The first and main pillar in the therapy of patients with ovarian cancer is surgery by a vertical section of the abdomen (vertical laparotomy). During surgery, the experienced surgeon can closely inspect the abdomen and evaluate the spread of the tumour. It still often happens that a reliable diagnosis can only be made during surgery. In this case the extracted suspicious tissue is histologically examined with the so-called frozen section procedure or cryosection.
During surgery, both ovaries and the tubes, which together are called adnexa, are removed. Furthermore, the removal of the uterus and the greater omentum as well as the removal of lymph nodes in the area of the pelvis and the abdomen (systematic lymphonodectomy) are part of the standard surgical treatment. Depending on the tumourspread, the removal of additional structures such as the peritoneum or parts of the large or small intestine may be needed. In this case the insertion of a temporary or permanent artificial anus (stoma) can be necessary.
Surgery of ovarian cancer is therefore a big intervention in order to remove every visible tumour lesion. This surgery should only be performed by well trained and very experienced gynaecologic surgeons. Therefore, it is well advised that such a surgery is performed in one of the big renowned centres.
The surgical treatment is usually followed by the second pillar of the treatment: chemotherapy with at least six cycles of carboplatin and paclitaxel. This standard combination has proven to be the best option in the accompanying chemotherapy following surgery (adjuvant chemotherapy). With medicamentous and non-medicamentous measures it is possible to counteract – at least to a great extent – the often feared adverse effects such as nausea. As also more serious adverse effects, e.g. a temporary decrease in certain blood cells can occur during chemotherapy, continuous care, supervision and collaboration between physician and patient are necessary.
Apart from the classical chemotherapy, more recent treatments, so-called targeted therapies, are already used or are still being tested regarding their clinical efficacy and dose. These drugs target specific altered structures in the cancer cells and are supposed to suppress further tumour growth. One such drug is ganetespib, which attacks the altered (mutant) protein p53 through a certain molecular mechanism. The mutant p53 molecule plays a central role in relation to aggressiveness and resistance to chemotherapy in ovarian cancer.