A woman who was told her cancer was too advanced for any treatment said she could not believe it because she felt so well. She demanded chemotherapy, to which her tumour responded well.

Some women were invited to choose between carboplatin chemotherapy alone or in combination with paclitaxel (Taxol), which can be harder to tolerate. One woman wanted to minimise the effects of treatment on her life and decided against paclitaxel. 

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Radiotherapy is rarely used as a first-line treatment for ovarian cancer, but one woman was offered it after her chemotherapy. Another who was receiving radiotherapy for a recurrence of her cancer was offered a 'booster' treatment without explanation of what this meant.

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No-one we talked to had refused conventional medical treatment in favour of alternative therapies or no treatment, although several knew they could. One woman decided to postpone a course of chemotherapy for a recurrence of her cancer because she had a hard time with chemotherapy and was not feeling emotionally strong enough to endure it. Others who had recurrences treated several times had decided against, or become resigned to, having no further treatment.

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Patients and doctors are often uncertain how best to share in decisions about treatments. Many women said they trusted their doctors' judgment completely and would accept whatever treatment they suggested. Sometimes the doctor made it clear that there was a choice, while also giving a clear steer about what they thought was the best option. Being asked about their preferences can surprise or shock women. Some worried that not accepting the doctor's advice would prejudice their future care. Others stressed the importance of feeling involved and knowing that doctors will both discuss and respect the decision, even if their choice would have differed.

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The government recommends that women with ovarian cancer be treated by a specialist gynaecological cancer team. These teams are usually based in larger cancer centres, so you may have to travel for your treatment.

When a diagnosis of ovarian cancer has been made a team of specialists, multidisciplinary team (MDT), will meet to discuss and agree on the plan of treatment that is best for your situation. The team will include: 

1.   A surgeon who specialises in gynaecological cancers called a gynaecological oncologist.

2.   A clinical or medical oncologist (to advise on chemotherapy).

3.   A radiologist (who analyses x-rays).

4.   A pathologist (who advises on the type and grade of the cancer, and how far it has spread).

The team may also include a number of other healthcare professionals such as a'

1.   Gynaecological oncology nurse specialist

2.   Dietitian

3.   Physiotherapist

4.   Occupational therapist

5.  Psychologist or counsellor.

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Last reviewed June 2016.
Last updated June 2016.


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