Chemotherapy for ovarian cancer

We often hear the question of whether ovarian cancer is a death sentence. Is chemotherapy necessary for ovarian cancer or is it a thing of the past? Let's figure it out.

Ovarian cancer is the second most common cancer after uterine cancer and is one of the most common causes of death among all malignant oncology. The cause of cancerous tumors is generally not fully understood. It is generally accepted that heredity, toxic substances, and infections play a role in the development of this disease. The presence of ovarian cancer in several close relatives - mother, daughter, or sister - increases the risk of developing the disease by half and contributes to its development ten years earlier. There are four stages of the disease:

• Stage one – the ovary is affected, usually on one side.
• At the second stage, both ovaries are involved in the malignant process.
• Stage 3: Cancer spreads to the omentum.
• Stage four: cancer cells invade neighboring organs and metastatically spread throughout the body.

The age of sixty is considered the peak age for the disease. Women under forty-five rarely get sick.

The initial stages of the disease most often occur without obvious clinical manifestations. Symptoms such as irregular menstrual cycles, problems with urination and defecation (constipation), distending and pressing pain in the lower abdomen, pain during sex, bloating, and occasionally bloody discharge in the middle of the menstrual cycle are often noted; exudate may be present in the pelvis and abdominal cavity.

The main and objective sign of ovarian cancer is considered to be the detection of a motionless, voluminous, lumpy or rough formation in the pelvis. If a woman's appendages are easily palpated after menopause, this may also indicate the presence of a tumor.

Among the leading directions of ovarian cancer treatment is combined therapy, which includes surgical treatment and chemotherapy. Radiation therapy is very rarely used for this disease. Currently, radiosurgery is gaining popularity in the treatment of cancer, in particular malignant ovarian tumors. The method is practically painless, bloodless, and does not damage healthy tissue. Radioactive rays are directed to the place where the cancerous tumor is located using so-called gamma knives. The location of the tumor must be calculated very accurately. But this method is applicable only to small tumors.

If the patient has early stages of the disease, the ovary affected by cancer is removed. If the uterus is involved, the ovaries, uterus and fallopian tubes are removed. The fact is that it is never possible to completely rule out errors in diagnosis, so specialists in the field of gynecological oncology believe that it is better to be on the safe side. Despite all the advances in medicine, surgery combined with chemotherapy is considered the main method of treating ovarian cancer today.

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Indications for chemotherapy for ovarian cancer

Every patient who has undergone surgery for ovarian cancer must undergo chemotherapy. Indications for chemotherapy for ovarian cancer are:

• Ovarian cancer of the first b-fourth stage, confirmed by histology and cytology.
• The woman's general health status does not exceed two on the WHO activity scale.
• Radical removal of a malignant ovarian tumor in order to prevent the development of metastases, as well as recurrence of malignant ovarian tumors.
• To slow the growth of stage three and four tumors during their partial removal.
• When surgery is performed to relieve a woman's condition if the tumor cannot be removed. In this case, chemotherapy increases survival.
• Before surgery to increase its effectiveness and reduce the scope of the operation.

Chemotherapy for ovarian cancer may be prescribed in the following cases:

• after surgery to completely remove the tumor, to prevent the development of metastases and tumor recurrence;
• after surgery to partially remove stage III or IV tumors, to inhibit growth or destroy the remains of malignant tissue;
• after palliative treatment, when the operation is not performed radically, but only to alleviate the patient's condition; in this case, chemotherapy can significantly affect the survival of cancer patients;
• before surgery, to improve the effectiveness of the operation.

After surgery, at least 3 courses of chemotherapy are usually administered:

• immediately in the postoperative period;
• 40-60 days after surgery;
• 90-120 days after the second course.

Further, at the doctor’s discretion, chemotherapy can be carried out every six months.

Chemotherapy course for ovarian cancer

After surgical treatment of a malignant ovarian tumor, chemotherapy courses are almost always administered. Chemotherapy for ovarian cancer is administered on average in three to four (or more) courses. The woman undergoes the first course immediately after the operation, and the following ones: after one and a half to two months - the second course, after three to four months - the third, if more are needed, they are administered every six months.

During the first course of chemotherapy for ovarian cancer, the patient receives the largest amount of the drug, and during subsequent courses, the dose should be no less than seventy-five percent of the previous one. To achieve long-term survival, chemotherapy for ovarian cancer is continued for one to three years.

Chemotherapy treatment of ovarian cancer has its own peculiarities. They are related to the fact that the neoplasm of the appendages cannot be seen with the naked eye before surgery. For this reason, if the patient is not supposed to undergo surgery, then a course of chemotherapy is prescribed to ensure that the tumor is destroyed. Even after surgery, chemotherapy can serve as a preventive measure against the recurrence of the tumor.

