First Treatment for Ovarian Cancer
- Neoadjuvant chemotherapy is chemo given before ovarian cancer surgery, usually when a tumor has spread widely or to certain inoperable areas.
- The goal of surgery is to remove all visible cancer. Doctors use tools such as imaging and a laparoscope to help them decide if that is likely.
- If doctors determine that initial surgery would not be successful, then chemotherapy may be given first.
- The chemo can help shrink the tumor so it can be removed during surgery.
- The order of treatment may vary depending on COVID-19 conditions in your area
The decision whether to treat with surgery initially or with chemotherapy initially can be quite complex. There are two medical important factors that come into play. The first is to determine whether a patient is healthy enough to safely undergo a major surgical procedure. Do they have any underlying conditions or disease that would impair their recovery? Are they strong enough or are they too frail? And, again, remember that your clinician may recommend altering your treatment order depending on the COVID conditions in your area and your hospital’s policies on surgeries which can potentially be delayed.
Read MoreTo help doctors decide the best course of treatment, they 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 determine whether they're able to do what's called a debulking procedure, to remove all visible disease.
If there is concern that the disease has spread beyond the ovaries and the pelvis–called stage 3 or stage 4 cancer–or the cancer has infiltrated organs or parts of organs that can’t be removed, then doctors have to consider neoadjuvant therapy. Dr. Bupathi says that determining whether to administer chemotherapy “in the neoadjuvant setting"as well as all aspects of your careis dependent on imaging and then a frank, open discussion with your surgeon.
Multidisciplinary tumor boards, where a number of specialists review and discuss your treatment options, are often a part of the decision-making process. In cancer treatment, a tumor board review may include a medical oncologist, a surgical oncologist, a pathologist, and a radiation oncologist. These specialists can discuss what the surgeon thinks he or she can do upfront versus what the rest of the medical team thinks they can do to help shrink a patient’s tumor in advance so that the surgery has a good chance of success.
Many oncologists say they make it a point to clear up the misconceptions that many patients have about chemotherapy. While it may not be a walk in the park, "there is definitely a belief among patients that chemotherapy is worse than the disease itself," one oncologist says. "What I hear most often is that the effects of chemotherapy are worse than the effect of cancer." Patients especially fear the nausea and vomiting, and may wrongly believe they’ll be sick all of the time. And while that might have been the case 20 years ago, it is clearly not true nowadays. According to oncologists, patients should know that if they are throwing up, then they are not doing their job.
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