What are the treatment options?
Your gynecologic oncologist will likely choose surgery first if they determine that you are healthy enough for surgery and that there is a high likelihood that they will be able to safely remove any tumor they can see in the abdomen during the surgery.
Surgery may be performed via a traditional open incision in the abdomen or using a minimally invasive technique such as laparoscopy or robotic technology. If cancer is found during this surgery, your doctor will likely perform a complete hysterectomy, lymph node dissection, omentectomy (removal of an internal fat pad hanging down from the stomach and colon), pelvic washing (collection of sterile water that has been swished around the abdomen to pick up floating abnormal cells) and other biopsies of the lining of the abdomen. This is to determine whether it has spread beyond the ovary where it started, also known as staging.
In order to tell if you have cancer during the surgery, the doctor will send the tissue to the pathology lab for what is called a “frozen section.” This is when the pathology doctor gives a preliminary report to determine if there is concern for cancer. Most of the time this is a pretty accurate assessment of what the final report shows after they have had plenty of time to look all the way through the tumor. Occasionally, though, the diagnosis will change when the pathologist receives more information.
At surgery, if your gynecologic oncologist sees a tumor beyond the ovary, he or she will aim to remove all visible disease. If this is the case, your surgery may include removal of part of the bowel, the spleen, the diaphragm or even the liver in order to remove as much bulky tumor as possible. If your surgery is more extensive, you will need to prepare for a longer hospital stay and possibly some time spent in the intensive care unit.
If your doctor thinks that your tumor has spread to too many areas, he or she might decide that you would do better with surgery after a course of chemotherapy, since surgery is most successful if the doctor can remove all visible disease. If this is not possible, your treatment outcome will be the same if you get chemotherapy first; furthermore, this might help you to avoid a prolonged hospital stay.