Ovarian cancer treatment requires a gynecological oncologist and surgeon who will remove the ovarian cancer using the protocol of cytoreductive surgery. Ref.1 is very explicit on this: “Formal residency programs in obstetrics and gynecology and general surgery do not usually provide the depth of knowledge and experience needed for the surgical management of ovarian cancer”. Once the abdomen is opened, it may turn out that what looked at first like a stage I or II cancer, is suddenly a stage III.
This requires cytoreductive surgery where all the visible cancer and the affected lymph glands have to be surgically removed. Apart from gynecological surgery this may involve complicated abdominal surgery and possibly urological surgery. What looked first like a 1 hour surgery could therefore turn into a 3 ½ hour procedure with three different surgeons. At the end of the procedure two goals would have been achieved: staging surgery on the one hand and cytoreductive surgery on the other hand. The surgeon or the surgeons could now face the family and say that they have removed all the cancerous tissue and also advise what other therapy would be required to complete the treatment.
The reason the surgery is so crucial is the fact that the ovarian cancer stays a stage IA, if all of the local cystic cancer has been successfully removed without an incident. However, if the cyst is punctured inadvertently during the surgery and cancer cells leak into the abdomen, immediately a stage IC or even a higher stage would have been created with a much worse prognosis. What I cannot emphasize enough is that a woman with a suspicion for ovarian cancer should be treated at one of the large Cancer Clinics where the above procedures are available.
In the 1980’s several outcome trials were done in the major cancer centers throughout the world. What was learnt was that even in early disease of ovarian cancer there is often much more widespread disease (IC or IIC instead of IA or IIA). It also became clear that with applying radiotherapy to the whole abdomen including the right hemidiaphragm for stage III patients improved the 5-year survival by a stunning 25% from 18% to 43%. Further it was learnt that chemotherapy following surgery in stage III and IV patients can lead to overall response rates of 80% with clinical remission in 40% to 50% of patients. When a second look-surgery is done, it turns out that only 25% to 30% of all patients are truly histologically free of disease and these are the patients who will experience long-term disease free survival. Other treatment modalities are intraabdominal radioactive phosphorus or cisplatinum along with chemotherapy.
The following table summarizes the typical ovarian cancer survival rates (5-year survival rates) when all the principles outlined above are applied.
5-year survival rates for ovarian cancer
|Ovarian cancer stage||5-year survival rate||Comments:|
|IA and IB||95%||No postoperative therapy|
|IC, IIA and IIB||80%||postoperative chemotherapy|
|IIC||58%||Radio- or chemotherapy|
|IIIA and IIIB||43%||Radio- or chemotherapy|
|IIIC||27%||combination chemotherapy, second look surgery|
1. V.T. DeVita et al. : Cancer- Principles & Practice of Oncology, Vol.1, 4th edition. J.B. Lippincott Co., Philadelphia, USA, 1993. Ovarian cancer chapter.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Ovarian cancer chapter.
3. S Ginath et al. Int J Oncol 2001 Jun;18(6):1133-1144.
4. Y.-L. Hu et al. J Natl Cancer Inst 2001 May 16;93(10):762-767.
5. MKTuxen et al. Br J Cancer 2001 May;84(10):1301-1307.
6. U Wagner et al. Clin Cancer Res 2001 May;7(5):1154-1162.
7. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
9. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008