Cancer of the Ovary
Cancer of the ovary (ovarian cancer) is common and unfortunately does not usually give symptoms until it is rather advanced. Women with ovarian cancer usually notice “bloating” of their abdomen. Some think that they have gained weight, but they wonder why this “overweight” is localized only in their abdomen. In other words, their buttocks, legs, arms, back and shoulders still have the shape they always had. This bloating is a result of fluid accumulation inside the abdomen (ascites) and has been produced by the ovarian cancer cells. This also means that because this fluid is full of cancer cells, these cancer cells come in contact with all the intra-abdominal organs and are implanted on them since the fluid bathes all these organs. This is exactly why ovarian cancer with ascites is always metastatic. This is of paramount importance for the management strategy. An operation that would involve only resection of the uterus and the ovaries is certainly not enough, since the cancer cells have already been implanted in other areas far away from their origin in the ovary.
In this context, it becomes obvious how important is for the expert oncologic surgeon to design and implement a management strategy for these patients. Sometimes it may be preferable not to proceed with an operation initially, but rather start chemotherapy (neoadjuvant chemotherapy – downstaging), so the extent of the tumor can be shrunk and then followed by a radical curative surgery. Whether the first treatment should be surgery or preoperative chemotherapy and then surgery should be judged by the oncologic surgeon based on what it’s best for each individual patient.
Regarding the extent of surgery for ovarian cancer, resection of the ovarian tumor itself, along with the other ovary and the uterus are NOT ENOGH. The operation should always include all the greater omentum, and lymph node dissection along and around the internal and external iliac arteries and veins. Metastatic disease becomes apparent as a “hardening” of the otherwise very smooth surface of the internal lining of the abdomen, especially in the right side of the diaphragm on top and around the liver. In such patients, all metastatic disease should be removed during the same operation. This may involve major operations involving removal of part of the small bowel, or colon, or the diaphragm, but it is essential to do it and not leave the metastases to be treated with chemotherapy after the operation. It is only under these circumstances (i.e.: radical surgery and removal of every palpable or visible metastatic lesion) that an operation for ovarian cancer can be truly curative.
