Cytoreductive
Surgery
How are the treatment options for ovarian cancer?
Ovarian cancer treatment involves a combination of cytoreductive surgery and chemotherapy. The goal of surgical treatment is to remove all of the tumour in the abdomen. The classical steps would include removal of the uterus along with both the ovaries, pelvic nodes, omentectomy and peritonectomy along with para aortic lymphadenectomy if involved. Because surgery is a local treatment, it cannot address micro metastatic cancer cells; to overcome this limitation intraperitoneal chemotherapy in the abdomen used during relapse. Systemic chemotherapy is used to treat micro metastases in distant sites away from the abdomen and is an integral part of treatment.
What are the investigations done to confirm a diagnosis of ovarian cancer?
Generally the first line of investigation in evaluation of a pelvic mass is an ultrasound of the abdomen and pelvis. Once a complex ovarian cyst has been identified, further imaging in the form of a PET CT or CECT Thorax, abdomen and Pelvis along with MRI abdomen may be performed. CA 125 is a tumour marker is elevated in ovarian cancer.
What does Cytoreductive surgery in ovarian cancer entail?
This complex surgery may involve:
- A total hysterectomy (removal of the uterus)
- A bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes)
- An omentectomy (removal of a flap of fatty tissue that covers the bowel in the abdomen)
- Lymphadenectomy ( Pelvis / Para aortic if involved )
- Removal of any other cancerous tissue or nearby organ (if required) that is visible within the abdomen
- Peritonectomy
After the completion of cytoreductive surgery, HIPEC is added to ensure that microscopic disease is also dealt with during the procedure
Role of systemic chemotherapy?
Systemic chemotherapy is as important in treatment of ovarian cancer as is surgery. The timing of chemotherapy would depend on the stage of disease with advanced ovarian cancer receiving chemotherapy initially followed by surgery and then completion of chemotherapy. Patients with early ovarian cancer will undergo surgery initially followed by adjuvant chemotherapy.