What is Surgical Staging?
Ovarian cancer is surgically staged, which means that the information that is used to determine whether or not the cancer has spread and to what areas comes mainly from surgical findings. When you have an operation at which point ovarian cancer is found and proven by pathology, the surgeon will usually at least remove the affected ovary and then perform multiple biopsies throughout the abdomen. These biopsies determine the stage, which is crucial to all subsequent treatment decisions.Complete or Incomplete?
If enough information has been gathered to clearly define the need for chemotherapy, that is the next phase of treatment. If the information obtained was incomplete (such as biopsies were not taken), there are two options:1/ Another surgery to complete the Staging procedures 2/ Chemotherapy, because while some patients with very early ovarian cancer can be cured without it, over 80% require it anyway.Treatment Options Based on Stage
This is a decision which may be helped by using a Risk/Benefit decision-making tool in discussing the options with your gynecologic oncologist. In any given case, either option may be reasonable depending upon which risks you are willing to tolerate more. Keep in mind that you may elect to go for a second surgery, hoping to avoid chemotherapy, but surgical findings (i.e. positive biopsies) may lead to a chemotherapy recommendation anyway. Finally keep in mind that a second surgery can sometimes be done by using laparoscopy (minimally invasive surgery), rather than requiring another big incision. If your gynecologic oncologist does not perform laparoscopy, this decision is worth a second opinion. If they do, but do not recommend it, minimally invasive surgery may simply not be a good idea for you based on your specific situation. Discuss this fully with your physician.How Much Chemotherapy Do I Need?
An additional decision in this situation is how many times should the chemotherapy be given? In advanced Stage disease, there is uniform agreement that between 6 and 8 cycles of chemotherapy should be given. Usually it is six. In early Stage disease there is a gray area, and it appears that 3 cycles may be just as good as giving 6 to 8. You might be wondering, why minimize treatment in the face of cancer? The answer is that the cure rate seems to be the same with 3 cycles, based on several good clinical trials including a recent one from the Gynecologic Oncology Group (GOG). So, why risk the additional damage from more chemotherapy which might affect you for the rest of your life?One cautionary note here is that there is a BIG difference between knowing that your cancer is early Stage after complete staging surgery and assuming that your cancer is “early” in the absence of complete staging. In the latter situation, you should consider getting all 6 to 8 cycles since you may actually have more advanced Stage disease hiding in areas that were not biopsied.
Source: Bell J,et al. Gynecol Oncol. 2006 Sep;102(3):432-9.