• Chemotherapy treatment can be carried out at all stages of the disease: to destroy the tumor, to slow its growth, to prevent metastases.
• Chemotherapy has quite a lot of side effects, which we will discuss below. But the undeniable advantage of chemotherapy drugs is that they affect all tissues of the body, and this significantly reduces the risk of developing near and distant metastases.
• Treatment with chemotherapy drugs has advantages even over radiation therapy, since the active substances of such drugs penetrate directly into the lesion via the blood or lymph flow.
• Chemotherapy affects even those cancer cells that are already growing and actively multiplying, but have not yet revealed themselves with specific symptoms (latent cancer).
• Chemotherapy is an important stage of cancer treatment, and it should not be abandoned.

Chemotherapy regimens for ovarian cancer

In chemotherapy for ovarian cancer, the best effect is observed with combination therapy rather than with the administration of individual drugs.

One of the most commonly used regimens for ovarian cancer chemotherapy is the SAR regimen:

• Cisplatin at a dosage of 50 mg/m;
• Cyclophosphamide at a dose of 400 mg/m;
• Adriablastin 30 mg/m.

In the treatment of germ cell tumors, the VFS regimen is active and effective:

• Vincristine at a dosage of 1 mg/m;
• Cyclophosphamide 400 mg/m;
• Actinomycin D at 0.25 mg/m.

The RVB regimen is also often used for germ cell tumors:

• Cisplatin 50 mg per meter;
• Vinblastine 0.2 mg per kg;
• Bleomycin at a dose of 105 milligrams.

If the cancer has recurred or the cancer has proven resistant to previous chemotherapy for ovarian cancer, other drug regimens may be used.

TIP diagram:

• Palitaxel 175 mg per square meter;
• Ifosfamide 3-5 g per square meter;
• Cisplatin 75 mg per square meter.

VeIP Scheme:

• Vinblastine 0.2 mg/kg;
• Ifosfamide from three to five grams per square meter;
• Cisplatin per square meter 75 milligrams.

VIP scheme:

• Etoposide from 50 to 100 mg per square meter;
• Ifofosfamide three to five milligrams per square meter;
• Cisplatin at seventy-five milligrams per square meter.

Monotherapy is carried out much less frequently – treatment with one drug. Practice shows that a combination of medications provides the maximum effect from treatment.

It is generally accepted that for complete destruction of the tumor, treatment should consist of six courses, but specialists have not yet given a clearly formulated opinion on this matter. Most doctors are inclined to believe that three or four courses of chemotherapy treatment are sufficient. In any case, the use of the “surgery plus chemotherapy” scheme has the maximum beneficial effect and significantly increases the chances of patient survival.

Each case of drug prescription requires an individual approach, as practice shows that in some cases patients have to undergo 8 or even ten courses to completely get rid of the tumor.

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Chemotherapy drugs for ovarian cancer

During chemotherapy for ovarian cancer, cytotoxic drugs are used, which are destructive to cancer cells and stop the growth of the cancerous tumor. Cytotoxic drugs are administered intravenously or intraperitoneally using a special tube, very rarely - orally in tablet form.

The most common antitumor drug used in ovarian cancer chemotherapy is carboplatin, a platinum derivative. It is administered intravenously only.

Cisplatin also belongs to platinum derivatives. It can cause tumor regression or tumor reduction. It is prescribed as an independent drug or in combination with other drugs.

Paclitaxel, a synthetic and semi-synthetic herbal medicine, an alkaloid extracted from the bark of the yew tree, is also often used in chemotherapy for ovarian cancer.

The semi-synthetic drug docetaxel is of plant origin, as needles of the European yew tree are used for its production.

Cyclophosphamide is used when it is necessary for a tissue transplant to take root or when it is necessary to reduce the immune system's response to changes in the body. This is possible due to the drug's ability to suppress the body's immune forces.

Doxorubicin is an anthracycline-containing antibiotic.

Gemcitabine is used alone and with other anticancer drugs. Topotecan is a topoisomerase inhibitor. It is most often used with cisplatin.

Oxaliplatin is used as an independent agent for metastatic forms of cancer, as a second-line therapy.

Contraindications to chemotherapy for ovarian cancer

Despite the effectiveness of chemotherapy, this treatment method has a number of contraindications that should be taken into account when prescribing a course of treatment:

• severe concomitant diseases, the course of which may be significantly worsened after a course of chemotherapy;
• severe disorders of the liver and renal filtration system, as well as hematopoietic organs;
• severe nervous system disorders, mental disorders that may prevent the patient from assessing the situation and expressing her consent to undergo a course of chemotherapy;

There are also contraindications for specific chemotherapy drugs. For example, Topotecan and Doxorubicin are not prescribed if the patient's condition is unsatisfactory (with severe weakness, poor health), with intestinal obstruction, or with significant changes in blood counts.

Based on the above, it should be concluded that each cancer patient should be considered individually, depending on the characteristics of the body.

Contraindications to chemotherapy for ovarian cancer include severe concomitant diseases or any disease in the decompensation stage.

