NCCN Guidelines for Patients® | Ovarian Cancer - page 32

Part 4: Treatment with surgery
NCCN Guidelines for Patients
: Ovarian cancer
Version 1.2013
The chart on page 31 describes the surgical treatments
and staging procedures recommended if your doctor
thinks you have ovarian cancer. The type and extent of
surgery and staging procedures you will have depends
on how far your doctor thinks the cancer has spread.
Clinical stage I or II ovarian cancer means that the
cancer looks like it hasn’t spread outside of your pelvis
(area between the hip bones). Therefore, you will have
surgical treatment and staging. Surgical treatment usually
involves a laparotomy to remove the cancer along with
the ovaries, Fallopian tubes, and uterus.
If the cancer is in one ovary only, then you may have
surgery that only removes the affected ovary and its
Fallopian tube. If the cancer is in both ovaries, then
you will have surgery that removes both ovaries, both
Fallopian tubes, and the uterus.
Surgical staging is done to look for cancer cells that have
spread outside of the ovaries or pelvis and can only be
seen with a microscope. These are called microscopic
metastases. Depending on how far your doctor thinks the
cancer might have spread, biopsies may be taken from
a number of organs and tissues. Surgical staging also
includes omentectomy and lymph node dissection. See
pages 22–24 for biopsy and surgical staging details.
If you have clinical stage III or IV ovarian cancer, you
will not have surgical staging procedures because the
cancer has clearly spread outside of the pelvis. If the
cancer hasn’t grown into a lot of tissue and can all
be removed by surgery, then you will have debulking
surgery. Debulking surgery removes as much of the
cancer as possible. Debulking surgery may remove all
or part of organs or tissues the cancer has spread to
such as the diaphragm, intestines, bladder, liver, spleen,
appendix, gallbladder, stomach, pancreas, omentum,
and peritoneum. See Figure 6 on page 24 and Figure 7
below. Lymph nodes that look different or are larger than
normal should also be removed if possible.
Figure 7. Possible debulking surgery sites
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