Treatment for ovarian cancer depends on the stage of the cancer, and a woman's overall health.
- Surgery and chemotherapy are usually both indicated for ovarian cancer treatment.
- There are many factors that inform how your doctor will approach your disease and treatment plans are individualized with each patient’s needs in mind.
- The main goal of a debulking surgery is to remove all visible disease.
After receiving a diagnosis of ovarian cancer, women and their oncologists have to make decisions about the best course of treatment. These decisions depend on a lot of different factors, including how far the cancer has spread and the overall health of the patient.
"When I'm [first] seeing someone with a diagnosed ovarian cancer there are several things that I want to take into consideration," says Dr. Marta Crispens, gynecologic oncologist at Vanderbilt University Medical Center. These include:
- What kinds of symptoms they're having from their cancer, or from any other underlying medical conditions.
- What their overall health status ishow hardy or how frail they arebecause that can have an impact on how their disease will be treated.
- The results of imaging–such as CT scans–that patients have to provide crucial information about their disease. The typical CT scan takes less than a half hour, and will provide doctors with imaging of your abdomen, pelvis, and possibly your chest
Read More "We look at the size of the disease, and how accessible it is,” says Dr. Crispens. "Our goal for surgery is ideally to remove all visible disease, or at the very least, reduce the tumor down to a centimeter or less." If, for instance, the cancer is confined to the ovaries and the omentum (the fatty apron that hangs from the intestines), and a surgeon believes they can get it all out from the beginning, and the patient is healthy and strong, then they might operate first and follow with chemotherapy afterward. On the other hand, Dr. Crispens says, if there’s extensive involvement of the
mesentery (the tissue that carries the blood supply to the intestines) and a lot of the small bowel would have to be removed along with the tumor, surgery wouldn't necessarily be the best option for a good quality of life. "So, maybe we need to back off and say, let’s do some chemotherapy first, try to shrink that tumor down to a place where it is reasonable that we can resect it, and then come back with chemotherapy afterward." This technique of "sandwiching" surgery between cycles of chemotherapy is called neoadjuvant chemotherapy. Doctors use this chemo-first approach in an effort to shrink down the cancer to a point where it is more feasible to operate on. Then, after the surgery, the patient typically goes through another few cycles of chemo to kill any remaining cancer cells.
Weighing all the factors and making these decisions is part of what doctors call "the art of medicine,” which involves making the best decisions possible with the information that’s available. Keep in mind, though, that there’s no one treatment that’s best for everyone, and that treatment decisions vary from patient to patient, and even from one cancer center to another. A patient, in consultation with a trusted oncologist, will make the decisions that are best for her.
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Marta A. Crispens, MD, is director, division of gynecologic oncology at Vanderbilt University Medical Center. Read More
