Ovarian cancer treatment in India
Ovarian cancer is treated with surgery and chemotherapy together, and the quality of the surgery matters more here than in almost any other cancer. The goal is to remove all visible disease. Who performs that operation has a measurable effect on how well treatment works.
- Main treatment
- Debulking surgery plus chemotherapy, in one order or the other
- The surgical goal
- No visible disease left behind. This is the strongest predictor of outcome
- Who should operate
- A gynaecological oncologist, not a general surgeon
- Testing that matters
- BRCA and HRD status, which open up PARP inhibitor treatment
- Often found late
- Symptoms are vague, so many cases present at an advanced stage
- Cost
- Depends on the plan. Written estimate before you travel
Why the surgeon matters more here
In most cancers, surgery removes a defined lump. Ovarian cancer commonly spreads across the lining of the abdomen as many small deposits, and the operation involves finding and removing all of them, which can mean working on the bowel surface, the diaphragm, the omentum and the lymph nodes in one long procedure.
The measure of success is whether any visible disease remains at the end. Complete removal is consistently associated with better outcomes than leaving deposits behind, and achieving it depends heavily on the surgeon's training and the number of these operations they perform.
Ask directly: is my surgeon a gynaecological oncologist, and how many ovarian debulking operations do they perform each year? This is not an impolite question. It is the most useful one you can ask about this cancer, and a good specialist will answer it without hesitation.
Surgery first, or chemotherapy first?
Both are legitimate, and which suits you depends on how extensive the disease is and how well you are.
Surgery first
- Preferred when complete removal looks achievable at the outset
- Chemotherapy follows to treat what surgery cannot see
- Gives a full picture of the disease from the start
Chemotherapy first
- Used when disease is too extensive to remove safely at first
- Shrinks deposits so surgery afterwards can be complete
- Also chosen when you are not yet well enough for major surgery
Chemotherapy given first is not a lesser option or a sign of hopelessness; for many women it is what makes complete surgery possible. Ask which route is proposed for you and why.
Chemotherapy and HIPEC
Chemotherapy for ovarian cancer is usually given intravenously over several cycles. Ovarian cancer is generally sensitive to it, which is one reason meaningful control is often achievable even with advanced disease.
Some centres offer HIPEC, heated chemotherapy circulated inside the abdomen during surgery. For ovarian cancer there is reasonable evidence supporting it in specific situations, particularly at the time of surgery after chemotherapy has been given first. It is not appropriate for everyone, and if it is proposed, ask why your case fits the criteria.
BRCA testing and PARP inhibitors
This has genuinely changed ovarian cancer treatment, and it is worth understanding. A proportion of ovarian cancers carry BRCA mutations, or show a related feature called homologous recombination deficiency. Where present, a class of tablets called PARP inhibitors can be given as maintenance treatment after chemotherapy, substantially delaying the cancer's return.
Two things follow. First, ask whether BRCA and HRD testing has been done, because without it you cannot know whether this treatment applies to you. Second, a BRCA mutation may be inherited, which has implications for your daughters, sisters and other relatives, and genetic counselling should be offered alongside the result.
Fertility, and what surgery removes
Standard surgery removes both ovaries, the fallopian tubes and the uterus, which ends fertility and brings on menopause. For younger women with very early-stage disease confined to one ovary, fertility-sparing surgery is sometimes possible, preserving the uterus and the other ovary.
This can only be considered before surgery, never after, so if having children matters to you, raise it in your very first conversation and make sure it is addressed rather than assumed away.
How long you will stay, and what it costs
Debulking surgery is major, meaning around a week to ten days in hospital and several weeks of recovery before flying. Chemotherapy runs over months in cycles. Realistically the full sequence is a matter of months, and many international patients have surgery in India and continue chemotherapy at home under an agreed plan.
India is substantially less expensive than Western countries for this surgery, and it has experienced gynaecological oncology units. You receive a written estimate covering the operation, hospital stay, pathology and follow-up before you commit, with no fee to us built in; the hospital pays us, so your bill is never marked up.
Questions patients ask
Is ovarian cancer curable?
Early-stage ovarian cancer confined to the ovary has good cure rates. Because symptoms are vague, most cases are found at a more advanced stage, where the realistic aim is often long remission and control rather than certain cure. Ovarian cancer responds well to chemotherapy, and PARP maintenance has extended remissions considerably for suitable patients.
What does debulking surgery involve?
Removing all visible cancer, which typically means both ovaries, the fallopian tubes, the uterus, the omentum, and any deposits on the bowel surface, diaphragm or lymph nodes. It can be a long operation. The aim is to leave no visible disease, since that is the strongest predictor of how well treatment works.
Should I have chemotherapy before surgery?
It depends on how extensive the disease is and how well you are. When complete removal looks achievable straight away, surgery usually comes first. When disease is too widespread to remove safely, chemotherapy first shrinks it so that surgery can then be complete. Both are standard and neither is a lesser option.
Should I be tested for BRCA?
Yes, testing is now standard practice for ovarian cancer. It determines whether PARP inhibitor maintenance treatment is available to you, which can significantly delay the cancer returning. It also has implications for blood relatives, so genetic counselling should accompany the result.
Will I go into menopause?
Yes, if both ovaries are removed and you had not already reached menopause. This happens immediately rather than gradually, and symptoms can be pronounced. Ask your specialist how it will be managed, including whether hormone therapy is appropriate in your case, since that depends on the type of cancer.
What reports should I send?
A CT of the abdomen and pelvis, your CA-125 blood level, any biopsy or cytology result, and BRCA or HRD testing if done. If you have already had surgery, the operation note and pathology report are important, particularly whether any disease was left behind.