An uncontrollable growth of abnormal cells in ovary leads to ovarian cancer. The main treatment for ovarian cancer is surgery. The surgical treatment to be given to the patient is decided to depend on the type of ovarian cancer and its stage.
There are approximately 30 types of ovarian cancers and are classified on the basis of cells where they start. Cancerous tumors of epithelium cell of the ovary are most common which include epithelial ovarian tumor, fallopian tube tumor, and primary peritoneal carcinoma.
Ovarian Cancer Surgery is a complicated procedure that is operated by a gynecological oncologist. The types of surgery are:
- Removal of one or both ovaries and fallopian tubes (unilateral/bilateral salpingo-oophorectomy)
- Removal of the uterus and cervix (total hysterectomy)
Need of Ovarian Cancer Surgery
Almost all types of ovarian cancer need a surgical procedure. However, the timing and type of surgery to treat ovarian cancer is decided by evaluating various factors, such as patient’s medical history, any previous cancer surgery and recurrence of the disease, and general health and fitness. Early stage cancer may be treated with surgery only while an advanced stage cancer needs the combination of surgery and chemotherapy.
Procedure for Ovarian Cancer Surgery
There are two major steps in Ovarian Cancer Surgery:
- Staging is the procedure to determine the extent of cancer spread in the body.
- Stage 1 cancer is limited to one or both ovaries.
- Stage 2 cancer is limited to ovaries and pelvis.
- The disease is considered at stage 3 when cancer spreads into abdomen moving outside of pelvis.
- When cancer spreads to the liver also, it is stage 4.
- Laparoscopy or laparotomy is done and samples are collected through biopsy. The tissue and fluid samples are sent to a lab for frozen section analysis to determine the presence of cancer. Once confirmed, the surgeon proceeds to next step of the surgery.
- Debulking is the process where the surgeon locates and removes as many of the cancerous tumors as possible. Removing all tumors larger than 1 cm is known as optimal-debulking. Chemotherapy is given after debulking to remove remaining cancer cells.
A number of tests are conducted to examine whether it is safe to do surgery. In cases where a patient is not fit and surgery is considered risky, treatment is started with chemotherapy.
- Complete blood tests are carried out to rule out deficiencies and blood-related diseases.
- Chest X-rays, ultrasounds, CT scans, cardiograms, and other imaging tests are conducted.
- Complete medical history is studied by the team of doctors.
- The patient needs to complete bowel preparation and clean the lower intestine before the surgery.
- The patient should not eat or drink anything at least 8 hours before the surgery.
- All the pre-surgery medications prescribed by the doctor must be regularly taken by the patient.
- General anesthesia is given to the patient.
- The surgeon applies small cuts for laparoscopy or a long cut for laparotomy on the abdomen.
- Samples from tissues of ovaries, uterus, and other organs surrounding them are collected and sent to a pathological laboratory.
- The surgeon identifies the stage of cancer-based on the reports and decides on the treatment.
- The surgeon carries out the process of debulking in which the cancerous tumors are located and removed.
- Depending on the stage of cancer, one or both ovaries and fallopian tubes are removed.
- The surgeon also removes uterus with cervix, parts of abdomen and lymph nodes in case of stage 2 or 3 cancer.
- The incisions are closed.
- The patient may need to stay in a hospital for 5-7 days.
- In about one week of the surgery, the doctor will decide further treatment after studying the test reports.
- In case of the advanced stage of ovarian cancer, chemotherapy or other specific therapies are recommended for which patient has to return to the hospital.
- It may take about six to eight weeks to recover depending on the general health and complexity of the surgery.
- Proper rest is important for fast recovery.
- Follow-up checkups in every 2-3 months are required to ensure that the treatment is working well.
- CA125 blood tests are done to check the growth of ovarian cancer post-treatment.
- PET-CT scan or MRI is also done to analyze the body’s response to treatment.
Risks involved in Ovarian Cancer Surgery
As ovarian cancer surgery is big, therefore the risks are also big especially in cases of advanced stages of cancer. Following are some risks and side-effects involved in the surgery.
- The risk of recurrence of ovarian cancer is there in advanced epithelial ovarian cancer which can return after some months or years after the treatment.
- There is a risk of experiencing gastrointestinal problems by the patient.
- After the surgery, the symptoms of stress, anxiety, and depression may increase.
- The patient may feel fatigue, pain, and swelling.
- Vaginal bleeding
- Loss of libido
Factors affecting the cost of Ovarian Cancer Surgery
- The fee of gynecological oncologist and medical team
- Cost of hospitalization
- Scans and other medical tests
- Need of chemotherapy or other targeted therapies
- The stage of ovarian cancer and type of surgery required