Surgery

Most women with ovarian cancer will have surgery at some point during the course of their disease, and each surgery has different goals:

Initial surgery: technique

Usually performed by laparotomy, a surgery that involves a vertical (up and down) incision in the abdomen that is large enough to allow the surgeon to look inside the body and remove cancerous tissue.

Sometimes includes debulking, which is described as removal of all visible cancer. In addition, it also involves removal of one or both ovaries and fallopian tubes (salpingo-oopharectomy) and often the removal of the uterus (hysterectomy). It is important that a gynecologic oncologist is the leader of the surgical team, as prognosis is closely related to how much of the cancer cannot be removed during surgery.

Goal: diagnosis
  • Obtain an accurate surgical diagnosis, which is crucial for planning an appropriate treatment strategy
  • Determine how far the cancer has spread ("staging" the cancer)
  • Obtain a biopsy sample to analyze the cellular characteristics of the cancer- Goal: treatment
  • "Debulking" to remove as much of the cancer tissue as possible
  • Optimal debulking of the tumor in women with bulky disease can improve outcome

Second-Look Surgery is a follow-up for women whose cancer responds to chemotherapy. [Not performed routinely]

Second-look surgery: techniques

Laparotomy and Laparoscopy
  • Surgery using fiberoptic scopes and tubes
  • Less invasive (can be performed through small [ = 1 inch] incisions in the abdomen)

Goal: diagnosis

  • To investigate whether any cancer remains in the abdominal cavity and will require further treatment
The role of second-look surgery in disease management is evolving, and this technique might be replaced by other, less-invasive assessment methods

Additional debulking surgery - Goal: treatment

  • To reduce cancer symptoms and improve the effects of chemotherapy

Surgery for recurrent ovarian cancer

  • To remove measurable disease after a reasonable disease-free interval
  • To remove bowel or ureteral obstruction
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