End stage ovarian cancer

End-of-Life Decisions for Ovarian Cancer Patients

An ovarian cancer diagnosis leaves you overwhelmed with emotions. You may feel angry, afraid, and confused — wanting to keep a positive attitude, but wanting to be realistic about the prognosis. Depending on your cancer stage, your ovarian cancer prognosis could be poor. Considering and preparing for the end of life shouldn’t make you feel like you’ve given up, but rather make you feel at peace and satisfied with your decisions.

Ovarian Cancer: End-of-Life Care Choices

If you reach a point where your ovarian cancer treatments are no longer successful and you choose only palliative (helpful, but non-curative) treatments to keep you comfortable, you’ll also need to choose how and where you want to be at the end of your illness. For women with ovarian cancer, especially late-stage or recurrent ovarian cancer, it is very important to make your wishes known.

You and your caregiver, family members, and other loved ones should discuss your options. You need to figure out what’s best for you, and how and where you’ll be most comfortable. But you should also consider the capabilities of your loved ones to take care of you and whether they can provide the end-of-life care that you need and deserve.

You can opt to be at a hospital or a nursing facility, to receive life-sustaining care or constant supervision. Many ovarian cancer patients want to be at home. Hospice care can be provided at home, as well as in a nursing facility or hospital. Hospice offers a medical team of support, usually including a nurse and certified nursing assistant, who all work under a doctor’s supervision. The hospice team also includes a chaplain and a social worker to help you, your caregiver, and your family.

Ovarian Cancer: A Personal Decision

Once your doctors have told you that treatment is no longer possible or helpful, it’s time to figure out how you want to handle the situation, and that decision is a personal one.

“Certainly in women for whom chemotherapy is no longer an option, where surgery isn’t going to help their course any further, then definitely at that point hospice is a consideration,” says Colleen Feltmate, MD, a gynecologist at Brigham and Women’s Hospital in Boston and the Dana Farber Cancer Institute’s Division of Gynecologic Oncology. “Hospice becomes helpful to the family and practitioners.”

Ovarian Cancer: Making the Decision

When choosing your end-of-life care support, think about what matters most to you and what will make you the most comfortable. Your decision also depends on what kind of support your family can offer you during the final stages of your illness.

“A lot depends on family support. We think it would be great for people to be home with their families at the end of their disease, but a lot of families may not have the capability or the emotional needs to take care of a family member who is going to die,” says Dr. Feltmate.

Hospice offers support for both patients and families, and will teach them the care skills they need to offer at home.

“Hospice provides education so families know what to expect, so that families know how to deal with things when they come up,” says Jane Cornett, MD, a physician with Hosparus of Louisville, a hospice organization in Louisville, Ky.

Dr. Cornett says agreeing to hospice care does not mean you’ve given up or are being negative. It just might be that aggressive care will no longer help you. With good symptom control that the hospice can offer, she says, ” you can find the ability to fight, to hope, and to keep going when your symptoms are controlled and you’re feeling better.”

Ovarian Cancer: Planning Brings Peace

Discussing and planning for end-of-life care with your caregiver and loved ones can bring a sense of peace to this difficult time. You deserve to have time with your family, in complete comfort and in a place that you have chosen.

Peter and Jean’s story

Jean started to struggle with bloating, abdominal pain and bowel symptoms – we knew something was wrong. Eventually, we managed to get an urgent appointment to see the GP, and Jean was diagnosed with cystitis. If I could live my life over again, I would have taken her to the hospital at this point. It is so important for GPs to be trained to spot these symptoms and associate them with ovarian cancer – that is why I’m telling our story.

When her symptoms persisted, we returned to our GP who referred her to a hospital consultant. Another few weeks passed, during which we decided to go away for the weekend, but we had to come home early. I called NHS 111 and a paramedic sent her straight to A&E. During an emergency operation the following day, doctors found abnormal cells and sent them for testing.

Treatment

Jean’s official diagnosis was stage III high grade serous fallopian tube carcinoma.

She had six cycles of carboplatin chemotherapy. After that, we were told to look out for the symptoms of ovarian cancer because it could be a sign that it was returning, so when Jean became bloated I immediately contacted Birmingham City Hospital. After an MRI scan she was put on another treatment.

Jean was determined to keep as active as she could, and I did my best to keep her involved. We both knew that her condition had advanced to a stage that meant her life expectancy was going to be seriously shortened, but she wanted to keep up her mental health, meet friends, go outside and live as normal a life as she could.

