• Surgical Procedures for Ovarian Cancer

    Treatment for ovarian cancer generally begins with a surgery called a laparotomy . The extent of the surgery from this point will depend on how advanced your cancer is. Even if your cancer has spread outside of your ovary, radical surgery is usually the best first treatment for ovarian cancer. Generally, the fewer cancer cells left behind after surgery, the better your outcome.
    The American Congress of Obstetricians and Gynecologists (ACOG) recommends that all women with ovarian cancer have surgery performed by a gynecologic oncologist—a doctor with special training in the treatment of cancers of the gynecologic organs.

    Laparotomy

    Laparotomy is the opening of your abdomen by traditional surgery. Depending on your situation, your surgical procedure may involve:
    • Exploring to identify exactly how advanced the cancer is and how far it has spread
    • Removing only the diseased ovary ( oophorectomy )
    • Removing both ovaries, both fallopian tubes, the uterus, and as much associated tissue as possible (if the cancer has visibly spread to other organs in the pelvis)
    • Removing both ovaries, both tubes, the uterus, and as much associated tissue as possible, as well as any suspicious-looking lymph nodes
    Most of the time, an incision will be made up and down in the midline of your abdomen, through which the ovary or female organs will be removed. The vagina will be sewn closed from the inside in such a way that sexual intercourse will not be hindered.
    Lymph nodes will be sampled routinely, and those appearing suspicious will be taken out. The omentum (a fatty tissue around the intestine) will be sampled if not entirely removed, as this is often involved with tumor deposits. The liver and diaphragm muscle will be explored as will the bowel and peritoneal fluid (the fluid that is inside your abdomen). Organs and lymph nodes that are removed will be sent to the pathologist for analysis.
    The goal of the surgery is to remove as much tumor as possible (called debulking), and some believe that optimal debulking is the single most important intervention that cures the patient. Optimal debulking is currently defined as leaving no piece of tumor behind that is greater than 1.0 cm in size. In the rare situation where more limited surgery is performed, the extent of the surgery will be dictated by what the surgeon finds. Patients should plan on having everything removed from the start.

    References

    Detailed guide: ovarian cancer. American Cancer Society website. Available at: http://www.cancer.org/ . Accessed April 8, 2009.

    Kasper DL, Harrison TR. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

    Ovarian cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/ovarian/ . Accessed April 8, 2009.

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