Stage II ovarian cancer is limited to the ovaries and other pelvic organs, but has not spread to the upper abdomen, lymph nodes or sites outside the abdomen. Each person with stage II ovarian cancer is unique, and the specific characteristics of your condition will determine how it is managed. The information on this Web site is intended to help educate you about treatment options and to facilitate a shared decision-making process with your treating physician.
The combination of cytoreductive surgery and chemotherapy treatment is the standard of care for treatment of stage II ovarian cancer. Individuals with stage IIA disease experience cancer recurrence rates of 30-40% and those in patients with more advanced stage IIB disease are even greater. This is because patients with stage II ovarian cancer are often left with microscopic disease following surgery and currently available chemotherapy is unable to eradicate all of the remaining cancer.1,2,3,4,5,6,7
Surgical cytoreduction (also called debulking) refers to the surgical removal of as much of the cancer as possible. Cytoreduction is beneficial because it reduces the number of cancer cells that ultimately need to be destroyed by chemotherapy and therefore, decreases the likelihood of the cancer developing a resistance to chemotherapy. Initial cytoreductive surgery in ovarian cancer is currently considered the standard of care because clinical studies have shown that patients who have had optimal cytoreduction live longer and have a longer time to cancer recurrence than patients who have had suboptimal cytoreduction.
Following cytoreductive surgery, all patients with stage II ovarian cancer are offered additional systemic treatment with the goal of destroying any remaining cancer not removed by surgery. Currently, this treatment is chemotherapy.
Neoadjuvant chemotherapy (NACT) refers to chemotherapy that is given prior to surgery. When surgery is performed after chemotherapy treatment, it is referred to as interval cytoreduction. Neoadjuvant chemotherapy can reduce the size of the cancer, thereby allowing easier surgical removal and more effective results from the subsequent chemotherapy.
Adjuvant Systemic Therapy
The delivery of cancer treatment following local treatment with surgery is referred to as “adjuvant” therapy and may include chemotherapy, precision cancer medicines, radiation therapy and/or immunotherapy.
Adjuvant chemotherapy is administered to decrease the risk of cancer recurrence following recovery from surgery because clinical trials have demonstrated that adjuvant chemotherapy improves survival compared to treatment with surgery alone. Standard systemic therapy typically consists of a platinum and taxane chemotherapy drug, however several other chemotherapy and precision cancer medicine drugs are available, and others are being developed in clinical trials.
Because many patients still experience recurrence of their cancer following standard therapy, patients should consider participation in clinical trials evaluating new treatment approaches as their initial option.
Before deciding to receive adjuvant systemic therapy treatment or to participate in a clinical trial, women should ensure they understand the answer to 3 questions:
- What is my prognosis (risk of cancer recurrence) without adjuvant therapy treatment?
- How will my prognosis be improved with adjuvant treatment?
- What are the risks of treatment?
Upon completion of adjuvant systemic therapy doctors perform a series of tests in order to determine the effectiveness of treatment. These typically include a CT or MRI of the chest/abdomen/pelvis and a CA-125. The cancer will either be undetectable (a complete response) or still present. If cancer remains additional therapy for recurrent or resistant disease will be offered.
If a complete response or remission is achieved patients should discuss the potential benefits of additional maintenance therapy with their doctor. This is a lower dose therapy designed to prolong the remission and improve the chance of cure.
Maintenance Therapy: Consolidation therapy, also called maintenance therapy, refers to extra systemic therapy that is given after completion of standard adjuvant chemotherapy. Maintenance therapy with the PARP inhibitors or Avastin have both been demonstrated to improve outcomes in select patients with stage III or IV ovarian cancer and are being evaluated in stage II disease.1,2,3,4,5,6,7
2 Shapira-Frommer R, Oza AM, Domchek SM, et al. A phase II open-label, multicenter study of single-agent rucaparib in the treatment of patients with relapsed ovarian cancer and a deleterious BRCA mutation. Journal of Clinical Oncology. 33, 2015 (supplement; abstract 5513).
3 Tesaro Inc., press release. Tesaro’s niraparib significantly improved progression-free survival for patients with ovarian cancer in both cohorts of the phase 3 NOVA trial. Available at: http://ir.tesarobio.com/releasedetail.cfm?ReleaseID=977524. Accessed July 6, 2016.
4 Genetech. (2016.) FDA Approves Genetech’s Avastin® (Bevacizumab) Plus Chemotherapy for a Specific Type of Advanced Ovarian Cancer. [Press release.] Can be retrieved from https://www.gene.com/media/press-releases/14647/2016-12-06/fda-approves-genentechs-avastin-bevacizu
5 Armstrong DK, Bundy B, Lenzel L et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. New England Journal of Medicine. 2006;354:34-43.
6 ACOG Committee on Gynecologic Practice. Intraperitoneal chemotherapy for ovarian cancer. Obstetrics and Gynecology. 2008;111:249-251.
7 Markman M, Liu PY, Wilczynski S et al. Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxel-based chemotherapy: A Southwest Oncology Group and Gynecologic Oncology Group trial. Journal of Clinical Oncology. 2003;