Ovarian Cancer Treatment: The Timeline From Diagnosis to Surgery

If your surgeon believes it is possible to “debulk” the tumor (meaning remove all visible disease) upfront, then surgery within two weeks from diagnosis is the goal. "We really try to get patients on the table quickly if we decide that we’re going to do surgery first," says Dr. Guntupalli. "We generally don't like to wait [longer] than at most two weeks before taking the patient to the OR because we think it's very, very important to get [the tumor] out." Also, he says "patients tend to be very uncomfortable because they have lots of ascites"fluid in the abdomen. "Oftentimes they’ll feel better after their surgery, because they have had all of that fluid removed."

There are time when an ovarian cancer diagnosis cannot be confirmed before surgery takes place. And patients will go into surgery not knowing whether or not they have cancer. But because this disease is a relatively aggressive cancer, doctors usually don't want to delay surgery any longer than necessary because they worry about spread in the interim. In these situations, an oncologist told SurvivorNet, most patients are anxious to proceed with surgery, not only to achieve the best possible outcome but also to alleviate the stress of waiting.

Despite their preference to do surgery as quickly as possible, doctors say there are cases in which surgery cannot and should not be step one. For these patients, particularly advanced stage 3 and 4, doctors will prescribe three or four cycles of chemotherapy prior to surgery, called neoadjuvant chemotherapy. In these instances surgery usually takes place about four months after diagnosis.

Types of ovarian cancer surgery

In certain situations a minimally invasive procedure may be appropriate to treat ovarian cancer. For instance, for patients whose disease is focused in the pelvis rather than spread out, robotic surgery, which uses cameras and special robotic surgery tools, makes it possible for surgeons to operate through a series of about five small (less than an inch) incisions around the belly button.

Unfortunately, robotic surgery isn't an option for every woman because many patients have disease that is too spread out for the robotic platform to achieve the goal of removing all or as much visible cancer as possible. Typically, patients will have open surgery involving an abdominal incision from the pubic bone to above the belly button, which allows access to the upper and lower abdomen. For advanced ovarian cancer, that surgery will usually involve a hysterectomyremoving both ovaries and the entire uterus and the omentum (a little known fatty apron located in the upper abdomen). Depending on where else the cancer has spread, it may sometimes be necessary to remove the spleen or parts of the colon, too.

Open surgery for ovarian cancer can take as long as seven hours. And though it's a big operation, overall, doctors say it is generally a safe surgery, after which most patients are left with microscopic disease only.

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