We reached a point when her oncologist told us that the clinical picture for Jean was one of disease progression, and she was switched to a new round of dose-dense carboplatin and gemcitabine chemotherapy. But then her CA125 level rose and she developed ascites. Her surgeon explained that he would carry out further surgery if he thought it would be beneficial, but he believed that it could cause further complications.

We realised we were coming to the end. The disease was progressing because Jean couldn’t have further chemotherapy, because she was too ill to cope with the side effects.

Climbing the stairs

Jean found she had less energy, but although we had a bed downstairs, she still went up and down the stairs every day. I put lots of family photos in the stairwell and I would say to her, “there’s no rush to get upstairs”. We’d climb the stairs together, slowly, and as we went up and down, we’d talk about all the things in the pictures, our family and all the things we’d done together over the years.

She continued to manage many things herself, but eventually she started to have more and more difficulty washing herself and doing up buttons. She became very bloated and had difficulty eating. We tried different types of nutritious soups and drinks. Our GP agreed that I could give Jean her morphine injections. My younger sister had had cancer and I remembered how much pain she had been in. I didn’t want Jean to go through that – and she didn’t. Although she had had good hospital care, she was determined that the hospital was not where she wanted to die. She wanted me to nurse her at home, which I did for the last six weeks of her life, but she had reached the point where she didn’t want anyone else to see her, not even our children or grandchildren. She wanted them to remember her as the lively person she had always been.

Because of Jean’s difficulty eating and weight loss, the hospice thought it might be a good idea for her to be admitted for symptom control. A bed was found for her very quickly, and within 3 days of her admission she had lost consciousness.

I spent much of each day with Jean at the hospice, but chose not to sleep there. I had seen so many people waiting in hospitals, hanging on for the end of someone’s life. When they finally did leave, they’d get to the end of the drive and the person they’d been waiting for would die. It’s almost as if, by leaving, they’d given the person permission to let go.

Smile

Jean died very peacefully at 6am on 15 December 2016.

It’s a strange thing to say, but as well as feeling very sad, I was relieved. She had been so alert and had led such an active life, that she would not have been able to cope with inactivity for very long.

Jean wanted her memorial service to be a happy occasion. We had three clergy, including a previous Bishop in Papua New Guinea, and played only joyful songs.

Losing Jean was a great challenge to my faith. She had given so much to so many people. Sometimes I’d ask myself why she was taken when she had more to give. One thing that helped a lot was preparing a commendation book so that people could write messages about her after she died. I didn’t want a situation where I didn’t talk about her and friends avoided talking about her, or a situation where I talked about her all the time. The book was a good way of talking about Jean in a natural way.

The reason I’m sharing my story now is that I want to raise awareness of the symptoms of ovarian cancer. If things had happened sooner, Jean could have responded better to treatment. I want to share my story to make more women and their husbands or partners aware of the need to push hard for their healthcare.

Before Jean died she made me promise two things, Firstly not to spend too long grieving, but to move on, and secondly to continue the interfaith, humanitarian, scouting and overseas health work we had worked on together. It was very hard, and adjustment has been very slow.

Now, as I sit here and look through Jean’s commendation book, two words stick out the most: ‘inspirational’ and ‘smile’. I only need to glance at the photographs in the stairwell to marvel at her courage and dignity, and see that Jean has a smile on her face in every single one. It’s wonderful to be able to reflect on that.

Find out more

  • Contact our nurse-led Support Line if you would like support, advice or information after reading this story
  • Join our TAKE OVAR campaign and help us raise awareness of the symptoms of ovarian cancer
  • Read our information for women with incurable ovarian cancer
  • Find out more about our support days for women with ovarian cancer

Palliative Care of the Patient With Advanced Gynecologic Cancer 

Cervical cancer tends to spread locally before it metastasizes to distant organs. When confined to the pelvis or regional lymph nodes, it may be cured with radical surgery, chemoradiation, or both. Despite advances in early detection, women without adequate screening can present with advanced stage disease. In the presence of distant metastasis, cervical cancer is generally not curable, and treatment is of palliative intent. Patients with advanced or recurrent cervical cancer may have any of the following symptoms:

· Vaginal bleeding or discharge

· Pelvic or back pain

· Anxiety and depression

· Urinary or bowel fistulas

· Lower extremity edema

· Deep venous thrombosis (DVT)

· Dyspnea from anemia or pulmonary involvement

· Uremia from ureteral obstruction

Vaginal bleeding

Available interventions to control vaginal bleeding include vaginal packing, radiation therapy, embolization of the uterine arteries, surgical resection, and arterial ligation. A Cochrane review of palliative measures to control vaginal bleeding in advanced cervical cancer, found no evidence supporting or refuting use of vaginal packing, tranexamic acid or interventional radiology approaches as compared to traditional radiotherapy.

