Chemotherapy Decision-Making for Ovarian Cancer

Factors Related to the Tumor

The decision to give chemotherapy is dependent on a lot of factors.  “It depends on the stage of the tumor, the grade, the underlying medical conditions of the patient, and the patient's ability to tolerate treatment," explains Dr. Lynn Parker, a gynecologic oncologist at Norton Cancer Institute in Louisville. "It really depends on the grade of the tumor, meaning how aggressive it looks under the microscope," explains Dr. Parker.

Tumors are staged and graded on a numerical scale. Tumors are staged from I to IV (the stages are listed as Roman numerals), and graded from 1 to 3. A cancer that is evaluated as Grade 1, for instance, has cells that are close to normal. These tumors tend to grow and spread slowly. On the other end of the spectrum, Grade 3 tumor cells are very different looking from normal cells or tissue. And they tend to grow rapidly and spread more quickly. Grade 3 is often referred to as “high-grade.”

Similarly, like grades, the stages of a tumor also progress numerically. A Stage I tumor is confined to the ovaries and fallopian tubes, but a Stage IV cancer has spread far beyond its initial location, and is affecting organs and tissues in the pelvis and abdomen, and beyond.

"If a woman's cancer is Stage IA, the earliest stage possible, they might not need any chemotherapy at all," explains Dr. Parker. "Some people with Stage I who have a higher grade cancer or more involvement on the surface of the ovary, for example, might need three chemotherapy treatments. But if you have more advanced diseasestage II to III, you may benefit from six treatments." Unfortunately, because symptoms are often minimal or at the very least vague until the tumor has been growing for a while, most women are diagnosed when the cancer is considered advanced.

Six chemotherapy treatments are standard, and sometimes all six are given after surgery is performed, and sometimes three are given in advance of surgery and three given afterwards. And the standard chemotherapy combination of drugs is a platinum-based drug like carboplatin and a drug from the taxene family like Taxol.

Factors Related to the Patient

Dr. Parker explains that chemotherapy decisions also have to take into account the underlying medical conditions of the patient and the patient's ability to tolerate treatment. While the combination of paclitaxel and carboplatin is standard therapy for ovarian cancer, some patients may not be good candidates to receive both drugs at once. They might have other medical conditions that contraindicate it, or they might be considered too frail to tolerate the therapy well, and need to build up their strength first.

For those patients, "you can actually use carboplatin by itself to start off with, and that is incredibly well tolerated," says Dr. Parker. "And for somebody who is frail, and the frailty is causing symptoms, we can at least start carboplatin and get the tumor to respond. After that their nutrition gets better, they're able to move around, they're stronger. And then we can add the Taxol into the mix. I can assure them that these are responsive cancers, we can use chemotherapy and get a good result, you can do well. I think that's incredibly important."

Gynecologic oncologists are skilled at taking these factors into account and making a well-considered chemotherapy decision for every woman with ovarian cancer.

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