First Treatment For Ovarian Cancer
- Deciding whether to do surgery or chemo first is complex.
- A patient's overall health and fitness are factors.
- The goal of surgery is to remove all visible cancer. Doctors use tools such as imaging and a laparoscopy to help them decide if that is likely.
- Chemo is given first if doctors determine that initial surgery would not be successful.
Doctors who are caring for ovarian cancer patients typically have two approaches to treatment. Both include a combination of chemotherapy and surgery, but the sequence of those treatments can vary.
The decision as to whether to treat with surgery initially or with chemotherapy initially is quite complex, says Dr. Irina Dimitrova, gynecologic oncologist at Henry Ford Health System, in Detroit. "The two most important factors that come into play are first, is the patient healthy enough to safely undergo a major surgical procedure?" Do they have any underlying conditions or disease that would impair their recovery? “The second factor is the disease itself. Will a surgeon be able to remove all visible disease? The goal of surgery is to remove all visible cancer, and if we determine that we are unable to do that, then the patient will probably get neoadjuvant chemotherapy, which means they'd get chemotherapy first."
Read More Doctors use several tools to assess the extent of the cancer, including imaging studies and what's called a diagnostic laparoscopy a minimally invasive surgical procedure that allows them to examine the organs inside the abdomen. Using a slender camera, they investigate the extent of the cancer, and whether they're able to do what's called a debulking procedure, to remove all visible disease. According to the National Institutes of Health (NIH), oncologists have had particular success with debulking in ovarian cancer patients, as compared with other types of cancer. If a patient isn't fit enough for surgery, or doctors aren't confident they can successfully remove the tumor, "then we treat them with chemotherapy first and monitor their response," says Dimitrova. Doctors usually give three or four cycles of chemotherapy, hoping to shrink down the cancer. “If they respond well to the chemo, and we get their health to a place where surgery is safe, we would then proceed with surgery” followed by additional chemotherapy treatment. Dimitrova says she makes it a point to clear up any misconceptions her patients have about chemo. "There is definitely a belief among patients that chemotherapy is worse than the disease itself," she says. "What I hear most often is that the effects of chemotherapy are worse than the effect of cancer," especially the nausea and vomiting. "Patients believe that they’re going to be sick all the time." And while that might have been the case 20 years ago, "it is clearly not true nowadays." If patients are throwing up all day, then the doctors are not doing their job.
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