Radical Cytoreduction Surgery For Ovarian Cancer with Peritoneal Carcinomatosis

What Does Radical Cytoreduction Surgery for Advanced Ovarian Cancer with Peritoneal Carcinomatosis Consist Of?

The diagnosis of ovarian cancer is made when the disease is already widespread in the abdominal and pelvic cavities in almost 80% of patients. (Stages III and IV of the disease) The picture is also called: “peritoneal carcinomatosis”.

This occurs when malignant cells from the ovary implant themselves in a thin membrane or layer of cells that lines the inside of the abdomen and pelvis and is called the peritoneum.

Cytoreductive Surgery in Spain.

Thus, at the time of diagnosis, the disease is not only found in the ovaries, but also in the form of implants (or nodules) on the peritoneum that covers the intra-abdominal organs such as the intestine, the liver, the spleen, the diaphragm, or the stomach.

Ovarian cancer gives very non-specific symptoms and this makes diagnosis difficult and delays around 3-6 months.

Advanced Ovarian Cancer Treatment

There are currently two treatment strategies for advanced ovarian cancer with peritoneal carcinomatosis. Exhibited below:

Today, Ginecólogos Oncólogos gynecologist oncologist surgeons specializing in ovarian cancer  (PDF) recommend complete removal of the disease at the time of surgery after diagnosis (primary cytoreduction surgery or cytoreduction for ovarian cancer).

This is because, all scientific studies show, it is the only modifiable prognostic factor for ovarian cancer patients with peritoneal carcinomatosis.

Therefore, to perform this type of surgery properly, specialized training of the surgical team is required.

To increase the chance of removing all of the diseases at the time of surgery, the procedures have to be performed by properly trained ovarian cancer surgeons – gynecologists.

In addition, it is equally important that they are carried out by multidisciplinary surgical teams where each specialist participates in the different moments of the surgery to guarantee the best therapeutic result.

Citoreduccion Primaria y de Intervalo

The diagnosis of ovarian cancer is made when the disease is already widespread in the abdominal and pelvic cavities in almost 80% of patients, cytoreduction due to ovarian cancer.

Cytoreduction Surgery for Ovarian Cancer
Gynecologist Oncologist. Uterus Polyp

Thus, multiple studies around the world have shown that life expectancies can be extended by up to 30% when surgeries are performed by gynecological oncologists who are specialists in ovarian cancer surgery such as cytoreduction for ovarian cancer, instead of general gynecologists or general surgeons.

cirugía del cáncer de ovario

To carry out an adequate surgery that gives the patient the maximum life expectancy, it is necessary to perform multiple surgical procedures in the same operative act and in the same patient.

Hence the importance of working in adequately trained and multidisciplinary surgical teams. They are usually surgeries of approximately 5-7 hours duration where, in addition to removing the uterus and ovaries, it is usually necessary to perform one of the following procedures:

Bowel resection with re-anastomosis

Surgery on the diaphragm

Lymph node removal

Removal of the peritoneum

Spleen resection (splenectomy)

Liver surgery

In any case, surgical treatment is always complemented with systemic chemotherapy for 6 cycles (or sessions) separated by 3 weeks each. This is called adjuvant chemotherapy.

what ovarian cancer looks like inside the abdominal cavity

What to do when advanced ovarian cancer patients with peritoneal carcinomatosis cannot be operated on?

When to indicate neoadjuvant chemotherapy with interval cytoreduction in women with advanced ovarian cancer with peritoneal carcinomatosis?

The most important point is that each patient with advanced ovarian cancer with peritoneal carcinomatosis is evaluated by surgeons – gynecologists specialized in ovarian cancer.

Thus, based on experience and training, the best initial treatment strategy for each particular patient can be decided.

Not all women with advanced ovarian cancer with peritoneal carcinomatosis can be initially operated on. In certain cases, 20-30% of patients, it is necessary to start treatment with 3 cycles of chemotherapy to reduce the disease (neoadjuvant chemotherapy).

After that, the response is re-evaluated and the possibility of performing a cytoreduction surgery (interval) or also called cytoreduction for ovarian cancer is assessed. Here again, the role of gynecologists specializing in ovarian cancer is key to making the best decision.

The indication of this treatment strategy is based on the following factors:

Age

Overall status

Presence and status of associated diseases (co-morbidities)

Extension of the disease (Unresectable disease or not)

Patient wishes

But in any case, the decision to start treatment with primary cytoreductive surgery or neoadjuvant chemotherapy must be individualized and made by a gynecologist specializing in ovarian cancer together with a multidisciplinary team specialized in advanced ovarian cancer with peritoneal carcinomatosis.

Is Ovarian Cancer with Peritoneal Carcinomatosis hereditary?

Advanced ovarian cancer with peritoneal carcinomatosis is hereditary in 20% of cases. Usually, the main inherited genetic mutations are associated with BRCA 1-2. It is important to mention that women with the mutation in these genes also have an increased risk of breast cancer.

What is the survival of women with advanced ovarian cancer with peritoneal carcinomatosis?

The prognosis of women with advanced ovarian cancer with peritoneal carcinomatosis depends on several factors. The most important factor and the only one that is modifiable is surgery.

This means that all macroscopically visible disease must be removed. While this group of women has the best prognosis, on the contrary, the prognosis worsens significantly when the disease is left after surgery. Hence the vital importance of being operated on by adequately trained gynecological oncologists.

