Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 23 peer-reviewed journal articles Updated
Gynecologic Oncology · Epithelial Ovarian Cancer

Standard of Care: Surgery, Chemotherapy, and Targeted Treatments

At a Glance

The standard of care for epithelial ovarian cancer combines debulking surgery to remove visible tumors with platinum-based chemotherapy. Maintenance therapies, such as PARP inhibitors, are often prescribed afterward based on the tumor's genetic markers to help prevent the cancer from returning.

The standard of care for epithelial ovarian cancer is a coordinated effort involving surgery and systemic treatments like chemotherapy and targeted maintenance drugs. Because this disease is now treated as a collection of distinct subtypes, your medical team will design a sequence of therapies specifically tailored to your tumor’s biology [1][2].

Surgical Excellence: The Goal of “R0”

Surgery is a cornerstone of treatment. The primary goal is complete macroscopic resection, often referred to as R0, which means removing all visible signs of the tumor [3][4].

There are two main ways surgery is sequenced:

  • Primary Debulking Surgery (PDS): This is the upfront removal of the tumor as the first step of treatment [3]. It is typically recommended for patients who are healthy enough for major surgery and where the tumor is in a location that allows for complete removal [5].
  • Neoadjuvant Chemotherapy (NACT) with Interval Debulking: If the tumor is too extensive or if the patient has other health concerns, doctors may give chemotherapy first to shrink the tumor. This is followed by Interval Debulking Surgery (IDS) to remove the remaining disease [6][5]. This approach can reduce the complexity of the surgery and lower the risk of complications [7][8].

The Physical Reality of Surgery

It is crucial to understand that this surgery typically involves the removal of both ovaries, the fallopian tubes, and often the uterus. For women who have not yet gone through menopause, this results in immediate surgical menopause and the loss of fertility. Your care team should discuss strategies for managing menopausal symptoms with you prior to surgery.

Furthermore, to achieve R0 (no visible tumor remaining), the surgeon may need to remove other affected areas, which can sometimes include parts of the bowel, the appendix, the omentum, or the spleen [5]. The physical and emotional scale of this surgery is significant, and preparing for a major recovery is essential.

Some patients may also hear about HIPEC (Hyperthermic Intraperitoneal Chemotherapy), or “hot chemo,” where heated chemotherapy is washed inside the abdomen during surgery. While sometimes used for specific cases or clinical trials, it is important to discuss with your doctor whether this is a standard and appropriate option for your specific subtype and stage [9].

Systemic Therapy: Chemotherapy

The standard chemotherapy regimen for most epithelial ovarian cancers is a combination of two platinum-based drugs: carboplatin and paclitaxel [10][11]. These drugs work together to kill rapidly dividing cancer cells.

For many patients, these are delivered intravenously (through a vein) every three weeks for six cycles—meaning your chemotherapy phase will last roughly 4.5 to 5 months [10].

Important Side Effects to Monitor: While taking paclitaxel, you must monitor for peripheral neuropathy (numbness, tingling, or pain in your hands and feet). Reporting this early is critical so your team can adjust your dose and prevent permanent nerve damage. Other common side effects include hair loss (alopecia) and the potential for allergic reactions during the infusion [10].

Maintenance Therapy: Extending the Response

Maintenance therapy is treatment given after your initial surgery and chemotherapy are finished. Its goal is to delay or prevent the cancer from coming back [12].

PARP Inhibitors

Drugs like olaparib and niraparib are a major advancement in care. They work by blocking a protein called PARP, which cancer cells use to repair their DNA [13].

  • BRCA and HRD Status: These drugs are most effective in patients whose tumors have a BRCA mutation or are HRD-positive (Homologous Recombination Deficient) [14][15].
  • Niraparib has also shown benefit in patients regardless of their HRD status, though the benefit is typically largest in those with the deficiency [13][12].

Bevacizumab (Avastin)

This is an angiogenesis inhibitor—a drug that prevents the tumor from growing the new blood vessels it needs to survive [16]. It is often used during chemotherapy and then continued as a maintenance therapy, sometimes in combination with PARP inhibitors [17][18].

Tailored Approaches for Specific Subtypes

For less common subtypes, the standard “one-size-fits-all” chemotherapy may not be the most effective choice:

  • Low-Grade Serous Carcinoma (LGSOC): Because these tumors can be resistant to traditional chemotherapy, doctors may use hormone therapy or MEK inhibitors (like trametinib), which target the specific signaling pathways that drive this subtype [19][20][21].
  • Clear Cell Carcinoma: Research is ongoing into specialized treatments, as these tumors often have unique genetic drivers like ARID1A mutations [22][23].

