SURGICAL MANAGEMENT OF OVARIAN AND FALLOPIAN TUBE CANCERS
Primary surgical therapy is
indicated in most of the ovarian malignancies, using the principle of cytoreduc-tive surgery, or “tumor debulking.” The rationalefor
cytoreductive surgery is that adjunctive radiation therapy and chemotherapy are
more effective when all tumor masses are reduced to less than 1 cm in size.
Because direct peritoneal seeding is the primary method of intraperitoneal
spread, multiple adjacent structures commonly contain tumor, resulting in
cytoreductive proce-dures that are often extensive. Each procedure includes the
Peritoneal cytology is obtained
on entering the abdomen to assess microscopic spread of tumor. Gross ascites is
aspirated and submitted for cytologic analysis or, if no ascites are found,
saline irrigation is used to “wash” the peritoneal cavity in an attempt to find
Inspection and palpation of the
entire peritoneal cavity is done to determine the extent of disease. This
includes the pelvis, pericolic gutters, omentum, and upper abdo-men, including
the liver, spleen, and undersurface of the diaphragm.
Partial omentectomy is usually
performed, whether or not tumor involvement is evident.
Sampling of the pelvic and
periaortic lymph nodes is performed. Without gross disease, biopsies are
obtained from the anterior and posterior cul-de-sac, right and left pelvic
sidewalls, right and left pericolic gutters, and diaphragm.
Because most ovarian cancer
presents at an advanced stage, adjunctive treatment using chemotherapy is
usually neces-sary. First-line chemotherapy is with paclitaxel (Taxol) combined with carboplatin.
With recurrence of disease, other
chemotherapeutic agents may be used, including ifosfamide, hexamethylmel-amine,
doxorubicin, topotecan, gemcitabine, etoposide, vinorelbine, and tamoxifen. Radiation therapy has only a limited
role in the management of ovarian cancer.
consists of clinical history and examina-tion,
various imaging studies (ultrasound and/or CT), and in epithelial cell tumors,
the use of serum tumor markers such as CA-125.