Why is surgery so important in ovarian cancer?
One of the problems with ovarian cancer is that it is diagnosed late, so the disease is usually found in advanced stages, with a worse prognosis for the patient.
In this context, surgery plays a crucial role in ovarian cancer, as confirmed by the Spanish Society of Medical Oncology (SEOM). Unlike other malignant tumours, “there is a correlation between the quality of surgery and patient survival.
As explained in an interview with Infosalus, the vice president of the Spanish Society of Surgical Oncology (SEOQ), Dr Pedro Cascales, in the case of ovarian cancer, the initial treatment is surgical, and specifically, what is known as ‘perfect surgeries’, that is, those where all visible disease is removed.
Why is surgery so crucial in ovarian cancer?
“These interventions correlate with a better prognosis, future for the patient, and even the chances of being cured. In the rest of the patients, we can improve the future, but if the procedure in ovarian cancer is not perfect, the chances of cure are meagre, even practically nil”, considers the surgeon.
In addition, it highlights that these operations are very complex, so it is essential to have a professional with the capacity and experience to perform them to achieve that perfect result. “If not, the prognosis is quite dark,” laments the Peritoneal Oncology Surgery Unit expert of the Virgen de la Arrixaca University Clinical Hospital (Murcia).
He underlines that Spain has good professionals and international prestige in this field. “Ovarian cancer only has one shot. If you waste the bullet unnecessarily, the patient’s future is difficult to overcome. That is why it is important that the team that intervenes be experienced. They are special patients, and human character goes hand in hand with professional worth”, insists the SEOQ member.
Let us remember that, as a general rule, each woman has two ovaries, which are located on each side of the uterus. They are almond-shaped and have a maximum length of between 2 and 4 centimetres. Specifically, the SEOM specifies three types of ovarian cancer: epithelial carcinoma, germ cell tumours, and stromal tumours. The first of these, epithelial carcinoma, represents 85-90% of ovarian cancers, the rest being rare.
Likewise, this scientific society estimates that most patients (70-80%) are diagnosed at an advanced stage of the disease; and ovarian cancer represents 3% of tumours in women, apart from being the fourth major cause of cancer death in women after lung, breast and colon cancer.
THE BIG PROBLEM: NON-SPECIFIC SYMPTOMS
The problem usually found with ovarian cancer is detected in the advanced stages. Its symptoms are very non-specific, which prevents it from being seen in time, according to Dr Cascales. Moreover, he affirms that this cancer “swims in a sea of antacids” because as it has “so non-specific” symptoms, many patients are first treated with stomach protectors or medications against gases.
” The symptoms that should alarm are the swelling of the abdomen and the pain in the pelvic area that, maintained over time, for more than 2-3 weeks, should make one think that something is happening. Most of the time, when studying them, they find nothing, which makes the cancer buy time, and when it is discovered, it is already advanced. In two-thirds of patients, it is like that, and when the disease has spread within the abdomen, “he says.
This SEOQ specialist compares ovarian cancer and a sack of seeds on how metastasis occurs in different body parts: “Ovarian cancer is like a sack of seeds. It has a certain ease of breaking spontaneously, and these tumour cells pass into the abdominal cavity. They can spread to every one of its corners (stomach, uterus, peritoneum membrane that covers all the viscera–, the small intestine, the large intestine, the spleen, and around the liver)”.
For this reason, as indicated, the ‘perfect surgeries’ for ovarian cancer usually entail, in addition to the removal of the uterus and the ovaries, which are mandatory, it involves “the basic treatment of ovarian cancer” they also include drying in many sometimes several organs or fragments of these affected.
OPEN SURGERY, THE MOST INDICATED
Once the diagnosis is precise and that surgery should be undertaken on the patient, the specialist at the Virgen de la Arrixaca University Clinical Hospital maintains that the recommended intervention in ovarian cancer is open surgery since it allows reviewing every corner of the abdominal cavity and removing those affected areas.
These procedures usually have an average duration of 5-6 hours since they require several interventions in one. “It takes time to review everything, remove the tumour masses, and use a meticulous technique since recovery is delicate. It is an aggressive surgery,” Cascales emphasises.
Of course, the expert in ovarian cancer surgery celebrates that the recovery in these patients is usually good, although, as in all surgery, he maintains that complications may appear. “It is a risky surgery, but thanks to the experienced teams, it is quite controlled,” defends the SEOQ expert.
The doctor recalls infections and haemorrhages, which can arise after any operation, as among the primary complications of ovarian cancer surgery. However, he points out that this surgery can cause a delay in the onset of small bowel function, known as transitory ‘intestinal paralysis’, a “serious but rare complication in teams experienced in these interventions.”
Lastly, in the case of women of childbearing age who wish to become mothers and are diagnosed with ovarian cancer, Dr Cascales points out that each patient is assessed individually. However, there is what is known as ‘surgery to preserve fertility, where just enough is operated on so that the woman can continue with her reproductive function, as long as it is medically possible, although she acknowledges that “really these are rare”.