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In the event that you are suspected of having ovarian cancer, you should be treated by a gynecologic oncologist, a subspecialist in the diagnosis and treatment of gynecologic cancers. Surgery is usually required for an accurate diagnosis and proper staging of the disease. The type of surgery you have depends on these factors:
The type of ovarian cancer you have
Whether the cancer is confined to your ovary or has spread
Whether you plan to become pregnant
Whether your general health is good
In certain instances, if your cancer was found at an early stage and has not spread, your surgeon may be able to leave your uterus and 1 ovary and fallopian tube intact (known as fertility-sparing surgery). Then you may be able to have children. If you have both your ovaries, fallopian tubes, and uterus removed, you will no longer be able to have children. You will enter sudden menopause, if you have not already reached it. That means you will no longer have menstrual periods and may need hormone replacement medications.
You may have more than 1 type of surgery--either as part of the same procedure, or as separate procedures. Depending on the type and stage of the cancer, you may or may not have another type of treatment, such as chemotherapy, before or after surgery.
No matter what type of surgery you have, it is important for the cancer to be surgically staged to determine the extent of the disease. To do this, a pathologist checks tissue samples (called biopsies) removed from your reproductive organs. The surgeon may also remove 1 or more lymph nodes. This is called a lymph node biopsy. The surgeon may also take tissue samples from other areas within the abdomen.
These are the types of surgery used to treat ovarian cancer.
This surgery is the one most commonly done for ovarian cancer. The following will be removed:
Your 2 ovaries
Your 2 fallopian tubes
Your cervix, which is the narrow end of the uterus.
The surgeon may also remove your omentum, a fatty apron of tissue that is attached to the large bowel.
In an oophorectomy, the surgeon removes 1 or both of the ovaries, depending on the likelihood that the cancer will spread. Another consideration may be whether or not you desire to have children. If the cancer has not spread to more than 1 ovary, it may be possible for the surgeon to treat you by removing only 1 ovary and 1 fallopian tube. This is called salpingo-oophorectomy. This procedure would enable you to attempt pregnancy.
Your doctor may remove 1 or more lymph nodes at the same time as an oophorectomy or hysterectomy. These small glands are part of your immune system and help your body fight infections. The surgeon removes nodes and checks them right away for signs of cancer.
During this surgery, which is also called debulking, the surgeon removes as much of the cancer as possible. Your doctor may recommend this surgery when the cancer has spread throughout the abdomen. If you have a debulking surgery and cancer has spread to your colon, you may need to have part of the colon removed as well. Most of the time, the colon can be reattached during this surgery, but you may need a colostomy. A colostomy means that the surgeon diverts a piece of your bowel through your abdomen to allow the remaining intestines to heal. Your stool will then drain into a pouch. This is usually temporary. Later on, it may be reversed by another surgery.
Debulking can also be done after some initial chemotherapy, called neoadjuvant chemotherapy, is given. This is called interval debulking. Usually, cytoreductive surgery is done first to remove as much tumor as possible. Then, chemotherapy is given. Some patients, especially those with extensive disease, older patients, and those with multiple medical problems, may have a different treatment strategy. It is important to have this surgery at a center with experience in the management of ovarian cancer. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment, and surveillance of female cancers including ovarian cancer.
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