Vaginal packing is usually a temporary measure. Gauze, lamb’s wool, or calcium alginate packing can be used. Monsel solution (ie, ferric subsulfate) applied to the packing or even formalin applied to only the tip of the packing may enhance this measure.

Other potentially helpful approaches include external beam radiation or brachytherapy. Type and length of radiation treatment should depend on the patient’s performance status.

Fulminant hemorrhage might require embolization of the uterine arteries, a procedure performed in the interventional radiology suite. If radiographically directed embolization is not available, laparotomy with ligation of the uterine arteries or the anterior divisions of the hypogastric arteries is another alternative, but should be used judiciously. A measure of this intensity is not appropriate when there is widespread dissemination of disease causing imminent threat to the patient’s life, but carefully selected patients may derive benefit. Symptomatic anemia from blood loss can be remedied with blood transfusions once bleeding is stopped.

Pain

Pain is often a very disabling symptom of advanced or recurrent cervical cancer. Regional nerve, muscle, and bone infiltration can cause severe discomfort. Goals of pain management are to optimize patient’s activities of daily living while also minimizing adverse side effects and substance abuse behavior. Reassessment of pain is necessary to confirm adequate control and management of adverse effects. Prior to prescribing narcotic analgesia, pain related to oncologic emergency must be ruled out. This includes bone fracture, threatened neural injury due to brain or spinal metastasis, acute abdomen or systemic infection.

Narcotic analgesics are a fundamental component of cancer pain treatment and may be prepared for oral, rectal, vaginal, sublingual, intravenous, intramuscular, epidural, or topical administration. Common adverse effects of narcotics include constipation, pruritus, nausea, drowsiness, and skin rash. Because constipation is almost universal with increasing doses of narcotics, a bowel stimulant should be prescribed simultaneously. For continuous pain, regularly scheduled opioids in long acting formulation should be given with supplemental doses for breakthrough. When initiating a long acting opioid, doses should be 50 to 100% of patients’ daily requirement. Breakthrough doses are prescribed at 10-20% of the total daily dose. Hospital or inpatient hospice admission may be required for control of severe pain crises.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antidepressant medications can often provide a favorable synergistic effect when prescribed concurrently with narcotics, especially for pain thought to be of neuropathic origin. A trial of anticonvulsant and topical agents can also be useful in neuropathic pain.

When pain is directly attributable to specific foci of disease, such as bone metastasis or para-aortic lymph node recurrence, a brief course of palliative radiation therapy yields substantial pain reduction in a high percentage of patients. However, pain relief may not be maximally achieved until 1-2 weeks after palliative radiation therapy. For diffuse bone pain, trial of bisphosphonate or denosumab can be considered.

Transdermal electrical nerve stimulation (TENS), massage therapy, and meditation or other biofeedback techniques are sometimes helpful adjuncts to narcotic therapy. Additionally, epidural analgesia can be particularly beneficial in patients with regional pain and significant side effects from systemic narcotic therapy. Interventional strategies also include neurodestructive procedures such as hypogastric plexus block for pelvic pain.

Anxiety and depression

Anxiety and depression are common comorbidities in patients with malignancy of any type and must be promptly recognized and treated. If they are not, pain control and patient compliance with other important therapies may be compromised. Patients at increased risk for anxiety/depression may display signs and symptoms of distress including poor sleep, poor concentration, feelings of anger and loss of control, preoccupation with illness and death and sadness about loss of usual health. Health care providers should screen for and acknowledge this distress. Referral to mental health professionals, counseling services and chaplaincy care should be offered with clinical evidence of moderate or severe distress . Effective therapies include anxiolytics, antidepressants, supportive counseling, spiritual counseling, and family support.

Fistulas

Advanced cervical cancer may cause urinary fistulas, vesicovaginal more commonly than ureterovaginal fistulas. Although not necessarily painful, fistulous drainage can have an extremely negative impact on quality of life. Because of constant odor, patients with fistulas may often choose to avoid social and family encounters, ultimately becoming housebound.

