In the hands of a gynecologic oncologist , approximately 25 to 30 percent of the women who have sub-optimal disease at the second-look surgery (any tumor nodule greater than 3/4 tn./2 cm in diameter) will undergo an optimal surgical debulking . An intra-abdominal catheter for intraperitoneal chemotherapy can also be placed during the operation.
Prognosis The prognosis primarily depends on the stage, grade and type of carcinoma as well as on the amount of residual disease after the initial surgery.
Women who have Stage II, III or IV Grade 1 carcinoma and a negative second-look procedure have an excellent prognosis. Women with Grade 2 or 3 cancers and a negative second-look also have a good prognosis, but have a significant risk for developing recurrent disease. It is estimated that 30 to 50 percent of women with Grade 3 cancer will develop a recurrence within five years even after a negative second-look. As a result, many gynecologic oncologists recommend giving additional treatment—intravenous or intraperitoneal chemotherapy, radioactive phosphorus or whole-abdomen radiation—after the second look.
For women who have microscopic disease at their second-look procedure, the prognosis is not as good and is partially dependent upon the grade of the cancer. These women are treated with more intravenous combination chemotherapy , intra-abdominal chemotherapy or whole-abdomen radiation.
Women with bulky residual cancer (implants greater than 3/4 in./2 cm) after a second-look procedure have a poor prognosis despite treatment with second-line chemotherapy.
