Surgery In women with early stage cancer, one or both ovaries are usually removed (with or without
removal of the uterus) and meticulous surgical staging is performed. This involves washings from the abdominal cavity to detect malignant cells , selective sampling of pelvic and aortic lymph nodes and meticulous inspection of the abdominal cavity surfaces with biopsy of any suspicious lesion and removal of the fatty tissue attached to the stomach and large intestines (omentectomy) and multiple, random biopsies of the lining of the abdominal cavity including the surfaces of the diaphragms.
In women with advanced cancer, surgical removal of as much tumor as possible, also called tumor debulking , is standard therapy. If possible, the uterus, both fallopian tubes, both ovaries, the omentum and as much of the grossly visible cancer as possible is removed.
Recent studies have shown that 25 to 35 percent of women with ovarian carcinoma will require intestinal or urologic surgery to obtain optimal tumor debulking (defined as leaving behind no tumor implant greater than 3/4 in. (2 cm) in diameter). A permanent colostomy may occasionally be necessary but is rare in women who have had a preoperative bowel prep—a cleansing of the intestines with enemas and laxatives and administration of oral antibiotics.
To decide if further treatment is required, second-look abdominal surgery is often performed after six cycles of chemotherapy in women without evidence of persistent cancer ( see "Treatment Follow-Up" ). In advanced recurrent cancer, surgery is sometimes required to relieve intestinal obstruction.
