Considerations Before Ovarian Cancer Surgery
- The spread of your cancer as estimated by initial testing
- Your overall health and any other conditions or “co-morbidities”
- The size and location of your tumor
A diagnosis of ovarian cancer is often followed by a recommendation for surgery. Once the oncologist has determined how extensive the cancer is and how far the cancer has spread—a process called staging—the next step may be a surgical procedure called debulking. In this type of surgery, the goal is to remove all visible tumor, leaving only microscopic disease to be treated later with chemotherapy. But not all women are considered ideal candidates for this surgery.
Assessing the Patient’s Medical History
“The number one thing I worry about is, Is it safe for the patient?,” says Dr. Saketh Guntupalli, a gynecologic oncologist at the Colorado University Denver School of Medicine. “Ovarian cancer patients often have other medical conditions such as diabetes, poorly controlled hypertension, or a history of stroke or heart attack that can make surgery a bit more difficult.” Surgeons must evaluate whether the patient can tolerate a debulking procedure.
Determining the Size and Location of the Tumor
Another consideration before debulking surgery is to evaluate whether all of the tumor can be removed, depending on its size and location. If, for example, a patient has a large mass on their pancreas, or a mass where the blood supply goes into the liver, then surgery can be very difficult. Surgeons need to determine whether they’ll be able to remove all of the tumor. “If we’re going to leave more than a centimeter behind, it may not be worth doing the surgery,” says Dr. Guntupalli. In that case, the oncologist may recommend neoadjuvant chemotherapy—chemotherapy to shrink the tumors before surgery.
Related: What Is It Like To Get Chemotherapy for Ovarian Cancer?
Using the Frailty Index
A third thing to consider before surgical removal of cancer is frailty, “something that we’re definitely looking at more,” says Dr. Guntupalli. He explains that surgeons can actually check a patient’s score on a Frailty Index to help determine whether a patient will have a good outcome. “We know that patients who are more frail, who are malnourished, or patients who have low levels of vitamin D or osteoporosis may do more poorly,” he says.
Carefully considering all these factors is crucial, because debulking surgery, like all surgery, carries risks. “Blood loss is one big risk,” says Dr. Guntupalli. “But we can usually replace lost blood.”
Developing a blood clot is another risk. “Women with gynecologic cancers can have a very high rate of developing a blood clot,” says Dr. Guntupalli. “People with cancer tend to make more of the blood factors that promote clotting.” The location of gynecologic cancer also makes blood clots more of a risk. “The gynecologic organs are in the pelvis, and if the tumor is growing on the blood supply to the legs, that can cause blood flow to slow down and allow clots to form.”
As with all types of surgery, patients facing debulking surgery need to have an extensive discussion with their surgeon to make sure that the surgery is the right thing for them.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Saketh Guntupalli is chief of gynecologic oncology at the University of Colorado School of Medicine, Denver. Read More
Considerations Before Ovarian Cancer Surgery
- The spread of your cancer as estimated by initial testing
- Your overall health and any other conditions or “co-morbidities”
- The size and location of your tumor
A diagnosis of ovarian cancer is often followed by a recommendation for surgery. Once the oncologist has determined how extensive the cancer is and how far the cancer has spread—a process called staging—the next step may be a surgical procedure called debulking. In this type of surgery, the goal is to remove all visible tumor, leaving only microscopic disease to be treated later with chemotherapy. But not all women are considered ideal candidates for this surgery.
Assessing the Patient’s Medical History
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“The number one thing I worry about is, Is it safe for the patient?,” says Dr. Saketh Guntupalli, a gynecologic oncologist at the Colorado University Denver School of Medicine. “Ovarian cancer patients often have other medical conditions such as diabetes, poorly controlled hypertension, or a history of stroke or heart attack that can make surgery a bit more difficult.” Surgeons must evaluate whether the patient can tolerate a
debulking procedure.
Determining the Size and Location of the Tumor
Another consideration before debulking surgery is to evaluate whether all of the tumor can be removed, depending on its size and location. If, for example, a patient has a large mass on their pancreas, or a mass where the blood supply goes into the liver, then surgery can be very difficult. Surgeons need to determine whether they’ll be able to remove all of the tumor. “If we’re going to leave more than a centimeter behind, it may not be worth doing the surgery,” says Dr. Guntupalli. In that case, the oncologist may recommend neoadjuvant chemotherapy—chemotherapy to shrink the tumors before surgery.
Related: What Is It Like To Get Chemotherapy for Ovarian Cancer?
Using the Frailty Index
A third thing to consider before surgical removal of cancer is frailty, “something that we’re definitely looking at more,” says Dr. Guntupalli. He explains that surgeons can actually check a patient’s score on a Frailty Index to help determine whether a patient will have a good outcome. “We know that patients who are more frail, who are malnourished, or patients who have low levels of vitamin D or osteoporosis may do more poorly,” he says.
Carefully considering all these factors is crucial, because debulking surgery, like all surgery, carries risks. “Blood loss is one big risk,” says Dr. Guntupalli. “But we can usually replace lost blood.”
Developing a blood clot is another risk. “Women with gynecologic cancers can have a very high rate of developing a blood clot,” says Dr. Guntupalli. “People with cancer tend to make more of the blood factors that promote clotting.” The location of gynecologic cancer also makes blood clots more of a risk. “The gynecologic organs are in the pelvis, and if the tumor is growing on the blood supply to the legs, that can cause blood flow to slow down and allow clots to form.”
As with all types of surgery, patients facing debulking surgery need to have an extensive discussion with their surgeon to make sure that the surgery is the right thing for them.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Saketh Guntupalli is chief of gynecologic oncology at the University of Colorado School of Medicine, Denver. Read More