Palliation of fistulas may be surgically accomplished by creation of a ureterointestinal conduit or by placement of bilateral percutaneous nephrostomies to decompress the ureters. Both procedures require an external appliance and maintenance. Functional status, life expectancy, and operative risk should guide the selection of the means of palliation.

Placement of nephrostomy tubes is a simpler procedure than surgical diversion of ureteral outflow. The tubes can be a source of infection and do require changing every few months. Patients should also be educated regarding signs and symptoms of blockage as tubes can become kinked or dislodged.

Occasionally, rectovaginal fistulas occur from primary tumor invasion of the adjacent rectum. These more often result from radiation injury or tumor recurrence. A diverting colostomy is the surgical procedure of choice in someone with a limited lifespan. Diverting end colostomy is associated with fewer long-term complications than loop colostomy.

Edema

Edema may be generalized anasarca caused by protein depletion and malnutrition or may be localized to the legs as a consequence of lymphatic and/or venous obstruction due to a large tumor burden in pelvic lymph nodes. Symptomatic relief of edema and leg discomfort may be achieved by the use of graded compression stockings, elevation of the legs, and administration of diuretics. Physical therapists with training and expertise in lymphedema management can facilitate fluid drainage with external massage maneuvers and appropriate placement of compression bandages.

Deep venous thrombosis

DVT may cause secondary edema. Anticoagulation is standard treatment for DVT unless medically contraindicated. Current evidence shows that treatment with low molecular weight heparin is more effective and safe in cancer patients when compared to warfarin. Prolonged anticoagulation is often necessary, because DVT typically recurs in patients with incurable cancer. Anticoagulation prevents further extension of the thrombus and promotes gradual recanalization of the vessel as the thrombus is resorbed. At the same time, collateral vessels enlarge to accommodate more flow, and the net result is relief of extremity swelling and improved comfort for the patient.

Continued anticoagulation in palliative care patients with limited life expectancy is controversial. Some patients may find daily injections both painful and inconvenient. While therapy can initially provide improvement in symptoms, it may be of limited use at the end of life. Decision to stop anticoagulation therapy must be made on an individual basis by addressing specific goals of care.

Because anticoagulation might exacerbate hemorrhage from recurrent cancer in the pelvis or elsewhere, vena cava filters are sometimes preferable to prevent pulmonary emboli and can be used when anticoagulation is contraindicated.

Pulmonary complications of cervical cancer

In the patient with end-stage cancer, dyspnea may be caused by anemia, pleural effusion, infection, heart failure, or lymphangitic spread of cancer. Blood transfusions can ameliorate the dyspnea of anemia.

Thoracentesis and pleurodesis can improve the symptoms of a malignant pleural effusion. With pleurodesis, drainage of fluid is followed by pleural instillation of talc or doxycycline to sclerose the pleural lining. Video-assisted thorascopic sclerosis (VATS) may also be considered to achieve higher sclerosis efficacy with shorter inpatient admission time. Insertion of an indwelling pleural catheter is an alternative treatment to talc pleurodesis. Advantages of an indwelling pleural catheter are that placement is a same-day procedure and the catheter allows for patient drainage for symptom control as an outpatient. In a randomized trial comparing indwelling pleural catheters vs talc pleurodesis, there was no significant difference between both methods in controlling dyspnea symptoms for patients with malignant pleural effusion.

Pneumonia and heart failure should be treated as in the patient without cancer. Lymphangitic spread of cancer can cause hypoxia and dyspnea. Both oxygen and narcotics ameliorate this symptom (see dyspnea section).

Uremia

Progressive or recurrent cervical cancer may cause uremia secondary to ureteral obstruction. Uremia may induce nausea, vomiting, somnolence, confusion, and seizures. Untreated uremia is eventually fatal.

Death may be delayed if ureteral obstruction is relieved by percutaneous nephrostomy or ureteral stents. If other complications of disease progression have proven refractory to medical or surgical intervention, relieving ureteral obstruction to provide transiently improved excretion of uric acid and other waste products only prolongs the patient’s pain and suffering. Patient and family counseling are necessary to identify the point at which further medical intervention is inappropriate in this setting.

