Surgery is an essential element throughout a woman's journey with ovarian cancer. Initially, an operation is typically necessary to make an accurate diagnosis of ovarian cancer. Then, surgery is performed to determine how advanced the cancer is—a process called staging—and to remove as much of the cancerous mass as possible, which may involve more than one surgical procedure. Because surgery is integral to the diagnosis and management of ovarian cancer, partnering with an expert surgical team is critical.
You'll find that expertise at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. We possess decades of in-the-trenches experience, consistently using the most advanced and effective methods of surgery and cutting edge tools. In fact, our gynecology oncologists who perform these delicate and complex surgeries have led or co-authored studies that inform the most recent surgical advances for ovarian cancer.
What to Expect from Ovarian Cancer Surgery
The diagnosis. We use a minimally invasive surgical (MIS) approach to evaluate and diagnose patients presenting with an ovarian mass. Advantages of MIS for a benign, or non-cancerous, tumor include:
- No overnight stay (usually)
- Faster recovery
Immediate evaluation. During the initial MIS procedure, our expert gynecologic pathologists evaluate the ovarian mass and, within 30 minutes, relay their findings to our surgical team. If the mass is malignant, additional surgery occurs immediately.
Comprehensive staging evaluation. Precise staging involves performing biopsies on sites throughout the pelvis and abdominal cavity, thereby determining the extent of the disease. This critical step determines the appropriate course of treatment.
- Some patients with Stage 1 disease require no additional therapy
- Most patients with Stages 11 through IV require chemotherapy.
- Comprehensive staging uncovers advanced stage disease in a considerable number of patients with ovarian cancer.
If you have stage 1 ovarian cancer:
Fertility preservation is a viable option for a select group of women with Stage 1 ovarian cancer and no evidence of the disease outside the ovary. Under these circumstances, we use a more conservative surgical approach, preserving the uterus, disease-free ovary and fallopian tube. Ultimately, these steps preserve a patient's childbearing potential.
If you have advanced ovarian cancer:
Optimal debulking. When we operate, we strive for optimal debulking, which means removing all the cancer except for residual nodules less than 1 cm. in diameter. Our vast experience, coupled with the use of the latest in surgical devices, ensures the most precise results. Occasionally, nodules that are too numerous or located in areas that make removal too risky prevent optimal debulking.
If you have recurrent disease:
Secondary debulking sometimes is performed on patients with recurrent disease. This step is preceded by aggressive surveillance techniques using advanced imaging that determine the location of new lesions. During secondary debulking, we can take samples of cancerous tissue and test their resistance to certain chemotherapy drugs, thereby making subsequent chemotherapy for each individual patient more targeted and effective.
Who is a candidate for secondary debulking? Patients who have:
- Been in remission for at least 12 months, an indication of responsiveness to chemotherapy
- Good performance status, meaning the ability to tolerate a second surgical effort
- Relatively localized disease (recurrence at a lymph node or lesion in spleen or liver)
Intraperitoneal chemotherapy delivers high doses of chemotherapy directly into the abdomen via a catheter. Pioneering research led by a Johns Hopkins researcher has found that patients with advanced ovarian cancer who receive traditional chemotherapy coupled with intraperitoneal chemotherapy attain significantly better survival rates than those who receive only traditional chemotherapy following surgery.
Intraperitoneal chemotherapy involves the surgical placement of an intraperitoneal (IP) port, the size of a half dollar, under the skin in the upper quadrant of the abdominal wall. A catheter attached to the port reaches directly into the pelvis, delivering chemotherapy. Surgical placement of the port requires a one-inch incision, closed with sutures that readily dissolve under the skin. After completion of chemotherapy, the port is surgically removed through a minor procedure that takes less than an hour.
Monitoring for Recurrence -- Surveillance
Women diagnosed with ovarian cancer are at risk for recurrence. That's why patients at the Kimmel Cancer Center undergo close surveillance through physical exams and blood tests (including CA 125 and radiographic imaging) to watch for recurrent disease. An ovarian cancer recurrence presents many choices; no one option is right for every patient. We strive to determine a patient's priorities in order to make the most informed therapeutic recommendation, which may involve one or more of the following strategies:
- Additional chemotherapy (Note: recent studies suggest that deferring chemotherapy until a patient becomes symptomatic may reduce side effects without adversely affecting survival)
- Additional surgery
- Biologic therapies that target metabolic "pathways" of unrestricted cancer growth