Epithelial ovarian tumors surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]
Overview
Surgical intervention is the mainstay of management of epithelial ovarian tumors. Surgery must be done for the purpose of staging and maybe treatment according to the stage of the tumor. Surgical management of the epithelial ovarian tumors, for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the ovary or not.
Surgery
- Surgery is the mainstay of management of epithelial ovarian tumors:[1][2][3][4]
- Surgery is indicated for the purpose of staging and maybe treatment according to the stage of the tumor.[5]
- Surgical management of the epithelial ovarian tumors, for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the ovary or not.
- Nonsurgical management may be considered in those with tumors smaller than 6 cm, especially those who is planning to get pregnant.[6]
- Surgery increses the risk of band adhesion formation that may be associated with future fertility in women.
- Surgery is usually reserved for patients with either:[6]
- Tumor size larger than 6 cm
- No plans for future pregnancy
- Post-menopausal women
Stage I Ovarian Tumors
- Unilateral salpingo-oophorectomy with or without lymphangiography or computed tomography (CT)
- Unilateral salpingo-oophorectomy followed by observation
- Unilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
- Unilateral salpingo-oophorectomy with conservation of uterus and contralateral ovar is indicated in those who plan for future pregnancies.
- Postoperative lymphangiography or CT is indicated for those who have not had the careful surgical and pathological examination of pelvic and para-aortic lymph nodes during surgery.
- Patients with surgically staged stage IA tumors may be observed carefully after surgery without the need for adjuvant treatment.
- Patients with incompletely staged tumor through surgery or those with higher stages may need adjuvant treatment.
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Unilateral salpingo-oophorectomy followed by observation
- Unilateral salpingo-oophorectomy with conservation of uterus and contralateral ovar is indicated in those who plan for future pregnancies.
- Chemotherapy is usually done postoperatively in those with ovarian germ cell tumors other than pure dysgerminoma and low grade (grade 1) immature teratoma, but it can also preserved for those whose tumors relapse after the surgery.
Stage II Ovarian Tumors
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- This option is considered for younger patients and those who desire to preserve their fertility for future pregnancies.
- Radiotherapy has been associated with ovarian failure.
- Adjuvant chemotherapy with the platinum-based regimen has replaced radiation therapy except in the rare patient in whom chemotherapy is not considered appropriate.
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Second-look laparotomy
- This strategy is not beneficial in patients with completely resected tumors who receive cisplatin-based adjuvant treatment.
- Second-look surgery may be beneficial in those whose tumor was not completely resected at the initial surgical procedure and who had teratomatous elements in their primary tumor.
Stage III Ovarian Tumors
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Chemotherapy is the preferred treatment in the patient who wants to preserve fertility.
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
- Second-look laparotomy
Stage IV Ovarian Tumors
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
References
- ↑ Stage I Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015
- ↑ Stage II Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015
- ↑ Stage III Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015
- ↑ Stage IV Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015
- ↑ Gershenson, David M. (2007). "Management of Ovarian Germ Cell Tumors". Journal of Clinical Oncology. 25 (20): 2938–2943. doi:10.1200/JCO.2007.10.8738. ISSN 0732-183X.
- ↑ 6.0 6.1 Caspi, Benjamin; Appelman, Zvi; Rabinerson, David; Zalel, Yaron; Tulandi, Togas; Shoham, Zeev (1997). "The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women". Fertility and Sterility. 68 (3): 501–505. doi:10.1016/S0015-0282(97)00228-8. ISSN 0015-0282.
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