Ovarian Cancer Surgery – The First Conversation

The first step after an initial diagnosis of ovarian cancer will be a conversation about whether surgery–to remove as much of the tumor as possible–is a good option. These first conversations can help determine how best to approach your surgery, or whether surgery is even the right choice with which to begin. SurvivorNet spoke to Dr. Amanika Kumar, gynecologic oncologist at the Mayo Clinic, about what to expect during those first conversations.

Essential First Conversations

Kumar says that all patients should have a comprehensive conversation with their doctor about the sequence of their treatment (surgery or chemotherapy first) and what the different options are. Doctors can discuss these difficult treatment choices and include patients in their own treatment plans. Quality of life may differ for the patient depending on the treatment sequence chosen. “Every patient deserves a conversation about treatment versus no treatment, and if treatment, here are our pathways,” she says. For example, according to Kumar, there are two questions she asks women to determine whether surgery is the right next step:

1. “Is the disease resectable?” – According to Kumar, if the doctor can remove a patient’s tumor completed to no visible disease, then surgery is a viable treatment option. If not, then surgery isn’t recommended. The overall goal, however, is to remove so much of the tumor that no visible part remains left behind.
2. “Is the patient fit for surgery?” – If the tumor is removable with surgery, then doctors like Kumar determine whether a patient is fit and healthy enough for surgery, since it is such an intensive and radical surgery.

Patient Fitness and Surgery Eligibility

To assess a patient’s eligibility for surgery, Kumar uses several factors, including:

• Age
• Nutrition
• Cardiovascular fitness
• Heart Disease
• History of Blood Clots
• History of Heart Attacks

There is lots of attention given to the health and eligibility of a woman for surgery because it is a long, intensive procedure, involving all four quadrants of the abdomen. Kumar says that since there is a risk of complications associated with having surgery, a comprehensive discussion with your doctor about the risks and benefits of having initial surgery is essential to the success of your treatment plan. “These surgeries can be very aggressive,” says Kumar. “They’re long, there’s a rate of complication that we can’t ignore. We want to make sure that patients are able to get through that complication, survive that complication, and get to chemotherapy, which is very important.” For example we know that despite surgery removing all visible disease, cancer cells are still present after surgery and need to be attacked quickly after surgery by chemotherapy so that they do not grow.

However, it is key that women advocate for themselves, as we know that doctors may hold assumptions and contain biases about certain patients. For example, doctors may initially assume an elderly patient can’t undertake surgery or chemotherapy, but elderly patients may have just as good or better fitness than many younger women. That’s why it’s important that doctors take a complete patient history and fitness assessment as described above to understand each woman’s ability to take on ovarian cancer treatment.

She reassures us that if these conversations are had and patients are found to be informed and ready for the procedure, then surgery will likely be performed. “As long as the patient–who is fit–understands the degree of surgery and the benefits of surgery, as well as the risks of surgery, most of the time we’re going to try to do surgery up front,” says Kumar.

Be sure to have a comprehensive initial discussion with your physician to lay out your treatment options.

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