Treatment of Advanced Stage Epithelial Ovarian Cancer

A scheme for the management of patients with advanced-stage epithelial ovarian cancer is presented in Figure 118-6. The components of this approach are discussed below.

Cytoreductive Surgery in Ovarian Cancer
Patients who have advanced-stage epithelial ovarian cancer documented at initial exploratory laparotomy should undergo cytoreductive surgery to remove as much of the tumor and its metastases as possible in order to facilitate the effectiveness of subsequent therapies. The operation usually includes the performance of a total abdominal hysterectomy and bilateral salpingo-oophorectomy, a complete omentectomy, and resection of metastatic lesions on the peritoneal surfaces or from the intestines. In addition, the pelvic tumor may directly involve the rectosigmoid colon, the terminal ileum, and the cecum. In some patients, most or all of their disease is confined to the pelvic viscera and the omentum, so that removal of these organs results in the extirpation of all gross tumor, a situation that is associated with a reasonable chance of complete response.

The rationale for cytoreductive surgery relates to three general theoretical considerations: (1) potential physiologic benefits from excising the tumor; (2) improved tumor perfusion and increased growth fraction, that may increase the likelihood of a response to chemotherapy or radiation therapy; and (3) enhanced immunologic competence of the patient.