Knowing Your Options: Ovarian Cancer Surgery
- Bird Brown, 27, of Alaskan Bush People, underwent emergency surgery to remove two ovarian cysts and may need a hysterectomy.
- Hysterectomies are among the treatment options for ovarian cancer.
- Typically, surgery for ovarian cancer involves a midline incision in the abdominal wall. Before proceeding doctors will make an assessment: can they remove almost all, or all the tumor completely?
Because of the high-risk of a cancerous tumor developing, Brown must make the difficult decision to have a full hysterectomy, which would mean the removal of her uterus and ovaries she could never bear children naturally.Read More
Ami Brown herself was diagnosed with lung cancer in 2017 and made a successful recovery.
Types Of Surgery For Ovarian Cancer
Surgery is the main form of treatment for most ovarian cancers, but how much surgery will depend on how far your caner has spread and on your overall health.
"The goal for surgery is to leave no visible tumor," says Dr. Peter Argenta, a gynecologic oncologist at University of Minnesota Health Cancer Care.
Typically, surgery for ovarian cancer involves a midline incision in the abdominal wall. Before proceeding doctors will make an assessment: can they remove almost all, or all the tumor completely?
"If I open up a patient and see that that's not going to be possible, we close them up and start with chemotherapy," Dr. Argenta says. Chemo before surgery, called neoadjuvant chemotherapy, can help shrink a tumor, making it easier to surgically remove.
Depending on the stage of the ovarian cancer, debulking surgery, which is the removal of as much tumor as possible, may involve the surgical removal of the uterus, also known as a hysterectomy.
Surgery generally starts with a total abdominal hysterectomyremoving the uterus, fallopian tubes, ovaries, cervix. Surgeons also remove something called the omentum, an apron of fatty tissue that covers and supports the intestines and organs in the abdomen, because ovarian cancer sometimes spreads to this area.
"Then we go up to the diaphragm, and bit by bit, we go over each and every organ and try to remove any tumors that we may see," says Dr. Argenta.
How To Approach Ovarian Cancer Surgery
Typically there are two approaches to ovarian cancer surgery, according to SurvivorNet experts. They are staging and debulking.
“If someone has a large mass that we need to remove and then we find out there’s a cancer, we need to find out if that cancer has spread or not,” says Dr. Lori Weinberg, an obstetrician-gynecologist at Minnesota Oncology.
So in staging the doctors are trying to figure out if this is a more advanced disease or if it was more localized to the ovary, according to Weinberg.
However, the situation is very different when a patient is taken to the operating room to do a debulking surgery.
“So we’re not sampling microscopic areas hoping to find if there’s any disease hiding in places. We’re taking out everything that we can visibly see, and that’s a debulking surgery,” said Weinberg.
She adds, the ”gold standard” for trying to determine if, indeed, there’s ovarian cancer or not is a tissue biopsy.
Nowadays, thanks to modern medicine, some surgeries can be performed with robotic assistance, and a hysterectomy is one of them.
Robotic surgery is a type of minimally invasive surgery, and uses cameras and special robotic surgery tools to makes it possible for surgeons to operate through a series of small incisions. For ovarian cancer, doctors make about five incisions, each less than a centimeter in size, around the belly button rather than a large open incision down the abdomen midline, said Dr. Weinberg.
Dr. Weinberg points out though that robotic surgery is not an option for every woman with ovarian cancer.
"Most patients with ovarian cancer have disease that is spread out in multiple places, where the robotic platform just cannot achieve what we can do through an open incision. We really have to tailor our approach to treatment based on what we're seeing from the imaging, and also on a patient's physical exam,” she said.