Common questions in this guide

What is the difference between primary debulking and interval debulking surgery?
Primary debulking surgery is performed as the very first step of treatment to remove as much of the tumor as possible. Interval debulking is done after a few rounds of neoadjuvant chemotherapy, which shrinks the tumor beforehand to make surgery safer and more effective.
Will surgery for ovarian cancer cause early menopause?
During surgery for epithelial ovarian cancer, it is standard to remove both ovaries, the fallopian tubes, and often the uterus. For premenopausal women, this causes immediate surgical menopause and loss of fertility.
What side effects should I watch for during standard chemotherapy?
A standard regimen uses paclitaxel, which can cause peripheral neuropathy, or numbness and tingling in your hands and feet. It is crucial to report these symptoms early so your care team can adjust your dose and prevent permanent nerve damage.
Why are BRCA and HRD tests important for my treatment plan?
These tests identify specific genetic features in your tumor that affect how its cells repair DNA. If your tumor has a BRCA mutation or is HRD-positive, you may be a strong candidate for targeted maintenance drugs called PARP inhibitors.
What is maintenance therapy for ovarian cancer?
Maintenance therapy is an ongoing treatment given after your initial surgery and chemotherapy are finished. It uses targeted drugs like PARP inhibitors or bevacizumab to delay or prevent the cancer from coming back.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Am I a candidate for Primary Debulking Surgery (PDS), or is Neoadjuvant Chemotherapy (NACT) a better first step for me?
  2. 2.What is the surgical goal for my upcoming procedure, and what is your plan if complete macroscopic resection (R0) cannot be achieved?
  3. 3.Will I be tested for BRCA and HRD status to help determine if PARP inhibitors should be part of my maintenance plan?
  4. 4.Is bevacizumab (Avastin) an appropriate addition to my chemotherapy or maintenance therapy?
  5. 5.Given my specific subtype (e.g., LGSOC), are there targeted treatments like MEK inhibitors or hormone therapies we should consider?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (23)
  1. 1

    Recommendations for biomarker testing in epithelial ovarian cancer: a National Consensus Statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology.

    Oaknin A, Guarch R, Barretina P, et al.

    Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 2018; (20(3)):274-285 doi:10.1007/s12094-017-1719-x.

    PMID: 28815456
  2. 2

    Seeing beyond the tumor: computed tomography image-based radiomic analysis helps identify ovarian clear cell carcinoma subtype in epithelial ovarian cancer.

    Ren J, Mao L, Zhao J, et al.

    La Radiologia medica 2023; (128(8)):900-911 doi:10.1007/s11547-023-01666-x.

    PMID: 37368228
  3. 3

    A Narrative Review of Clinical and Molecular Criteria for the Selection of Poor Candidates for Optimal Cytoreduction in Epithelial Ovarian Cancer.

    Pariza G, Mavrodin C, Potorac A, et al.

    Life (Basel, Switzerland) 2025; (15(8)) doi:10.3390/life15081318.

    PMID: 40868967
  4. 4

    Patients with stage IV epithelial ovarian cancer: understanding the determinants of survival.

    Dabi Y, Huchon C, Ouldamer L, et al.

    Journal of translational medicine 2020; (18(1)):134 doi:10.1186/s12967-020-02295-y.

    PMID: 32293460
  5. 5

    Interval debulking surgery is not worth the wait: a National Cancer Database study comparing primary cytoreductive surgery versus neoadjuvant chemotherapy.

    Lyons YA, Reyes HD, McDonald ME, et al.

    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 2020; (30(6)):845-852 doi:10.1136/ijgc-2019-001124.

    PMID: 32341114
  6. 6

    Comparative Retrospective Analysis of Ovarian Cancer Treatment Outcomes: Neoadjuvant Therapy with and without Surgical Intervention.

    Iyengar R, Murali Mohan Reddy G, Kumaresan P

    Indian journal of surgical oncology 2025; (16(4)):876-881 doi:10.1007/s13193-024-02144-0.

    PMID: 40949408
  7. 7

    The prognosis impact of NACT-IDS and PDS in advanced ovarian cancer: a systematic review and meta-analysis.

    Xie Q, Cui M

    Journal of gynecologic oncology 2025; (36(4)):e61 doi:10.3802/jgo.2025.36.e61.

    PMID: 40017161
  8. 8

    Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline.

    Wright AA, Bohlke K, Armstrong DK, et al.

    Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2016; (34(28)):3460-73 doi:10.1200/JCO.2016.68.6907.

    PMID: 27502591
  9. 9

    Evaluation of external validity of the OVHIPEC-1 trial in a real-world population.

    van Stein RM, Sikorska K, van der Aa MA, et al.

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2023; (161(2)):640-648 doi:10.1002/ijgo.14618.

