Ovarian Cancer Treatment Sequence
- The sequence of ovarian cancer treatment is unique to the individual
- The goal of surgery is to remove all visible disease
- Chemotherapy can help reduce the burden of disease prior to surgery
“Deciding between primary surgery and neoadjuvant chemotherapy is an important early decision in the care of patients with ovarian cancer,” says Dr. Ramez Eskander, gynecologic oncologist at the University of California, San Diego. “The goal of surgery, whether upfront, or after a patient receives a few cycles of chemotherapy, is to remove all visible disease.”
Read MoreDoctors never go into a surgery for ovarian cancer expecting to leave portions of the tumor behind. In fact, surgically removing only some of the disease can delay necessary chemotherapy treatment, which could be critical for the patient’s survival. That’s one reason why determining which treatment to pursue first chemotherapy or surgery is so critical. “The decision depends largely on the distribution of the disease where the cancer is in relation to other structures in the pelvis and abdomen,” says Dr. Eskander. Doctors use radiographic imaging and clinical examination to determine whether or not they will be able to remove all of the disease with confidence. For patients with widely distributed disease that cannot be safely removed without unacceptable complications, the first line of defense is usually chemotherapy. Receiving chemotherapy treatment preoperatively can help reduce the volume of disease, so doctors don’t have to remove as much tissue during surgery.
“The intent of neoadjuvant chemotherapy is to control disease, to shrink the tumor,” Dr. Eskander says. So, for example, if you have evidence of disease in several areas of the liver, doctors are not going to remove the liver to get rid of the tumor. Instead, they’ll use neoadjuvant chemotherapy to coax those diseased areas in the liver to die off.
Making the Best Decision
While studies are at odds about whether neoadjuvant chemotherapy improves survival for patients with ovarian cancer, the “chemo-first-protocol” does reduce the risk of surgical complications by 25 to 30 percent. Still, if you’re a good candidate for surgery without pre-treatment with chemotherapy, doctors usually prefer to go that route.
“It’s important to see a provider at an institution that has the resources to not only perform the surgery, but also make decisions about the best course of treatment for your specific cancer,” Dr. Eskander says. Ovarian cancer treatment is a team effort that requires input and insight from a variety of professionals ranging from radiologists and surgeons to oncologists and supportive care professionals.
The bottom line: Doctors have more options than ever before for the treatment of ovarian cancer. Conversations with your health care team and careful planning can help you navigate the experience with the greatest ease.
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