The primary treatment for ovarian and fallopian tube cancer is surgery and chemotherapy. The goal is to remove all of the tumor tissue and achieve a correct stage determination.
Patients with ovarian cancer in stage I in the low-risk group do not need chemotherapy. All other patients needs postoperative chemotherapy. Early stage fallopian tube cancer (£ stage II) may have a different biology from ovarian cancer. Many patients have lymph node metastases, therefore, a pelvic and paraaortal lymph node dissection is recommended during the primary operation. Stage I with infiltration of serosal tissue or tumor rupture increases the frequency of recurrence. Adjuvant chemotherapy may be considered.
Patients with poor general health condition, or high probability that the tumor cannot be completely resected, may be candidates for neoadjuvant chemotherapy, postponing the operation until after three cycles.
- Borderline ovarian cancer can usually be treated with surgery alone, even in advanced cases. This type of tumor is slow-growing and does not respond well to chemotherapy.
- Non-epithelial ovarian cancer is generally sensitive to chemotherapy and radiation therapy, but due to side effects, radiation therapy is not widely used.
- Germ cell tumors are high-grade malignant tumors which respond well to treatment with chemotherapy and radiation therapy. These tumors are often unilateral. Due to the sensitivity to chemotherapy, conservative surgery may be carried out and the patient will most often preserve her fertility.
Radiation therapy is not often used, except in specific palliative situations.
For recurrence of ovarian or fallopian tube cancer, where recurrence is twelve months or more after primary treatment, it is recommended to operate before starting chemotherapy, in some cases. For most patients, immediate chemotherapy is started.