In many cases, ovarian cancer treatment involves a combination cytoreductive surgery and chemotherapy. The goal of surgical treatment is to remove a tumour and any nearby tissues to which the cancer may have spread. However, in addition to a localized tumour, ovarian cancer often involves micro metastases that have spread away from the ovaries to other parts of the body. Because surgery is a local treatment, it cannot address micro metastatic cancer cells. Therefore, a systemic treatment like chemotherapy, which involves the use of powerful drugs that can enter the bloodstream to reach and destroy widespread cancer cells, may be used either before or after cytoreductive surgery.
The main type of cytoreductive surgery that is performed to address ovarian cancer is called a laparotomy, or initial cytoreductive surgery. When performing a laparotomy, a gynaecologic oncologist can accurately diagnose and stage a tumour, remove as much cancer as possible from the abdominal region and assess whether additional therapy may be necessary. 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)
- Removal of any other cancerous tissue that is visible within the abdomen
During the procedure, the surgeon will also obtain tissue samples from the upper abdomen, collect small amounts of abdominal fluid and remove some nearby lymph nodes by taking a biopsy so that these samples can be examined under a microscope for evidence of cancer.
After the completion of cytoreductive surgery and chemotherapy, a patient will typically undergo a physical examination, a CA-125 blood test and radiologic studies, all of which can be used to evaluate the effectiveness of treatment. If no signs of cancer are found, a patient is said to be in a complete clinical remission. However, micro metastases are not always detectable through the currently available tests. For this reason, a gynaecologist may recommend an additional procedure known as a second-look laparotomy to further evaluate a patient’s response to treatment.