OVARIAN CANCER

This is the most common type of surgery used for advanced ovarian cancer (Stage III or IV). The goal is to remove as much of the tumor as possible, ideally leaving no visible cancer behind (this is called "optimal debulking").

The surgeon will remove:

The ovaries (one or both, depending on the extent of the disease)

The fallopian tubes

The uterus (in most cases, a hysterectomy is performed)

Surrounding tissues, such as lymph nodes, the omentum (a layer of fatty tissue in the abdomen), and any other organs that might be affected (e.g., part of the colon, spleen, or diaphragm).

The extent of surgery depends on how far the cancer has spread.

Purpose: Considered for young women with early-stage ovarian cancer (usually Stage I) who wish to preserve their fertility.

Procedure: Involves removing only the affected ovary and fallopian tube, leaving the other ovary and uterus intact. This allows the possibility of future pregnancy.

Purpose: Performed in advanced-stage ovarian cancer (Stage III or IV) after a patient has undergone neoadjuvant chemotherapy (chemotherapy given before surgery).

Procedure: This surgery is typically done after the initial rounds of chemotherapy have shrunk the tumor. The goal is to remove as much of the remaining cancer as possible.

Timing: Interval cytoreduction is performed after chemotherapy but before further chemotherapy. This allows the surgeon to attempt optimal debulking, meaning as much of the visible tumor is removed as possible.

Advantages:

Better surgical outcomes: Chemotherapy can reduce the size of large or diffuse tumors, making them easier to remove.

Reduced complications: Tumors that have been shrunk by chemotherapy may be less invasive or attached to nearby organs, leading to fewer complications during surgery.

When It's Used: Typically used for women with debulking surgery not possible initially due to widespread disease, or when the cancer is too advanced at the time of diagnosis for an immediate surgery.

Purpose: Performed when ovarian cancer recurs after initial surgery and chemotherapy, typically in patients with recurrent disease (usually Stage III or IV).

Procedure: This surgery is done to remove any remaining cancer after the cancer has returned, usually in areas such as the peritoneum or lymph nodes. Secondary cytoreduction aims to remove as much of the recurrent tumor as possible to improve the effectiveness of subsequent treatments like chemotherapy or targeted therapy.

Timing: It is performed during the recurrent phase of ovarian cancer, typically after the cancer has relapsed following an initial successful treatment (surgery + chemotherapy).

Advantages:

Improved prognosis: For some women with recurrent ovarian cancer, secondary cytoreduction can improve overall survival and quality of life by reducing the amount of active cancer.

Chemo-sensitization: Removing tumor masses may make the remaining cancer more responsive to chemotherapy or other treatments.

When It's Used: This surgery is considered when the recurrence is limited to a few areas, and the tumor can be safely removed without causing significant harm to other organs.

HIPEC

HIPEC involves delivering heated chemotherapy directly into the abdominal cavity after cytoreductive surgery (tumor removal) to target remaining cancer cells. The heat enhances the effectiveness of the chemotherapy drugs, helping them penetrate cancer cells more effectively. This treatment is typically used for cancers that have spread within the abdomen, such as ovarian cancer, colorectal cancer, and peritoneal mesothelioma.

Surgery (Cytoreduction): The procedure starts with cytoreductive surgery, where as much visible tumor as possible is removed from the abdomen. This is crucial because HIPEC works best when most of the cancer has been surgically removed, leaving minimal residual disease.

Chemotherapy Delivery: After the tumor removal, heated chemotherapy (usually a combination of drugs like cisplatin or carboplatin) is circulated within the abdominal cavity. The chemotherapy is typically heated to about 41-42°C (105.8-107.6°F), which increases the cytotoxic effects of the chemotherapy.

Circulation and Drainage: The heated chemotherapy is circulated throughout the peritoneal cavity for 60-90 minutes, allowing it to come into direct contact with any remaining cancer cells. Afterward, the chemotherapy is drained out of the abdomen.

Localized Treatment: Since the chemotherapy is delivered directly to the affected area, it can target residual cancer cells within the peritoneum more effectively than systemic chemotherapy, which circulates throughout the entire body.

Improved Survival Rates: For patients with peritoneal carcinomatosis (cancer spread in the abdomen), HIPEC has been shown to improve survival outcomes and reduce recurrence, particularly in certain cancers like ovarian cancer, mesothelioma, and colorectal cancer.

Higher Concentration: The heat enhances the chemotherapy’s effectiveness, allowing higher doses to be used without significantly increasing side effects.

HIPEC is used for advanced ovarian cancer when it has spread in the abdomen but is still resectable. It helps treat any remaining cancer cells after surgery, improving outcomes and survival chances.