Nausea and vomiting

Nausea and vomiting can be a result of disease progression as well as various treatments. In progression of disease, mechanical obstruction of large or small bowel can produce nausea/vomiting. Patients may experience anxiety and anticipatory nausea related to chemotherapy treatments. Pretreatment with anti-emetics prior to chemotherapy often controls chemotherapy induced nausea and vomiting. Infection, central nervous system metastases, and metabolic derangements, such as uremia, can also cause nausea. Identifying cause of nausea/vomiting is important so treatment can be directed to underlying pathophysiologic mechanism.

Metabolic causes of nausea and vomiting can be relieved by correcting the metabolic imbalance. Hypercalcemia is an uncommon paraneoplastic manifestation of metastatic gynecologic cancer for which hydration, diuretics, steroids, calcium-binding agents, and bisphosphonates should be considered. In the palliative setting, multiple agents can be used for control of nausea and vomiting including phenothiazines, butyrophenones (e.g. haloperidol), anticholinergics, antihistamines, steroids, or 5HT-3 antagonists. For nonspecific nausea and vomiting, National Comprehensive Cancer Network (NCCN) guidelines recommend initiation of dopamine receptor antagonist (e.g. prochlorperazine, haloperidol, metoclopramide, olanzapine) that can be titrated to maximum benefit. If symptoms persist, a combination of therapy can be used by adding an anticholinergic (e.g. scopolamine), antihistamine and/or cannabinoid. Patients with anxiety related nausea may benefit from addition of benzodiazepine.

Nausea and vomiting caused by brain metastases can be improved through the use of radiation therapy and steroids. Nausea related to slow bowel transit or carcinomatosis ileus can be improved with prokinetic activity of metoclopramide, its use is contraindicated in cases of obstruction and should be used with caution in combination with phenothiazines due to risk of extrapyramidal symptoms.

Diarrhea

Diarrhea can also accompany advanced or recurrent cervical cancer. While loose bowel movements are a frequent result of acute lower gastrointestinal toxicity from pelvic radiotherapy, this effect nearly always resolves within a few weeks after treatment is completed. Agents that reduce diarrhea include anticholinergics and opiate derivatives, such as loperamide, diphenoxylate and atropine. Hydration and electrolyte repletion should be encouraged with a bland diet. If diarrhea is severe with >7 stools a day, inpatient hospital admission may be necessary with IV fluid hydration and antidiarrheals. C diff infection and fecal impaction should be ruled out.

Occasionally, diarrhea remains a long-term adverse effect following successful treatment of cervical cancer. A suspected contributing influence is chronic mucosal change within the terminal ileum (where bile acid reabsorption can be impaired) from radiation therapy, especially when patients experience exacerbation with intake of fatty foods. Dietary modification can be particularly helpful in this regard. Ultimately some patients will require small bowel resection or bypass.

The 4 Stages of Ovarian Cancer, Explained

If you’re diagnosed with ovarian cancer, doctors will assign the cancer one of four “stages.” These categories are based on how far the cancer has spread. Stage 1 means the tumor has not spread beyond the ovary. Stage 4 is the most advanced and signifies that the cancer has spread around the body. Each stage also has subcategories.

Ovarian cancer staging is determined by three things: the size of the tumor; whether the cancer has spread to the lymph nodes; and whether the cancer cells have metastasized to organs that are farther away (like the liver) or to the fluid around the lungs.

Staging is one of the first steps in figuring out how to deal with cancer. “Staging determines further treatment and it determines prognosis,” says Otis Brawley, MD, chief medical officer of the American Cancer Society. “Usually clinical stages 1, 2, and 3 are going to get some type of surgery with the intention to try to cure. Stage 4 is not going to get surgery unless it’s for purposes of palliation.”

Everyone is different and every cancer is different. The stage of your ovarian cancer at the time you’re diagnosed doesn’t seal your fate. But it does give you valuable information to help navigate the days ahead.

Here are the four stages of ovarian cancer and the typical treatments for each.

RELATED: 8 Ways to Lower Your Ovarian Cancer Risk

Stage 1 ovarian cancer

Stage 1 tumors are confined to the ovaries or fallopian tubes and have not spread at all.

This type of tumor is the easiest to treat, even cure. Overall, women who are diagnosed with stage 1 ovarian cancer have a 90% chance of still being alive five years later. Many will also live many years beyond that.

