Part 4: Treatment with surgery
NCCN Guidelines for Patients
: Ovarian cancer
Treatment options for borderline ovarian cancer depend
on three important factors. The first factor is whether
previous staging was complete or not complete. The
second factor is whether or not there are invasive
implants. The third factor is whether or not you want to
have babies after treatment.
Staging is considered complete if the previous surgery
removed all of the cancer along with the affected ovary
and its Fallopian tube, nearby supporting tissues, and the
omentum. The uterus, other ovary, and other Fallopian
tube may be left because fertility-sparing surgery is
always an option for borderline ovarian cancer.
Previous surgery and staging were complete:
case, one option is to start observation with follow-up
tests. Observation is a period of testing after treatment
(surgery) to check that treatment worked. If there are
invasive implants, another option is to have surgical
treatment to remove the remaining ovary, Fallopian tube,
and uterus, followed by adjuvant chemotherapy. Adjuvant
treatment is given after surgery to rid your body of any
remaining cancer cells.
Previous surgery and staging were not complete:
this case, observation with follow-up tests is always an
option. Observation is a period of testing after treatment
(surgery) to check that treatment worked. Follow-up tests
are done to check for signs that the cancer is growing or
has come back after treatment.
If you want to have babies, another option is to have
fertility-sparing surgery—removal of one ovary and its
Fallopian tube—and surgical staging procedures. If you
have invasive implants, a third option is to have fertility-
sparing surgery and surgical staging procedures followed
by adjuvant chemotherapy. Adjuvant treatment is given after
surgery to rid your body of any remaining cancer cells.
Surgical staging procedures involve taking biopsy
samples from the tumor and nearby tissue where cancer
cells may have spread. (See pages 22–24 for biopsy
and staging details.) Such sites include the uterus, other
ovary and Fallopian tube, pelvis, diaphragm, peritoneum,
abdomen, and ascites or peritoneal washings.
Omentectomy should also be performed to take biopsies
of the omentum. Lymph node dissection may be
considered on a case-by-case basis to take biopsies of
nearby lymph nodes.
If you don’t want to have babies, then completion surgery
is an option. Completion surgery involves removing any
remaining cancer cells as well as the uterus, ovaries,
and Fallopian tubes. It may also involve lymph node
dissection and omentectomy. If you have invasive
implants, a third option is surgery to remove both ovaries,
both Fallopian tubes, and the uterus, plus surgical
staging procedures and adjuvant chemotherapy.
For recommended follow-up tests, see
page 55. See page 41 for details about chemotherapy
and page 46 for recommended adjuvant chemotherapy