What About Stage 4 Ovarian Cancer?
A few words regarding Stage IV (4) cancer is important. In the past it was thought that if an ovarian cancer appeared in the lung area or in the liver or spleen, the prognosis was so poor that surgery would not help very much. Recent studies suggest that, while each situation is different,this may not be true. The prognosis may be somewhat worse than Stage III, but in most cases, aggressive surgical cytoreduction should still be strongly considered if technically feasible, if the patient understands the risk vs. benefit and if they are able to medically tolerate it. If the surgery is “optimal”, the prognosis can significantly improve and come closer to results seen in Stage III.Summary of Cytoreductive Surgery Benefits
In general, a MAJOR predictor of the possibility of cure in Stage II to IV cancer is the degree to which “optimal” cytoreduction is achieved. Over the years, the strong weight of medical evidence (many medical papers) supports removing as much cancer as possible before chemotherapy. There are biological theories, which I will not go into detail about, that support the benefits of aggressive cytoreduction in improving chemo-response.Basically, the surgery makes it easier for the chemotherapy to work by reducing the number of cells that the chemotherapy has to kill (from billions/trillions to hundreds/tens of thousands……or possibly less if nothing visible is left). The surgery also forces all cells that are left to start dividing at the same time (division is how they grow), making it easier for the chemo to kill them at the same time in their lifecycle.
Given this information, if you have not had “optimal” cytoreduction performed, a risk/benefit discussion should be considered about a second operation to complete this task. Issues include the technical and medical reasons for “sub-optimal” cytoreduction, how far away from the very best microscopic “optimal” you already are, the type of chemotherapy you are planning, how much time has passed since the initial surgery and other considerations.
In general, a discussion about another surgery may be a bigger consideration if the initial surgery was rather minimal due to lack of expertise, or the lack of a gynecologic oncologist. For example, if you had a surgery which amounted mainly to biopsies only, an additional surgery might be reasonable. However, you have to consider how the chemotherapy plan fits into the overall picture.