There are subtypes of stage 1 ovarian cancer. Stage 1A means the cancer is only in one ovary or fallopian tube. “This is an important stage because the tumor is basically confined to one ovary and not growing into anything else and it can be removed completely intact,” says David Kushner, MD, professor of gynecologic oncology at the University of Wisconsin School of Medicine and Public Health. In some cases, women with stage 1A ovarian cancer can skip chemo.

Stage 1B is when the cancer has reached both ovaries or fallopian tubes but no farther. Stage 1C means the cancer is still on the inside of both ovaries or fallopian tubes and has also broken through the surface of the ovary to reach the outside. This could happen before surgery or during surgery (called intraoperative surgical spill). Ovarian cancer cells may also be found in the fluid in the abdomen.

RELATED: How to Know If You Should Get Genetic Testing for Ovarian Cancer

Stage 2 ovarian cancer

In stage 2 ovarian cancer, the tumor is still in the ovaries and fallopian tubes but has also started spreading to nearby organs in the pelvis.

“Stage 2 means that the tumor has actually come in contact with and spread to other organs nearby,” says Dr. Brawley. ”This could be the uterus or fallopian tubes, in the case of 2A. Stage 2B means that it has grown into other nearby organs like the colon, bladder, or rectum.”

Overall, the five-year survival rate for this stage is 70%. Treatment usually consists of surgery and chemotherapy.

RELATED: 5 Signs Your Bloating Could Be Something Serious

Stage 3 ovarian cancer

By stage 3, an ovarian cancer tumor is still in one or both ovaries or fallopian tubes but has started to spread even farther. Stage 3A is divided into two categories. In Stage 3A1, the cancer is still in one or both ovaries and is found in the lymph nodes. In Stage 3A2, the cancer may or may not be in the lymph nodes, but microscopic cells have spread to the abdominal cavity.

Stage 3B means the tumor is in one or both ovaries or fallopian tubes and outside the pelvis. The doctor can actually see the cancer that is in the abdomen now, but it’s still no bigger than 2 centimeters in diameter. It may or may not be in the lymph nodes.

By Stage 3C, the cancer has spread from the pelvis to the abdomen and is bigger than 2 centimeters. It may even have reached the surface of more distant organs like the liver or spleen. Again, the lymph nodes may or may not be affected.

This type of ovarian cancer is treated much the same as stage 2 cancer, with surgery to remove the affected organs then chemo and perhaps more surgery. The overall five-year survival for stage 3 ovarian cancer drops to 39%.

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Stage 4 ovarian cancer

Stage 4 is the most advanced stage of ovarian cancer. Here, the cancer has metastasized far beyond the ovaries and/or fallopian tubes. In stage 4A, cancer cells are found in the fluid around the lungs. In 4B, they’ve moved even farther to the inside of the spleen, liver, lungs, brain, or other organs far away from the original tumor, as well as to lymph nodes located in the groin.

When the cancer is this advanced, says Dr. Brawley, doctors stop trying to cure it. Treatment–including chemotherapy, surgery, and other palliative procedures–is focused on making the patient comfortable. The five-year survival rate for stage 4 ovarian cancer is 17%.

Advanced Ovarian Cancer: What Happens Next?

Once your doctor knows the type of ovarian cancer you have and its stage, it’s time to decide on your treatment. The following are the main treatments for ovarian cancer:

  • Surgery is the primary treatment for ovarian cancer, but it’s not a treatment everyone needs. Removing the tumor can also mean removing a portion of your ovary, which may help slow or stop the cancer’s progression. In some cases, the entire ovary or both ovaries are removed. Some women may decide to remove both ovaries and their uterus and fallopian tubes.
  • Chemotherapy is a type of drug treatment designed for cancer. The medication enters your bloodstream and then finds and destroys cancerous cells. Chemotherapy is often very effective, but it can also damage the body’s healthy cells.
  • Hormone therapy is designed to reduce or block hormone production. Some hormones help certain tumors grow and spread. With reduced hormone levels, the cancer may not grow or spread as quickly.
  • Radiation therapy is a type of treatment that uses X-rays and high-energy particles to destroy cancer cells. It’s most often used to treat ovarian cancer that has spread or metastasized beyond the ovaries.
  • Targeted therapy is a newer treatment that aims to reduce the damage done to healthy cells while it targets and destroys the cancerous cells. Targeted therapy drugs are different from chemotherapy because they seek out cancerous cells and destroy them. By destroying the targeted cells, this type of therapy can slow cancer progression.

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