Ovarian Cancer - Surgery

Highlights	Diagnosis	Radiation Therapy
Introduction	Prognosis	Resources
Symptoms	Treatment	References
Causes	Surgery
Prevention	Medications

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Surgery

Surgery for ovarian cancer employs laparotomy, which is a major abdominal operation. It is the primary diagnostic tool for ovarian cancer and also plays a role in treatment. Complete surgical intervention includes the following:

Surgical staging (examining all tissues and organs in the pelvic cavity for accurate assessment of the disease stage).
Debulking (removal of as much of the cancerous tissue as possible). This is an important component of ovarian cancer management and should be performed by a surgeon trained in cancer surgery techniques. (Researchers are also studying possible survival benefits with interval debulking surgery, which is a second procedure performed after the initial chemotherapy in patients with advance cancer.)

Ovarian cancer patients are urged to seek the expertise of a qualified gynecologic oncologist (a surgical specialist in female reproductive cancers) and a qualified medical oncologist with special expertise in the chemotherapeutic management of gynecologic cancer.

Surgical Staging

Surgical staging includes biopsies of the following:

The undersurface of the diaphragm.
The omentum (the fatty layer that covers and pads organs in the abdomen).
Sometimes lymph nodes along the abdominal aorta.

An abdominal wash is performed by injecting a salt solution into the abdominal cavity to facilitate microscopic detection of malignant cells not visible to the naked eye. The surgeon then evaluates the pelvis and abdomen and removes suspected cancer tissue. The entire affected ovary is usually removed (oophorectomy) during surgical staging if the surgeon believes it might be cancerous. The tissue is sent to a laboratory for an immediate evaluation called a frozen section diagnosis. The physician will also examine the bowel and bladder for cancer invasion.

Preservation Surgery in Premenopausal Women with Early Cancer

If the tumor is in an early stage on one ovary and a young woman wants to retain her ability to have children, the surgeon may be able to remove only the affected ovary and perform surgical staging. Chemotherapy follows in selected patients. Studies indicate that in carefully selected young patients, many can expect normal fertility afterward. It should be noted, however, that most women with ovarian cancer are not candidates for this procedure.

Total Hysterectomy and Bilateral Salpingo-Oophorectomy and Debulking

The goal of surgery is to remove as much of the tumor as possible (called debulking or cytoreductive surgery) for improving symptoms and increasing the effectiveness of chemotherapy. The surgery itself is typically performed as follows:

In premenopausal women in later stages, and in all postmenopausal women, the surgeon usually removes the uterus (a hysterectomy) and both ovaries and fallopian tubes (a bilateral salpingo-oophorectomy).
In addition, the surgeon usually removes the omentum (omentectomy), any growths on the diaphragm and intestine, and possibly certain lymph nodes (lymphadenectomy).