Surgical management of ovarian cancer

The management of ovarian cancer presents one of the greatest challenges to physicians caring for patients with cancer. The treatment almost always involves a combination of surgery and chemotherapy. Over the past 75 years we have formed a rational system for the surgical management of this disease. Initial surgical therapy should include the following three objectives: (1) staging, (2) cytoreduction, and (3) determining a definitive histologic diagnosis. The importance of meticulous staging cannot be overstated. Fully one third of patients not compulsively staged will be upstaged if surgically restaged. Cytoreductive surgery is the mainstay of initial treatment. Data clearly demonstrate that ovarian cancer is different from other solid tumors in that reduction of the tumor burden is important in the management of this disease. Patients with less than 1 to 2 cm of disease remaining at the conclusion of initial surgery have a survival advantage over those who do not. The benefits of secondary cytoreduction are less clear, and data support the concept of cytoreduction in many circumstances. These surgical issues surrounding ovarian cancer support the concept that physicians trained to treat ovarian cancer be involved in its management. Data are emerging that clearly suggest that gynecologic oncologists should be involved in both the surgical and medical management of patients with ovarian cancer.