Surgical Treatment

Once a mass has been identified and examined radiographically, surgery is necessary to make a complete diagnosis. Surgery provides the opportunity to define the disease and resect (surgically remove) it. When cancer is ostensibly confined to the ovary, a systematic exploration of the abdomen and pelvis with biopsies of some 15-20 different sites is performed (a staging laparotomy).

When, as is so often the case, the disease is scattered widely throughout the abdominal cavity, a resection of as much cancer as possible is performed, occasionally requiring the removal of portions of the intestine. Ovarian cancer has a characteristic spread pattern it sprinkles and studs the inside of the abdominal cavity, a "salt and pepper" effect. It is important for the operating surgeon to be aggressive in his or her approach to the management of this disease, since many studies have shown a correlation between the amount of residual cancer and the chances of a patient responding to chemotherapy and living longer. Those patients with the smallest amount of residual disease have the very best prognosis.

Prognosis

Prognosis is clearly related to several key features of a woman s cancer, most importantly stage and grade. Stage defines the extent of disease. For the overwhelming majority of women with ovarian cancer, the disease is advanced. Survival for Stage III or IV disease is 15-20% at five years. When fortunate enough to find the disease when it s confined to the ovary, survival for Stage I disease is 80-85%. Grade describes the pattern of growth as seen under the microscope. Grade 1 cancers have a pattern of growth similar to that of normal tissues, and these cancers grow more slowly and are more likely to do well. Grade 2 and 3 cancers have a very disordered pattern of growth and consequently, are more unpredictable in their behavior. The woman who has Stage 1 Grade 1 disease is likely to be cured by surgery alone.