Current ovarian cancer care uses cytoreductive surgery and platinum-taxane chemotherapy as core therapies, supplemented by targeted maintenance (notably PARP inhibitors for BRCA/HRD-positive disease) and, in select cases, anti-angiogenic agents, intraperitoneal approaches, or radiation for symptom control. Genetic testing, multidisciplinary planning, and clinical trials guide personalized treatment and survivorship planning.
Overview
Treatment for ovarian cancer now relies on a multimodal approach tailored to tumor type, stage, genetics, and patient goals. The three traditional pillars - surgery, chemotherapy, and radiation - remain important, but targeted and maintenance therapies, genetics-driven decisions, and supportive care have changed how clinicians plan treatment.
Surgery: cytoreduction and fertility considerations
Surgery is often the first step for epithelial ovarian cancer. The goal is cytoreduction (debulking) to remove as much tumor as possible, because lower residual disease improves chemotherapy response and outcomes. Surgeons may perform removal of one or both ovaries and fallopian tubes, the uterus, and visible tumor from the abdomen and pelvis.
For selected patients with widespread disease, doctors may give chemotherapy first (neoadjuvant) and perform interval debulking later. In carefully chosen early-stage cases, fertility-sparing surgery is an option; specialists will discuss risks and alternatives.
Minimally invasive and robotic approaches are used for some early tumors, while extensive open procedures remain necessary for advanced disease. Multidisciplinary surgical planning improves safety and outcomes.
Chemotherapy and targeted systemic therapy
Platinum-based chemotherapy (commonly carboplatin) combined with a taxane (commonly paclitaxel) remains the backbone of systemic treatment for most ovarian cancers. Chemotherapy is usually delivered in cycles, and side effects such as fatigue, nausea, neuropathy, and low blood counts are managed proactively.
Targeted and maintenance therapies now play major roles. PARP inhibitors (for example, olaparib, niraparib, rucaparib) are widely used as maintenance therapy after response to chemotherapy, especially for patients with BRCA mutations or homologous recombination deficiency (HRD). Anti-angiogenic therapy (bevacizumab) is another option in frontline and recurrent settings for selected patients.
Immunotherapy (checkpoint inhibitors) has limited activity in unselected ovarian cancer but is an active area of research and may benefit some patients in trials.
Intraperitoneal and intraoperative options
Delivering chemotherapy directly into the abdomen (intraperitoneal chemotherapy) or heated intraperitoneal chemotherapy (HIPEC) at the time of surgery is offered in specialized centers for selected patients. These approaches aim to increase local drug concentration and improve local control; clinicians will weigh potential benefits and risks case by case.
Radiation therapy
Radiation is less commonly used as primary therapy for ovarian cancer. Clinicians employ it for targeted palliation of symptoms, isolated recurrences, or when local control is required. Modern techniques can focus doses and limit exposure to normal tissue.
Personalized care, genetic testing, and clinical trials
Guidelines recommend genetic testing (including BRCA) and tumor profiling for most patients with epithelial ovarian cancer because results guide treatment choices and family risk management. Treatment decisions involve gynecologic oncologists, medical oncologists, genetic counselors, and supportive-care teams.
Clinical trials remain important for access to new agents and approaches. Palliative care and survivorship planning should begin early to manage symptoms, long-term effects, and quality of life.
Making decisions
Each treatment plan balances tumor biology, stage, patient preferences, and goals such as fertility preservation. Clear communication with the care team and consideration of clinical trials help patients choose evidence-based options and supportive care.