Ovarian cancer surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Huda A. Karman, M.D.
Overview
Surgery is the preferred treatment and is frequently necessary to obtain a tissue specimen for differential diagnosis via its histology. Surgery performed by a specialist in gynecologic oncology usually results in an improved result. Improved survival is attributed to more accurate staging of the disease and a higher rate of aggressive surgical excision of tumor in the abdomen by gynecologic oncologists as opposed to general gynecologists and general surgeons.
Surgical Therapy
Surgical managements depends on the status of the patient, grading and staging of the tumor: [1][2][3][4][5][6][7][8]
- Early-Stage Ovarian Epithelial, Fallopian tube, and Primary Peritoneal Cancer
- If the tumor is well differentiated or moderately well differentiated, surgery alone may be adequate treatment for patients with stage IA and IB disease.
- Surgery should include hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Additionally, the undersurface of the diaphragm should be visualized and biopsied
- Pelvic and abdominal peritoneal biopsies and pelvic and paraaortic lymph node biopsies are required and peritoneal washings should be obtained routinely.
- In selected patients who desire childbearing and have grade I tumors, unilateral salpingo-oophorectomy may be associated with a low risk of recurrence.
- Primary surgical cytoreduction.
- Patients diagnosed with stage III and stage IV disease are treated with surgery and chemotherapy; however, the outcome is generally less favorable for patients with stage IV disease.
- The role of surgery for patients with stage IV disease is unclear, but in most instances, the bulk of the disease is intra-abdominal, and surgical procedures similar to those used in the management of patients with stage III disease are applied.
- The options for intraperitoneal (IP) regimens are also less likely to apply both practically (as far as inserting an IP catheter at the outset) and theoretically (aimed at destroying microscopic disease in the peritoneal cavity) in patients with stage IV disease.
- Advanced-Stage Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer
- Surgery has been used as a therapeutic modality and also to adequately stage the disease.
- Surgery should include total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy and debulking of as much gross tumor as can safely be performed. While primary cytoreductive surgery may not correct for biologic characteristics of the tumor, considerable evidence indicates that the volume of disease left at the completion of the primary surgical procedure is related to patient survival.
- Adjuvant Therapy
- For patients unable to undergo surgery, or for those with greater than 1 cm residual disease following surgery, IV chemotherapy is the standard.
- The foundation is the platinum agents: cisplatin, or its second-generation analog, carboplatin, given either alone or in combination with other drugs.
References
- ↑ Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ (2002). "Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis". J Clin Oncol. 20 (5): 1248–59. doi:10.1200/JCO.2002.20.5.1248. PMID 11870167.
- ↑ Chi DS, Eisenhauer EL, Lang J, Huh J, Haddad L, Abu-Rustum NR; et al. (2006). "What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)?". Gynecol Oncol. 103 (2): 559–64. doi:10.1016/j.ygyno.2006.03.051. PMID 16714056.
- ↑ Chang SJ, Hodeib M, Chang J, Bristow RE (2013). "Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis". Gynecol Oncol. 130 (3): 493–8. doi:10.1016/j.ygyno.2013.05.040. PMID 23747291.
- ↑ Hoskins WJ (1994). "Epithelial ovarian carcinoma: principles of primary surgery". Gynecol Oncol. 55 (3 Pt 2): S91–6. doi:10.1006/gyno.1994.1346. PMID 7835815.
- ↑ Redman CW, Warwick J, Luesley DM, Varma R, Lawton FG, Blackledge GR (1994). "Intervention debulking surgery in advanced epithelial ovarian cancer". Br J Obstet Gynaecol. 101 (2): 142–6. doi:10.1111/j.1471-0528.1994.tb13080.x. PMID 8305389.
- ↑ Eisenkop SM, Spirtos NM, Lin WC (2006). ""Optimal" cytoreduction for advanced epithelial ovarian cancer: a commentary". Gynecol Oncol. 103 (1): 329–35. doi:10.1016/j.ygyno.2006.07.004. PMID 16876853.
- ↑ van der Burg ME, van Lent M, Buyse M, Kobierska A, Colombo N, Favalli G; et al. (1995). "The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer". N Engl J Med. 332 (10): 629–34. doi:10.1056/NEJM199503093321002. PMID 7845426.
- ↑ Rose PG, Nerenstone S, Brady MF, Clarke-Pearson D, Olt G, Rubin SC; et al. (2004). "Secondary surgical cytoreduction for advanced ovarian carcinoma". N Engl J Med. 351 (24): 2489–97. doi:10.1056/NEJMoa041125. PMID 15590951.