Other factors associated with survival or life expectancy, but not modifiable, including the advanced age and general condition of the patient, the extent of the disease at the time of diagnosis, the histological subtype of the tumor, and the degree of intrinsic aggressiveness that it has.

Thus, while more than 60% of women with advanced-stage ovarian cancer survive for more than 5 years if all of the disease has been removed at the time of surgery, this figure may drop very significantly when unsatisfactory surgery is performed after diagnosis.

Therefore, the lifespan of women with advanced ovarian cancer and peritoneal carcinomatosis will depend on several factors, including cytoreduction which removes the entire disease as a fundamental factor. It is very important to control all aspects related to the disease to guarantee the patient the best standards of care, both in terms of quantity and quality of life.

When is an end-stage peritoneal Carcinomatosis due to ovarian cancer considered?

Certain women with ovarian cancer may experience a recurrence, or return, of the tumor. Although in certain cases it is possible to repeat the cytoreduction surgery, in some cases, the patient with advanced ovarian cancer with peritoneal carcinomatosis enters the terminal phase.

In this case, the tumor can extensively affect the intestine and it is necessary to take all palliative measures to relieve the symptoms of pain and intestinal obstruction.

Our team is made up of specialists in internal medicine and palliative care who provide the best quality of care for this time of illness.

Recommendations after hospital discharge for Ovarian Cancer Surgery

Post-surgical recommendations offered by Doctor Lucas Minig after surgery for ovarian cancer for our patients:

Testimonials from patients with radical cytoreductive surgery.

Doctor Lucas Minig Specialist in radical cytoreduction surgery in Valencia, Spain

Dr Lucas Minig
Dr Lucas Minig
Susana Heredia Opinion of Doctor Lucas Minig
Opinion Merche operated by Doctor Lucas Minig
Dr Lucas Minig
Dr Lucas Minig
Dr Lucas Minig
Dr Lucas Minig
When the worst prognosis (ovarian adenocarcinoma) was confirmed one day in April 2011, Dr. Lucas Minig entered my life and became part of my gallery of heroes. With Dr. Minig, a smile, strength and empathy entered my room every day like I have rarely encountered in my life. I will never thank Dr. Minig enough for his love, drive, effort, and many other things that I cannot describe now, because emotion prevents me. I have never met anyone with such a clear calling in such a difficult undertaking. God bless you Lucas and I pray that you can help many women as you did me.
Beatriz Fernández
Ovarian Adenocarcinoma Treatment
Five years ago Dr. Minig operated on me for ovarian cancer. The surgery went very well and the subsequent ovarian cancer treatment has also allowed me to get on with my life. I will always appreciate the doctor's work but, above all, the diagnosis phase was decisive, because of how he spoke to me, how he explained everything to me, with sincerity, clarity, closeness and a lot of affection towards me and my family. And thanks to that I had the necessary confidence to face everything with sufficient serenity and courage. It would not have been the same if I did not get to have Dr. Minig, whom I will always be grateful for his dedication.
Juana Zayas
Operation on a patient with ovarian cancer
Two months after my 35th birthday, and two years after having my second child, I was diagnosed with ovarian cancer. After an ultrasound they saw a 10 cm cyst on the left ovary, they referred me to an ovarian cancer expert, I had never heard of a gynecologist oncologist. I have recommended Dr. Minig on several occasions and will continue to do so, for his human warmth but above all for the great professional he is. He is an expert in gynecological oncological surgery, an expert in ovarian cancer, therefore there is greater SURVIVAL and better quality during the operation and treatment.
Susana Heredia
Patient testimony Ovarian Cancer Operation.
I was diagnosed with ovarian cancer in the middle of my first pregnancy. I had to undergo diagnostic surgery at 20 weeks gestation and when I found out the result of the biopsy I left the office completely stunned. I am very clear that thanks to changing hospitals and meeting Dr. Minig and that team of doctors, my son and I are here and although I cannot have more children, I am aware of how lucky I am. I am also clear that without the love of my family I do not know where I would be at this moment.
Merche
Diagnosed with ovarian cancer, surgery performed in Spain
Eva was, and is even more so today, a very active woman writer. He details all the things that went through his mind when he found out he had cancer and how this disease changed his life for the better. Today already recovered and fully enjoying life.
Eva
A patient operated on for ovarian cancer by Doctor Lucas Minig in Valencia.
My family was absolutely an anchor, they have always seen things positively, I was very lucky with my friends, thanks to the expert doctor in ovarian cancer I was able to return to my family and friends.
Guada
Patient operated on for ovarian cancer with peritoneal carcinomatosis
This video describes the opinion of Florentina, a patient operated on for advanced ovarian cancer with peritoneal carcinomatosis due to advanced ovarian cancer. The importance of 3 things stands out: Never lose hope, go to specialized professionals, and the help of the psychologist-oncologist to know how to interpret the problem and come out stronger. Thanks for your testimony!
Florentina
Patient operated on for advanced ovarian cancer with peritoneal carcinomatosis
My family has always been there, in everything, at first I was sunk but you have to trust the doctor and the treatments, the first thing I asked was if my hair was going to fall out, but hey, it grows back, you have to be very positive that advanced ovarian cancer with peritoneal carcinomatosis gets ahead.
Angeles
Patient operated on for advanced ovarian cancer with peritoneal carcinomatosis
Testimony Operated Cancer Cervix Uterine by Laparoscopy

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