Deciding Whether to Get Chemotherapy Before Surgery
- Doctors usually treat ovarian cancer with some combination of chemotherapy and surgery, but the sequence can vary
- Neoadjuvant chemotherapy is chemo that’s done before surgery
- A goal of neoadjuvant chemotherapy is to shrink the tumor to make it easier to remove during surgery
- This may be preferable for women whose cancer has spread, who have a large amount of cancer, or who aren’t healthy enough to go through surgery
Chemotherapy uses strong medicine to stop cancer cells all over your body from dividing and growing. It can be an important part of treatment for ovarian cancer, which has often spread beyond the ovaries to other organs by the time it’s detected.
Most women who have ovarian cancer will get chemotherapy at some point during the treatment process. The question is when you’ll get it — before surgery or after? Typically, treatment starts with surgery, followed by chemotherapy, but that approach isn’t right for everyone.
Neoadjuvant chemotherapy means that you get the treatment before surgery. Making this decision takes some careful consideration by you and your doctor.
“When determining the initial steps upfront of ovarian cancer, we look at the patient and their disease together,” says Dr. Adam ElNaggar, a gynecologic oncologist at West Cancer Center in Memphis, Tennessee. Your health, and the extent to which your cancer has spread, will dictate which treatment you get first.”
When To Choose Neoadjuvant Chemotherapy
Doctors recommend surgery first when they feel confident that they can remove all visible signs of cancer.
“One of the goals of the surgery is to remove all visible disease,” Dr. ElNaggar says. The term doctors use to describe this is “cytoreduction” or debulking surgery. If imaging tests reveal that your cancer has spread to organs like your liver, removing it surgically becomes more difficult for your surgeon, and more invasive for you.
In that case, your doctor may recommend neoadjuvant chemotherapy first to shrink the tumor. The goal being that when you have a procedure afterward, your surgeon won’t have as much tissue to remove.
Another reason to delay surgery in favor of chemotherapy is to give your body time to heal from the effects of your cancer. The energy demands of growing ovarian tumors can leave some women very weak and thin — a condition called cachexia. When cancer spreads into your abdomen or lungs, it can cause fluid to build up in these organs, which can produce uncomfortable symptoms like shortness of breath and appetite loss.
Women who have become weak or frail from their cancer are “less able to undergo an aggressive upfront surgery,” Dr. ElNaggar says. In those cases, neoadjuvant chemotherapy may be the better first step.
Neoadjuvant Chemotherapy – What to Expect
Because a combination of chemotherapy drugs tends to work better against the cancer than one drug alone, this treatment usually includes a platinum-based drug like carboplatin, coupled with another chemo drug like paclitaxel (Taxol).
You’ll get these drugs intravenously, which means through a vein (IV), about every three weeks. The full treatment typically consists of three cycles of chemotherapy, according to Dr. ElNaggar. However, the number of cycles can vary based on factors like your disease stage, health, and how well you respond to the treatment. After you complete the full three cycles, your doctor will do imaging scans to assess your cancer’s status, which may be followed by more chemotherapy cycles.
Chemotherapy drugs need to be powerful to kill cancer cells. Because they target rapidly-dividing cells — cancer cells, as well as hair cells, immune cells, and other types of cells — these drugs can cause side effects such as:
- Fatigue
- Hair loss
- Mouth sores
- Gastrointestinal issues like nausea, vomiting, and diarrhea
- Increased risk for infections
- More frequent bruising and bleeding
Not everyone who receives chemotherapy will have these side effects, but being aware of them in advance can help you deal with them if they do arise. Doctors have an arsenal of medicines to minimize nausea, diarrhea and constipation. Taking naps and getting more exercise can also help you combat some of these side effects.
