Cancer Services in Ireland:
The National Cancer Control Programme (NCCP) was set up in 2007 to implement the National Cancer Control Strategy. The NCCP aims to reduce the number of cancer cases and deaths from cancer by applying best practice in areas such as prevention, early detection, diagnosis, and treatment. After the launch of the NCCP in 2007, a key priority was the establishment of designated cancer centres for cancer surgery. There are 9 designated cancer centres.
Cancer Centres in Ireland:
Beaumont University Hospital
Mater University Hospital
St Vincent’s University Hospital
St James’s University Hospital
Cork University Hospital
University Hospital Waterford
Galway University Hospital (satellite: Letterkenny General Hospital)
University Hospital Limerick
Our Lady’s Children’s Hospital Crumlin
The majority, but not all, cancer surgery now takes place in the designated cancer centres.
As well as the designated cancer centres, other hospitals provide cancer services such as chemotherapy and radiotherapy.
Treating Ovarian Cancer
There are a number of ways of treating ovarian cancer, and new methods are emerging all the time. Your treatment will depend on your individual circumstances but will possibly include surgery to remove the tumour and chemotherapy to kill the cells that are dividing uncontrollably. You may have surgery first or you may have chemotherapy and then surgery. You may also be put on a maintenance treatment. Decisions on your treatment will be made at a multidisciplinary team meeting (MDT) where healthcare workers from different disciplines involved in your care will discuss your case. A specific treatment plan is devised for every patient and many aspects will be taken into account such as the type of ovarian cancer you have, how effective the treatment is, the side-effects, the stage of disease, the extent of the surgery and your general health. This will all be discussed with you before a decision is made as to what treatment you should have.
Surgery
In most cases, surgery is needed. A specially qualified surgeon (a Gynae-oncologist) should do this operation. If you have surgery first it is known as primary cytoreductive surgery and if you have chemotherapy first and then surgery, it is known as interval cytoreductive surgery.
The aim of the operation is to remove as much of the tumour as possible, but cause as little damage as possible to your surrounding organs. Sometimes it is not possible to remove all the tumour.
Your surgeon will discuss your operation and give you the chance to ask as many questions as you want to. You will be asked to sign a consent form to give your permission for the operation.
If you are a younger woman and the cancer is at an early stage, your surgeon may try to adapt the operation so that you may still be able to have a baby.
After surgery you are likely to be in hospital for about a week and you will have to take it easy at home for several weeks.
Chemotherapy
In most cases, you will be advised to have chemotherapy, either in advance of surgery (neoadjuvant chemotherapy) or to kill any cancer cells left after surgery (adjuvant chemotherapy). Chemotherapy is the name for drugs that kill cancer cells. A doctor called a Medical Oncologist prescribes it. There are many different types of chemotherapy and your oncologist will discuss the various options with you to help select the best treatment for you.
Chemotherapy has been used to treat ovarian cancer for many years and platinum-based drugs – cisplatin and carboplatin – are the drugs most widely used. They are usually given in combination with a drug called paclitaxel.
Most chemotherapies for ovarian cancer are given as an intravenous treatment (using a small tube into your vein) in the Oncology Day ward in your hospital. The most commonly used chemotherapy regimen (carboplatin and paclitaxel) is given once every 3 weeks.
Each treatment is followed by a rest period to allow you to recover from side effects. Each 3-week period is called a cycle of treatment. You normally have about 6 cycles in all. The side effects of different chemotherapies vary, and you can discuss this with your oncologist.
A newer way of administering chemotherapy that is sometimes used in the treatment of ovarian cancer is known as Hyperthermic Intraperitoneal Chemotherapy (HIPEC). This is where heated chemotherapy is placed in the abdomen for approximately 90 minutes after the surgery and then removed. Large studies have shown that in certain patients this approach can prolong survival but it is not suitable for every patient.
The treatment of all cancers, including ovarian cancer, is changing as more is learned about how cancer develops. New and improved treatments are identified through clinical trials. If there is a clinical trial available for which you may be eligible your oncologist will discuss this option with you. Please ask your Doctor if there are any clinical trials suitable for you. For more information on cancer clinical trials in Ireland visit www.cancertrials.ie
Radiotherapy
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
Radiotherapy is rarely used to treat ovarian cancer. It may occasionally be used to treat an area of cancer that has come back after surgery and chemotherapy if other treatment options are no longer appropriate.
It may also be used to reduce bleeding, pain, or discomfort.
Radiotherapy is given in a radiation oncology unit. Your doctor (radiation oncologist) will discuss your treatment with you in detail beforehand.
Targeted Therapy:
Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to identify and attack cancer cells while doing little damage to normal cells. These therapies attack the cancer cells’ inner workings − the programming that makes them different from normal, healthy cells.
Each type of targeted therapy works differently, but all alter the way a cancer cell grows, divides, repairs itself, or interacts with other cells.
Bevacizumab (Avastin®) is a targeted therapy that belongs to a class of drugs known as angiogenesis inhibitors and it targets a protein called vascular endothelial growth factor (VEGF). It works by stopping the cancer developing new blood vessels. This reduces the cancer’s supply of oxygen, which may cause it to stop growing or shrink. Avastin is often given as a maintenance treatment after chemotherapy.
The side effects can be discussed with your oncologist.
PARP Inhibitors:
PARP stands for Poly (ADP-ribose) polymerase. It is a protein that helps damaged cells to repair themselves. PARP Inhibitors stop PARP working which means the cell cannot repair itself and cannot function. PARP inhibitors can work better in patients with a BRCA mutation so you may have genetic testing done to see if you are suitable for this drug. BRCA mutations can be inherited (germline) or they may have developed within the tumour (somatic). There are a number of different PARP inhibitors on the market and patients receive these as a maintenance treatment following chemotherapy. For more information on PARP inhibitors please see our webinar:
Immunotherapy:
Immunotherapy uses your immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells. Studies are still ongoing to identify which ovarian cancer patients might benefit from this form of treatment.