• Impaired function of the kidneys, liver, hematopoiesis; significant deviations from the norm of creatinine levels; total bilirubin more than 40 mm/l; ALT - above 1.8; AST - above 1.3; neutrophils - below 1500 mm3 ^; the number of platelets is less than 100 thousand/ ^mm3.
• Neurological disorders of a higher degree than the second.
• Intellectual and behavioral impairments that may affect the ability to comply with chemotherapy.
• Hypersensitivity reactions to the proposed chemotherapy drugs, allergies.

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Side effects of chemotherapy for ovarian cancer

The most common side effect of chemotherapy for ovarian cancer is baldness. After some time, hair growth is restored. Nausea, vomiting, dizziness, and loose stools are common, as most chemotherapeutic drugs are very toxic. At this time, patients may lose weight due to lack of appetite. These phenomena also quickly disappear after the end of the course of treatment. The blood picture may change: hemoglobin, leukocyte count, and platelet count decrease. In order to monitor the blood picture, patients undergoing chemotherapy for ovarian cancer undergo weekly clinical blood tests.

Most specialists recommend using Carboplatin when prescribing intravenous chemotherapy drugs, as this drug has less pronounced side effects compared to Cisplatin. At the same time, the effect of these drugs is almost identical.

It is also possible to use other medications and their combinations.

The action of chemotherapy drugs is aimed at destroying and breaking down cancer cells. At the same time, these medications also affect healthy tissue. The doctor takes all this into account when prescribing treatment - he will definitely try to choose a drug that will have a minimum number of side effects.

The number and severity of side effects depend on the specific drug, the duration of therapy and the dosage used.

The most characteristic manifestations include:

• skin rashes, mostly on the palms of the hands and feet;
• hair loss;
• attacks of nausea and vomiting;
• lack of cravings for food;
• the appearance of ulcers in the mouth.

Chemotherapy drugs also affect the blood-forming organs, which affects the number of blood cells. Blood composition disorders, in turn, can cause the following symptoms:

• feeling of fatigue, weakness (as a result of anemia);
• decreased immunity (frequent colds and infectious diseases are possible);
• increased vascular permeability (bleeding, appearance of hematomas on the body).

After completing the chemotherapy course, most of the side effects disappear. Thus, hair growth resumes, appetite is restored. However, it happens that some medications cause long-term side effects, or even such effects that subsequently remain for life. For example, Cisplatin can provoke a violation of kidney function, and in combination with taxanes, this drug can cause neuropathy (damage to nerve endings and fibers). Neuropathy is usually manifested by a feeling of "goosebumps", pain, numbness in the distal parts of the limbs. In addition, chemotherapy can lead to infertility or early menopause - these phenomena can be temporary or permanent.

In extremely rare cases, chemotherapy can cause damage to white blood cells and lead to the development of myeloid leukemia, a malignant blood disease. However, this is a very rare occurrence, and the doctor must closely monitor the treatment process to prevent such a complication.

Complications of chemotherapy for ovarian cancer

One of the most common complications of ovarian cancer chemotherapy is severe suppression of the hematopoietic system. Severe anemia and leukopenia may develop. Kidney complications, including renal failure, are also common. To prevent complications of this kind, the patient undergoes an ultrasound of the kidneys and gives blood for renal tests (the level of creatinine in the blood serum is monitored). Deviations from the cardiovascular system are possible. In order to avoid them, the patient periodically undergoes an electrocardiogram before and during treatment. The patient's appetite and weight are monitored to avoid exhaustion and cachexia. Complications in the form of toxic hepatitis are possible, since the drugs are very toxic, and the liver is not always able to cope with them. The patient is periodically prescribed a blood test for liver function tests.

Recurrence of tumors after a course of treatment is not uncommon. Typically, relapses can occur within one and a half to two years after the last course of chemotherapy. Ovarian cancer can announce itself by the appearance of malignant cells in the space between the body of the uterus and the rectum.

The risk of complications depends on many factors.

• Whether surgery was performed and to what extent the tumor was removed;
• from the structure of the neoplasm (a histological examination is carried out to determine the structure);
• from the duration of chemotherapy and drug dosages;
• depending on how many drugs were used in the treatment.

To reduce the risk of complications, a woman must adhere to the following rules:

• completely give up harmful activities such as drinking alcohol, smoking, and drugs;
• consult a doctor in a timely manner regarding any diseases of the genital area;
• eat properly and nutritiously;
• avoid exposure of the body to radiation, X-rays, and chemical agents;
• Once every six months, the patient must undergo a preventive examination by a gynecologist and oncologist, with mandatory ultrasound examination and analysis of venous blood for tumor markers.

If a person is diagnosed with cancer, you should not perceive it as the end of the world, but you should not hesitate either. But the attitude towards serious and long-term treatment is a must. Treatment carried out on time has saved more than one life. Cancer treatment methods, including ovarian cancer chemotherapy, are constantly being improved, undergoing changes, in order to come to the aid of doctors in the fight for the main value on earth - human life and health.

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