Ovarian Cancer

Home » Ovarian Cancer » Stage 3 and Stage 4 - Epithelial Cancer, Germ Cell Tumor

Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Stage 3–Epithelial Cancer

Like Stage 1 and Stage 2 epithelial cancers, Stage 3 epithelial cancer initially is treated by surgery, including total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy, and tumor debulking.

Postoperative management may include combination chemotherapy with/without follow-up surgery to remove any remaining cancerous tissue.

Stage 3–Germ Cell Tumor
If the germ cell tumor is a dysgerminoma (the most widespread germ cell tumor, representing nearly half of all cases), treatment begins with surgery, including total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking.

If the remaining post-operative tumor is small, surgery will be followed by radiotherapy of the abdominal region. If the remaining postoperative tumor is large, surgery will be followed by systemic chemotherapy.

Germ cell tumors that are not dysgerminomas (e.g., an embryonal carcinoma, immature teratoma, choriocarcinoma, polyembryoma, or mixed germ cell tumor) may require one of the following treatment programs:

• surgery, including total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking, followed by chemotherapy, with/without additional surgery to remove remaining cancerous tissue; or
• chemotherapy, followed by surgery, including total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking, with/without additional chemotherapy.

If the patient has a non-dysgerminatous tumor on one side and she wants to have children in the future, her treatment may consist of modified surgery (unilateral salpingo-oophorectomy) followed by chemotherapy.

Recent studies have shown that intraperitoneal chemotherapy may increase survival in patients with Stage III ovarian cancer who have undergone surgery. In this treatment, high doses of chemotherapy drugs are infused directly into the abdominal cavity through a catheter to destroy remaining cancer cells. These drugs eventually enter the bloodstream and may destroy any cancer cells that have spread.

Intraperitoneal chemotherapy usually is administered in 6 cycles, approximately every 3 weeks. Side effects of treatment, which can be severe and include abdominal pain, bloating, fatigue, and infection, may prevent patients from completing all 6 cycles.

Stage 4–Epithelial Cancer
This type of ovarian cancer is managed by tumor debulking surgery to remove as much cancerous tissue as possible, followed by combination chemotherapy. The benefit of postsurgical therapy is not well-established for patients with advanced (Stage 3 or 4), borderline cancers. However, because of the risk of distant relapse, some form of systemic therapy should be considered.

Stage 4–Germ Cell Tumor
If the germ cell tumor is a dysgerminoma (the most widespread germ cell tumor, representing nearly half of all cases), treatment begins with surgery, including total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking, followed by chemotherapy.

If some tumor remains after chemotherapy, additional forms of chemotherapy may be needed.

If the patient has cancer in only one ovary and she wants to have children in the future, her treatment may consist of modified surgery (unilateral salpingo-oophorectomy), followed by chemotherapy.

Germ cell tumors that are not dysgerminomas (e.g., an embryonal carcinoma, immature teratoma, choriocarcinoma, polyembryoma, or mixed germ cell tumor) may require one of the following treatment programs:

• surgery, including total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking, followed by chemotherapy, with/without additional surgery and additional chemotherapy to remove remaining cancerous tissue, or
• chemotherapy, followed by surgery, including total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking, with/without additional chemotherapy.

If the patient has cancer in only one ovary and she wants to have children in the future, her treatment may consist of modified surgery (unilateral salpingo-oophorectomy), followed by chemotherapy.

Recurrent–Epithelial Cancer
Reappearing epithelial ovarian cancer is problematic. To date, there is no standard treatment, although a number of clinical trials are underway to test the pros and cons of different programs. Some of these trials include:

• chemotherapy, with follow-up surgery;
• new chemotherapeutic drugs;
• new combination chemotherapies; and
• surgery to relieve symptoms caused by ovarian cancer.

Comfort and pain-relieving care are always options. The patient should discuss these alternatives with her physician, since open communication is very important and will help her to receive the best care.

Recurrent–Germ Cell Tumor
The treatment of recurrent germ cell tumor is based on tumor type. Recurrent dysgerminomas usually are managed by chemotherapy, with/without radiotherapy.

Recurrent germ cell tumors that are not dysgerminomas (e.g., an embryonal carcinoma, immature teratoma, choriocarcinoma, polyembryoma, or mixed germ cell tumor) usually are managed by chemotherapy.

For more information on treatment options by stage 1 & 2 click here.

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