Most of the ovarian cancer is present in an advanced stage. Documentation of disease is one of the most important steps to plan proper treatment. In staging laparoscopy, a small camera is placed into the abdomen to see any suspicious spread of disease that can be missed in imaging. These findings are captured, the peritoneal carcinomatosis index (PCI) score is recorded, and a biopsy can be taken at the same time. This procedure is very important to plan treatment of patients.

Surgery for ovarian cancer is known by various names like Cytoreductive Surgery/Debulking Surgery. The goal of these surgeries is to remove the tumor completely without leaving any visible disease behind.
After the diagnosis of ovarian cancer is done, when a patient is taken up for surgery upfront without any prior treatment (like chemotherapy), it is known as Primary Debulking Surgery. During this surgery, the uterus, both the ovaries, the omentum, the appendix, and the lymph nodes affected part of the peritoneum (a lining of the abdominal cavity) are removed.

In advanced cases of ovarian cancer, which is a more common presentation after staging laparoscopy, chemotherapy is administered, and then the patient is taken up for surgery, which is known as Interval Cytoreduction or Interval Debulking. This is usually more extensive surgery than the primary debulking surgery. During this surgery, the uterus, both the ovaries, omentum, lymph nodes, appendix, gall bladder, peritoneum, and sometimes, if needed, part of other organs like rectum, stomach, spleen, and intestine are also removed to achieve complete clearance of disease.

In cases of advanced ovarian cancer after the cytoreduction process to increase the effectiveness of treatment, there is the concept of killing microscopic cancer cells by heated chemotherapy. In this, with the help of specialized machinery, heated chemotherapy is circulated through the abdominal cavity at a set temperature.

It is a novel drug delivery system in which a special pen-like device is used to inject chemotherapy inside the abdomen. This method is very useful to control the disease, which got spread to the peritoneum and could not be operated on because of many factors, like an unfit patient, extensive disease, etc. Many patients with ovarian cancer, stomach cancer, and colon cancer benefit from this method.

This is a special form of delivering chemotherapy directly into the peritoneal (abdominal cavity) in patients with advanced ovarian cancer. An intra-peritoneal (IP) port system is introduced underneath the skin of the abdominal wall through a tubing passed into the abdominal cavity, under general anaesthesia. This new approach is used successfully before or after the surgery.

Cancer treatment is done to use multimodality treatment. Chemotherapy is one of the most important components of ovarian cancer treatment.
Chemotherapeutic drugs are agents that are used to kill cancer cells. Chemotherapy is used through various routes. Most commonly, it is used in injection form and injected through veins.

• Neoadjuvant: Patients undergo chemotherapy prior to surgery or radiation to reduce the cancer burden and to control further spread.
• Adjuvant: When chemotherapy is injected after the surgery it is known as adjuvant chemotherapy.

This therapy has revolutionized the treatment of advanced ovarian cancer, where drugs specifically “target’ cancer cells and relatively spare other cells, this has changed the perspective of ovarian cancer treatments.

In advanced cases, biological therapy or immunotherapy may be suggested for treatment. Immunotherapy targets the cells, which affect the body’s immune response and help the body in eliminating cancer cells.