You’ll have a conversation with your doctor about which treatment — neoadjuvant chemotherapy or surgery first — is the best way to approach your cancer. Regardless of which option you choose, your doctor and the rest of your medical team will help you navigate your treatment and manage any side effects it might cause.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Adam ElNaggar is an assistant professor of gynecologic oncology at the University of Tennessee Health Science Center (UTHSC), and director of gynecologic cancer research at the West Cancer Center in Memphis, Tennessee. His clinical interests include personalized medicine, advanced surgical techniques, and targeted therapies. Read More
Deciding Whether to Get Chemotherapy Before Surgery
- Doctors usually treat ovarian cancer with some combination of chemotherapy and surgery, but the sequence can vary
- Neoadjuvant chemotherapy is chemo that’s done before surgery
- A goal of neoadjuvant chemotherapy is to shrink the tumor to make it easier to remove during surgery
- This may be preferable for women whose cancer has spread, who have a large amount of cancer, or who aren’t healthy enough to go through surgery
uses strong medicine to stop cancer cells all over your body from dividing and growing. It can be an important part of treatment for ovarian cancer, which has often spread beyond the ovaries to other organs by the time it’s detected.
Most women who have ovarian cancer will get chemotherapy at some point during the treatment process. The question is when you’ll get it — before surgery or after? Typically, treatment starts with surgery, followed by chemotherapy, but that approach isn’t right for everyone.
Read More Neoadjuvant chemotherapy means that you get the treatment before surgery. Making this decision takes some careful consideration by you and your doctor.
“When determining the initial steps upfront of ovarian cancer, we look at the patient and their disease together,” says Dr. Adam ElNaggar, a gynecologic oncologist at West Cancer Center in Memphis, Tennessee. Your health, and the extent to which your cancer has spread, will dictate which treatment you get first.”
When To Choose Neoadjuvant Chemotherapy
Doctors recommend surgery first when they feel confident that they can remove all visible signs of cancer.
“One of the goals of the surgery is to remove all visible disease,” Dr. ElNaggar says. The term doctors use to describe this is “cytoreduction” or debulking surgery. If imaging tests reveal that your cancer has spread to organs like your liver, removing it surgically becomes more difficult for your surgeon, and more invasive for you.
In that case, your doctor may recommend neoadjuvant chemotherapy first to shrink the tumor. The goal being that when you have a procedure afterward, your surgeon won’t have as much tissue to remove.
Another reason to delay surgery in favor of chemotherapy is to give your body time to heal from the effects of your cancer. The energy demands of growing ovarian tumors can leave some women very weak and thin — a condition called cachexia. When cancer spreads into your abdomen or lungs, it can cause fluid to build up in these organs, which can produce uncomfortable symptoms like shortness of breath and appetite loss.
Women who have become weak or frail from their cancer are “less able to undergo an aggressive upfront surgery,” Dr. ElNaggar says. In those cases, neoadjuvant chemotherapy may be the better first step.
Neoadjuvant Chemotherapy – What to Expect
Because a combination of chemotherapy drugs tends to work better against the cancer than one drug alone, this treatment usually includes a platinum-based drug like carboplatin, coupled with another chemo drug like paclitaxel (Taxol).
You’ll get these drugs intravenously, which means through a vein (IV), about every three weeks. The full treatment typically consists of three cycles of chemotherapy, according to Dr. ElNaggar. However, the number of cycles can vary based on factors like your disease stage, health, and how well you respond to the treatment. After you complete the full three cycles, your doctor will do imaging scans to assess your cancer’s status, which may be followed by more chemotherapy cycles.
Chemotherapy drugs need to be powerful to kill cancer cells. Because they target rapidly-dividing cells — cancer cells, as well as hair cells, immune cells, and other types of cells — these drugs can cause side effects such as:
- Fatigue
- Hair loss
- Mouth sores
- Gastrointestinal issues like nausea, vomiting, and diarrhea
- Increased risk for infections
- More frequent bruising and bleeding
Not everyone who receives chemotherapy will have these side effects, but being aware of them in advance can help you deal with them if they do arise. Doctors have an arsenal of medicines to minimize nausea, diarrhea and constipation. Taking naps and getting more exercise can also help you combat some of these side effects.
You’ll have a conversation with your doctor about which treatment — neoadjuvant chemotherapy or surgery first — is the best way to approach your cancer. Regardless of which option you choose, your doctor and the rest of your medical team will help you navigate your treatment and manage any side effects it might cause.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Adam ElNaggar is an assistant professor of gynecologic oncology at the University of Tennessee Health Science Center (UTHSC), and director of gynecologic cancer research at the West Cancer Center in Memphis, Tennessee. His clinical interests include personalized medicine, advanced surgical techniques, and targeted therapies. Read More
