How does the Women’s Surgery Center treat ovarian cancer?
The optimal treatment of ovarian cancer requires a combination of surgery, chemotherapy and, in some rare cases, radiation therapy. When ovarian cancer is suspected because of pelvic growth, additional evaluation is necessary. Ovarian cancers may spread to other organs in the pelvis, local or regional lymph nodes, or through the blood to other locations in the body, most frequently to the bowel, bladder, uterus, lungs, and liver. In order to effectively plan treatment, it is important to first determine the extent of the spread or the stage of the cancer. In order to gain the most information prior to surgery, a number of tests are performed. These may include an ultrasound and CT-scan of the abdomen and pelvis and several blood tests, including a CA-125 level.
Accurate surgical evaluation of ovarian cancer is necessary for nearly all patients and can only be accomplished during the surgical procedure to determine the stage of the cancer and to remove as much cancer as possible. Staging is the measurement of how much, if at all, the cancer has spread, and involves node dissection, or removal of the lymph nodes during the procedure. The removal of lymph nodes does not add time or additional complications to the surgical procedure. Treatment recommendations vary depending on the stage of ovarian cancer.
Surgical treatment of ovarian cancer.
Despite surgical removal of the tumor, many patients with ovarian cancer will already have microscopic cancer cells, called micrometastases, that have spread away from the ovary to other locations in the abdomen and distant parts of the body. These micrometastases often cannot be detected by currently available tests. Surgery is a local therapy and cannot treat micrometastatic cancer. Therefore, additional systemic treatment using chemotherapy is required to treat micrometastatic cancer. Information obtained during surgery and from other tests determines whether additional treatment with chemotherapy is necessary. Because many patients with ovarian cancer have advanced disease at diagnosis, the majority of patients will receive chemotherapy as part of the overall treatment plan.
Often, patients with ovarian cancer are initially treated with surgery aimed at debulking (decreasing the size of) the tumor. This type of surgery, in which the goal is to remove the greatest volume of cancer cells possible, is also called "cytoreductive" surgery. After completion of the surgery, most patients are placed on a chemotherapy regimen.
Over the past several years, there has been increasing interest in administering chemotherapy both before and after surgery. Chemotherapy given before surgery is referred to as neoadjuvant chemotherapy, and the surgery that follows is referred to as “interval” cytoreductive surgery. By administering chemotherapy first, micrometastatic cancer cells may be more easily destroyed and chemotherapy may reduce the amount of cancer, thereby allowing for more complete surgical removal of the cancer. The use of neoadjuvant chemotherapy remains controversial, but it may be considered for selected patients with advanced disease who do not appear to be candidates for initial surgery.