How Debulking Surgery Treats Ovarian Cancer
- For ovarian cancer, the decision-making around whether or not to proceed with debulking surgery often revolves around whether the surgeon will be able to remove all visible tumor
- The incision usually extends from the pubic bone to above the belly button
- The stage and extent of disease dictate the organs (ovaries, fallopian tubes, etc.) and other tissue that may need to be removed during a debulking procedure
- Intravenous NSAIDs and movement can help ease pain after surgery
The main goal of surgery is to remove as much of the cancer as possible to pave the way for a successful chemotherapy regimen. Doctors often look at CT scans and other imaging studies to determine where they might find the tumors, to assess the size and how accessible it may be. The analysis of this information will inform whether a staging procedure is recommended to confirm their assessment or if the cancer appears to present in an advanced stage, your doctor may suggest going straight to a debulking surgery.
Read MorePrimary Debulking Surgery
When there's evidence the cancer has spread and is at a later stage, "You’re going to approach that in a particular way. You’re either going to get a biopsy and do neoadjuvant chemotherapy, or chemotherapy cycles before surgery, or you’re going to go in and do a primary debulking," Dr. Metzinger says.Primary debulking means having surgery before chemotherapy. The goal is to remove as much of the cancer as possible. Your doctor will determine if this procedure is appropriate for you, and whether you're healthy enough to tolerate the surgery without having significant side effects, before proceeding.
Underlying conditions like poorly controlled diabetes or high blood pressure, or a past stroke or heart attack, could make this procedure too risky for you. If primary debulking isn't an option, one option may be neoadjuvant chemotherapy to shrink the tumor enough so that it's easier to remove during a future surgery.
Debulking Surgery: What to Expect
Surgery for ovarian cancer is complex and can vary significantly depending on the spread of disease. Many women present with advanced disease because of the difficulties around screening. Often by the time there is a suspicion of cancer it will have already metastasized significantly. As a result those women often require a large procedure. Your doctor will aim to remove all visible tumors. That might require the removal of your ovaries, uterus, fallopian tubes, pieces of your lymph nodes, as well as any cancer that has spread to your colon, liver, or to other areas of your abdomen.
Portions of other organs may need to be removed as well. And sometimes debulking surgery also involves a bowel resection, which means removing and reconnecting a part of the intestine. After a bowel resection many patients must use an ostomy bag, which collects the waste leaving the body through an opening in the abdomen. The ostomy bag is usually temporary, and can be reversed once the bowel heals.
When you're left with no visible traces of cancer, or no tumor that measures larger than 1 centimeter (less than half an inch), your cancer is considered to be "optimally debulked." People whose cancer is optimally debulked tend to have a better prognosis than those with larger tumors left behind after surgery. To wipe out any cancer cells that might remain, many women get chemotherapy after surgery.
Ovarian cancer debulking surgery is typically done via an open procedure, through a vertical incision in the abdomen. The surgery can take several hours, depending on how extensively the cancer has spread. "Whatever time it takes, you’re there for the duration to be able to get all visible disease out," Dr. Metzinger says.
Pain Control After Surgery
You may be worried about pain control after a major surgery like debulking. Many doctors and institutions have different approaches but pain control is a major element of the surgical process and your doctor has many options to keep you comfortable during surgery and through recovery.
Dr. Metzinger's hospital uses intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) like acetaminophen (Tylenol), in combination with narcotics for post-surgical pain relief. Because narcotics can be habit-forming and potentially cause constipation, sleepiness, and other side effects, it's best to only take them for as long as necessary to manage your postoperative pain.
Recovery time can often be six to eight weeks though patients are encouraged to get up and move around as soon as possible after surgery. While it may be difficult at first, it's been shown that the sooner patients are moving the better they'll usually feel, and the faster they tend to recover.
You'll feel better if you get up and start walking as soon as possible after your surgery. "The reason they have as much pain is because [they're] immobile," Dr. Metzinger says. "We've taken a different approach, and many places have taken a different approach to get these patients moving and give them adequate pain control."
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