Should You Have Chemotherapy Before Surgery for Ovarian Cancer?

Doctors may decide to start with chemotherapy when a patient isn’t healthy enough for surgery, or if her tumor is too large to remove completely.

When it comes to deciding on treatment options for ovarian cancer, the patient's choice is also taken into consideration. "It boils down to patient preference," says Dr. Zachary Reese, medical oncologist at Intermountain Healthcare in St. George, Utah, near Salt Lake City. "If there's something [like a tumor] there, a lot of people want to get rid of it as soon as possible, because there's always a risk that if left there [the cancer] could potentially get worse."

It's completely understandable to feel this way, but it's also important to make sure you have all the information about your specific situation. "Everybody's different, and what's right for Sally is not right for her neighbor down the road," says Dr. Reese.

This is where the surgical team and your oncologist come into play. "In many cases, surgeons will do an evaluation and then come back to me and recommend doing chemotherapy first, because it’s going to make the surgical outcome much better," says Dr. Reese. "There may be a big tumor that's pushing on the bladder or the bowels and trying to cut that out could lead to potential complications." Doing neoadjuvant chemotherapy first can shrink the tumor and make it easier to remove without damaging other organs in the process.

Once all this information is gathered, you'll sit down with your oncologist and surgeon to weigh the benefits and risks of every treatment approach, to find the best option for you.

Positive Results With Neoadjuvant Chemotherapy

"Almost all patients with ovarian cancer are going to see some response to chemotherapy upfront," says Dr. Reese. That's because doing neoadjuvant chemotherapy will shed light on whether the cancer has regressed.

There will be clinical evidence on scans that there is less cancer in the body, as well as a drop in CA-125, a protein in the blood that, when high enough, is considered a tumor marker or early warning sign of ovarian cancer.

As a result of this treatment, your overall health will improve, and you'll start to feel better. The surgery that will follow may also have a higher likelihood of a successful outcome that leads to remission.

How Neoadjuvant Chemotherapy Works

Every patient is different, but neoadjuvant chemotherapy is typically a combination of two chemotherapy drugs given through an IV every three weeks. You may undergo three full cycles before your cancer is reassessed. From there, additional chemotherapy cycles may be added on, or surgery will follow.

You may have side effects like fatigue, hair loss, and gastrointestinal issues (nausea, vomiting) from chemotherapy, but there are many medications you can take to help manage these effects.

Even though chemotherapy will be part of your treatment plan at some point, your medical team will carefully weigh the decision of when to give it, considering your opinion in the process. "It's most important to gather as much information ahead of time,” says Dr. Reese. That way, your doctor knows that the decision you’ve made is the best possible one for you.

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