Neoadjuvant Chemotherapy
- “Neoadjuvant chemotherapy” refers to chemo given before ovarian cancer surgery
- It’s used when a cancer has spread widely or to certain inoperable areas
- The chemo can help shrink a cancer down to a point where it is possible to remove through surgery
Depending on the stage and grade of your ovarian cancer — meaning how far it has spread beyond the ovaries, if at all — your gynecologic oncologist may recommend what’s called “neoadjuvant chemotherapy.” Neoadjuvant chemotherapy is the medical term for a course of chemotherapy that’s administered before a surgery with the intention of shrinking the cancer to a level that’s more manageable to remove.
“For ovarian cancer, if we have any concern that the disease has spread past stage 3c or stage 4, or it’s in structures that we can’t remove, then we have to have a serious conversation about neoadjuvant chemotherapy,” says Dr. Rachel Brightwell, a gynecologic oncologist at Austin Cancer Center.
Read More So how do doctors determine whether the disease has spread to a point at which neoadjuvant chemotherapy is a good idea? According to Dr. Brightwell, this is where an imaging test called a CT scan can be helpful. “A CT scan of your chest, abdomen, and pelvis will give us a good layout of where the disease is,” Dr. Brightwell says. If the CT scan reveals that there is cancer in certain areas of the body, it might not be possible to remove it at all — in which case surgery “upfront” (meaning first) isn’t the best treatment option. In some cases, it can be hard to tell for sure from the CT scan, in which case Dr. Brightwell says that something called a “diagnostic laparoscopy” can be helpful. This is a simple procedure in which a small camera is inserted, giving doctors a better view of where, exactly, the cancer is located, and whether it is resectable (which means removable via surgery.) One of the locations that doctors would consider “unresectable” would be in the tissue around your abdomen, called the “mesentery.”
“If the tumor gets in there, we can’t resect the tumor because we’d disrupt the blood supply to the bowel,” says Dr. Brightwell. “And if we disrupt the blood supply to the bowel, you’re going to lose that bowel.”
In cases like these, starting with neoadjuvant chemotherapy — maybe three or four cycles, according to Dr. Brightwell — can hopefully shrink the cancer ahead of time, making it possible to perform surgery within disrupting a key organ function such as the bowel.
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