    PMID: 36495280
  10. 10

    Treatment With Niraparib Maintenance Therapy in Patients With Newly Diagnosed Advanced Ovarian Cancer: A Phase 3 Randomized Clinical Trial.

    Li N, Zhu J, Yin R, et al.

    JAMA oncology 2023; (9(9)):1230-1237 doi:10.1001/jamaoncol.2023.2283.

    PMID: 37440217
  11. 11

    Standard first-line chemotherapy with or without nintedanib for advanced ovarian cancer (AGO-OVAR 12): a randomised, double-blind, placebo-controlled phase 3 trial.

    du Bois A, Kristensen G, Ray-Coquard I, et al.

    The Lancet. Oncology 2016; (17(1)):78-89.

    PMID: 26590673
  12. 12

    Niraparib in Patients with Newly Diagnosed Advanced Ovarian Cancer.

    González-Martín A, Pothuri B, Vergote I, et al.

    The New England journal of medicine 2019; (381(25)):2391-2402 doi:10.1056/NEJMoa1910962.

    PMID: 31562799
  13. 13

    Niraparib first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer: final overall survival results from the PRIMA/ENGOT-OV26/GOG-3012 trial.

    Monk BJ, Barretina-Ginesta MP, Pothuri B, et al.

    Annals of oncology : official journal of the European Society for Medical Oncology 2024; (35(11)):981-992 doi:10.1016/j.annonc.2024.08.2241.

    PMID: 39284381
  14. 14

    Maintenance olaparib for patients with newly diagnosed advanced ovarian cancer and a BRCA mutation (SOLO1/GOG 3004): 5-year follow-up of a randomised, double-blind, placebo-controlled, phase 3 trial.

    Banerjee S, Moore KN, Colombo N, et al.

    The Lancet. Oncology 2021; (22(12)):1721-1731 doi:10.1016/S1470-2045(21)00531-3.

    PMID: 34715071
  15. 15

    Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer.

    Moore K, Colombo N, Scambia G, et al.

    The New England journal of medicine 2018; (379(26)):2495-2505 doi:10.1056/NEJMoa1810858.

    PMID: 30345884
  16. 16

    The roles and limitations of bevacizumab in the treatment of ovarian cancer.

    Nakai H, Matsumura N

    International journal of clinical oncology 2022; (27(7)):1120-1126 doi:10.1007/s10147-022-02169-x.

    PMID: 35477830
  17. 17

    Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial.

    Ray-Coquard I, Leary A, Pignata S, et al.

    Annals of oncology : official journal of the European Society for Medical Oncology 2023; (34(8)):681-692 doi:10.1016/j.annonc.2023.05.005.

    PMID: 37211045
  18. 18

    Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer.

    Ray-Coquard I, Pautier P, Pignata S, et al.

    The New England journal of medicine 2019; (381(25)):2416-2428 doi:10.1056/NEJMoa1911361.

    PMID: 31851799
  19. 19

    Therapeutic advances and molecular insights in low-grade serous ovarian carcinoma.

    Kabirian R, Gaillard T, Bello-Roufai D, et al.

    Bulletin du cancer 2026; (113(4)):533-540 doi:10.1016/j.bulcan.2025.11.005.

    PMID: 41402140
  20. 20

    Low-grade Serous Tumors: Are We Making Progress?

    Pauly N, Ehmann S, Ricciardi E, et al.

    Current oncology reports 2020; (22(1)):8 doi:10.1007/s11912-020-0872-5.

    PMID: 31989304
  21. 21

    Endocrine therapy in epithelial ovarian cancer.

    Langdon SP, Gourley C, Gabra H, Stanley B

    Expert review of anticancer therapy 2017; (17(2)):109-117 doi:10.1080/14737140.2017.1272414.

    PMID: 27967255
  22. 22

    Tumor Immune Microenvironment and Checkpoint Inhibition in Clear Cell Ovarian Carcinoma: Bridging Tumor Biology and Clinical Application in Immunotherapy.

    Borella F, Capella G, Cosma S, et al.

    Current issues in molecular biology 2025; (47(9)) doi:10.3390/cimb47090726.

    PMID: 41020848
  23. 23

    Clearer Horizons: The latest advances in clear cell ovarian cancer treatment.

    Blanc-Durand F, Ngoi N, Lim D, et al.

    Cancer treatment reviews 2025; (138()):102977 doi:10.1016/j.ctrv.2025.102977.

    PMID: 40517636

This page is for educational purposes and explains standard treatment options for epithelial ovarian cancer. Always discuss surgical choices and systemic therapies with your gynecologic oncologist to determine the best plan for your specific subtype.

Get notified when new evidence is published on Malignant epithelial tumor of ovary.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.