NCCN Guidelines for Patients® | Ovarian Cancer - page 35

Part 4: Treatment with surgery
NCCN Guidelines for Patients
: Ovarian cancer
Version 1.2013
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Adjuvant therapy:
Treatment that is given
after the main treatment
used to rid the body of
Removal of small
amounts of tissue or fluid to
be tested for disease
that kill all cells that grow
rapidly, including normal
cells and cancer cells
The double
layer of fatty tissue
covering the intestines and
organs in the belly area
Staging procedures:
Procedures during surgery
that are used to find out
how far the cancer has
See pages 22–24 for
biopsy and staging
The chart on page 34 shows the surgical treatment and staging procedures
recommended for ovarian cancer that has been confirmed by a previous
surgery. The treatment options depend on whether the previous surgery and
staging were complete or not.
Surgical staging is considered complete if the previous surgery removed all
of the cancer along with both ovaries and both Fallopian tubes, the uterus,
nearby supporting tissues, and the omentum. If prior ovarian cancer surgery
and staging were complete, then you don’t need any more surgery for staging.
In this case, you may receive adjuvant therapy next or observation. (See “
” at the end of this section.) If the previous surgery and staging weren’t
complete, you may have more surgery to confirm the cancer stage and to
remove any remaining cancer.
Previous surgery and staging were not complete:
For likely stage I ovarian
cancer, surgical staging is done to look for cancer that has spread outside of
the ovaries that can only be seen with a microscope. Surgical staging includes
taking biopsies of nearby tissue and fluid that cancer cells may have spread to
such as the diaphragm, peritoneum, abdomen, pelvis, and ascites or peritoneal
washings. Surgical staging also includes omentectomy and lymph node
dissection to take biopsies of the omentum and nearby lymph nodes. (See
pages 22–24 for details on biopsies and surgical staging procedures.)
Completion surgery involves removing the remaining ovary (or ovaries),
Fallopian tubes, uterus, nearby supporting tissue, and the omentum. If needed,
completion surgery also removes any remaining cancer that can be seen. If your
doctor thinks the previous surgery removed all of the cancer, then you may start
chemotherapy treatment instead of having more surgery. (See Part 5 on page
41 for details on chemotherapy.)
For likely stage II, III, or IV ovarian cancer that can all be removed by surgery,
you will have completion surgery as described above. If all of the cancer can’t
be removed by surgery, then you will start chemotherapy treatment. You may
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