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| The Johns Hopkins Ovarian Cancer Center of Excellence acknowledges and thanks Aventis, Genzyme, GlaxoSmithKline, Oncotech, Ortho Biotech, and The Pam McDonald Fund for their support of this website through provision of unrestricted educational grants. |
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Below are answers to previously submitted questions in the Ask the Expert Forum. Please note that the information is not indended to be used as medical advice -- please consult your physician with any medical concerns. |
| Category: Ovarian Cancer Surgery |
Q: Should a specialist perform surgery for an ovarian cyst?
A: Women, in conjunction with their surgeon, should make this decision based on the degree of probability that an ovarian cancer is present. In general, if there is a moderate to high level of suspicion that ovarian cancer is present, a gynecologic oncologist is the best choice to do the surgery or at least be available to assist in the surgery in the event that ovarian cancer is found. In addition, the surgery should be completed at a center that performs many ovarian cancer surgeries. Population-based outcome studies have shown that when women with ovarian cancer undergo surgery at a “high-volume” center, they survive longer than if the surgery is performed at a center with limited ovarian cancer experience. (More information in new release and journal club review.) Diagnostic algorithms in published medical literature compute the percentage risk of ovarian cancer based on parameters such as the patient’s age, menopausal status, degree of abnormality of CA125, and certain characteristics of the ovaries as seen on ultrasound. These diagnostic algorithms can be used to decide whether a surgery should be performed by experts in ovarian cancer surgery or your general gynecologist.
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Q: Can surgery cause ovarian cancer to spread?
A: This myth may have originated because some patients may not have received a CT scan after being diagnosed with an ovarian mass, and even if a CT scan is performed, it may not be sensitive enough to reveal very small metastases. When surgery to remove the mass reveals metastatic ovarian cancer unbeknownst to the patient, their family and the physician, the perception is that some element of the surgery caused the cancer to spread. In reality, the surgery may be a more sensitive diagnostic tool to detect the spread than other tools that had been used in these cases.
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Q: How likely is the risk of colostomy (an external bag to hold stool) as a result of ovarian cancer surgery?
A: It is extremely uncommon that patients will need a colostomy bag during initial ovarian cancer debulking surgery. Only about three percent of patients need such an intervention. In most cases, if the colon needs to be removed, surgeons can reattach it.
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Q: Is there a way to diagnose ovarian cancer without surgery? Can a biopsy of the ovary be performed?
A: Non-surgical techniques to definitively diagnose ovarian cancer currently are not available. Biopsies of ovarian cysts are not recommended. The limitations of attempting to diagnose ovarian cancer with biopsy techniques guided by ultrasound or CT are:
--rupture of the cystic mass when a biopsy needle is inserted with possible spread of the tumor to other sites.
--missing cancerous cells since some parts of the cyst may not contain cancer
Johns Hopkins scientists currently are studying innovative methods to detect ovarian cancer by identifying markers specific to the disease present in the blood. More information can be found in the Research section of this web site in a variety of news releases on several ovarian cancer blood test research projects.
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Q: How important is it to schedule surgery for ovarian cancer right after diagnosis? Is there a safe window of time? Should I wait for the specialized surgeon I want or settle for a surgeon with less experience in ovarian cancer?
A: It is our opinion that, in general, surgery for suspected ovarian cancer should be scheduled as soon as the patient can be medically cleared for surgery and undergo pre-operative preparation. That said, it is preferable to wait a short period of time (e.g. a week or so) to make sure that all important circumstances are optimized (operating room time, availability of intensive care unit bed etc). As far as the surgeon, this is probably the most important determinant of a successful surgical outcome (complete staging operation, optimal tumor debulking etc). It is far more important to have an experienced surgeon with the right philosophical approach to ovarian cancer surgery than to have the surgery performed more expediently by a less experienced operator.
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