Surgery is usually the first step in treating PPC or FTC and it should be performed by a gynecologic oncologist. The goal of the surgery is the removal of all visible disease because this approach has been shown to improve survival. This process is known as tumor debulking. When all visible disease is removed, or if only small tumor implants (less than 1 cm in diameter) remain, the patient is considered optimally debulked. Occasionally, the location of tumor within the abdomen or the condition of the patient does not allow for optimal debulking surgery to be performed. In this situation, chemotherapy may be given first and the patient might have surgery at a later time. Most surgery is performed using a procedure called a laparotomy during which the surgeon makes a long cut in the wall of the abdomen, although they are also commonly found at laparoscopy. If either PPC or FTC is found, the gynecologic oncologist performs the following procedures:
- Salpingo-ooophorectomy: both ovaries and fallopian tubes are removed.
- Hysterectomy: the uterus is removed usually with the attached cervix.
- Omentectomy: the omentum, a fatty pad of tissue that covers the intestines, is removed.
Occasionally, some of the nearby lymph nodes will be removed. Depending on the surgical findings, more extensive surgery, including removal of portions of the small or large intestine and removal of tumor from the liver, diaphragm and pelvis, may be performed. Removal of as much tumor as possible is one of the most important factors affecting cure rates.
Side Effects of Surgery
Some discomfort is common after surgery. It often can be controlled with medicine. Tell your treatment team if you are experiencing pain. Other possible side effects are:
- Nausea and vomiting
- Infection, fever
- Wound problem
- Fullness due to fluid in the abdomen
- Shortness of breath due to fluid around the lungs
- Swelling caused by lymphedema, usually in the legs or arms
- Blood clots
- Difficulty urinating or constipation
- Talk with your doctor if you are concerned about any of the problems listed.