Surgery relates to methods of treatment of the primary disease, which is used in most cases, at different stages of the disease.
Surgery for ovarian cancer - quite extensive. Cancers surgeon is satisfied that the maximum number of removed tumor mass. Stay in the clinic - Hospitalization is - 3-4 days. The recovery period takes a month or so.
Most women with ovarian cancer surgery involves removal:
- Both ovaries and fallopian tubes.
- Uterus and cervix.
This operation is called a total abdominal hysterectomy and bilateral salpingo-oophorectomy. If the tumor is a border or in an early stage, has a low degree of malignancy (1A) can be removed only affected ovary and fallopian tube.
Medical Center "Assuta" ( a network of private clinics in Israel ) offers surgical treatment of ovarian cancer . Assuta, above all, is a surgical center, equipped with advanced medical and diagnostic equipment. Here are practicing the best surgeons and treatment in line with international standards .
Before the surgery in ovarian cancer
Doctors must be sure that the patient can undergo surgery. some types of surveys will be carried out:
- chest X-ray;
- blood tests;
Before the surgery, held a meeting with the team of surgeons, anesthesiologists, will be given an explanation for the surgery. A physical therapist will tell you about exercises for breathing and legs that reduce the likelihood of potential complications. The patient will be given Stockings for preventing the formation of thrombi. Can also be assigned to blood thinning medications (anticoagulants), prevents the development of infection antibiotics. Information when you need to stop eating (for 6 hours) and the liquid (2 hours) will be given.
Surgery for ovarian cancer in the early stages in the Assuta
During surgery to remove the ovaries and uterus surgeon takes samples from several sites within the abdomen and pelvis, to find out whether the cancer has spread. Thus, fully it is determined stage of the disease. This will help the doctor determine whether therapy is needed after surgery.
fat layer is removed - gland located near the ovaries. This is important because the disease could spread to him. Resection of the gland called omentektomiya.
Also, the surgeon inserts a quantity of sterile liquid into the abdominal cavity, and then retrieves and sends it to the lab, that tested for the presence of cancer cells. The so-called peritoneal washings.
The doctor removes some lymph nodes around the uterus and ovaries, pelvic and abdominal cavity. Also taking tissue samples from the peritoneum and pelvic region that check for the presence of abnormal cells.
Palliative surgery for ovarian cancer at later stages (metastases)
If the tumor process has penetrated into other pelvic or abdominal cavity, the surgeon will tend to remove the maximum amount of tumor tissue as reasonably possible. The operation is called debulking. The smaller malignant cells remain after it, the easier it will be with the help of chemotherapy to destroy the cancer surviving segments. The doctor may take a few samples of the abdomen and pelvis to check where else could spread cancer. When in the peritoneum has fluid (ascites), its sample will also be sent to a laboratory for further study.
Elimination of intestinal lock
Sometimes ovarian cancer grows so that totally blocks the intestine. This condition is called obstruction. It causes:
- Bloating and overcrowding.
- Vomiting in large volumes.
In some cases, the surgeon has to remove part of the intestine. This is done when the disease affected organ and block it. It can be created stoma (artificial opening) in the abdominal cavity in order to provide an outlet for stool (colostomy). Often, this procedure is only temporary. Later, an operation to close the stoma.
If surgery is not considered as an option, doctors may use a drug called Octreotide to treat a blocked bowel. He can control the symptoms for some time. The drug reduces the amount of fluid produced in the stomach and in general in the digestive system.
Eliminating blocking the urinary system
Sometimes ovarian cancer is blocking one or both ureters which connect the kidneys to the bladder. Urine will become heated in the kidneys, increasing their volume and ultimately bring down. Your doctor may suggest two ways to release the kidney:
- installed inner stent into the ureter;
- located external stent - nephrostomy.
The stent into the ureter can deliver using a local anesthetic. For visualization apply x-rays or ultrasound. Sometimes stenting performed odes general anesthetic during cystoscopy. The doctor inserts a cystoscope into the bladder, with it places the stent in the ureter. Through this stent will pass urine from the kidneys to the bladder. After this operation, the patient will be emptied bladder conventional (traditional) manner.
Nephrostomy is a stent, which is introduced into the blocked kidney. The end of the stent out of the body in the kidney area. Attached bag to drain urine.
Removal of ascites (fluid in the abdominal cavity)
Ascites - the medical name for accumulation of fluid in the peritoneal cavity. Many women with ovarian cancer ascites observed. There are a number of reasons why this happens. For example, when cancer cells spread in the field, they can cause irritation and fluid accumulation. In addition, cancer can block part of the lymphatic system, resulting in delayed fluid from the abdominal cavity. Such swelling cause discomfort. The following symptoms may occur:
- loss of appetite;
Is useful chemotherapy for ascites.
In addition, carry out a procedure called paracentesis. The choice of method depends on the liquid removal stage of the disease and the general state of health. It applies to:
- Single needle placement in the abdominal cavity for draining fluids.
- Setting long-term catheter.
One-time removal of ascites
This type of draining fluid from the abdominal cavity is rapid method that facilitates bringing symptoms and comfort. The procedure is performed on an outpatient basis, and sometimes requires a hospital stay (overnight). The doctor injects a local anesthetic. Under ultrasound guidance, he performs a small incision, insert the tube (drainage), the liquid is collected in the bag.
If the tube will remain for a day or so, the doctor fixes it with a couple of stitches. Bandage that hold the catheter in place. How long it will remain dependent on the amount of liquid. Sometimes just a few hours. Sometimes that comes to stay at the clinic for several nights, so that the liquid to drain slowly. Quick draining several liters of fluid in a short time may decrease blood pressure and lead to a deterioration in health.
There are potential problems associated with the removal of the liquid:
- pain and discomfort;
- infection (peritonitis);
- drainage lock;
- fluid accumulation in the abdominal cavity pockets that make it difficult to drain;
- fluid flow after removal of drainage.
If you often need to remove ascites, your doctor may suggest a long-term placement of drainage.
Long-term catheter placement
Such a catheter may remain for several months. There are several types:
- Catheter PleurX allows drain fluid as needed. You do not need to visit the hospital.
- Shunt is a tube, which is entirely within the body. It directs the liquid from the peritoneal cavity into the main blood vessel. It is more difficult to install than the catheter PleurX. It requires the use of general anesthesia and hospitalization. According to studies, it benefits 7 out of 10 people (70%).
If the surgeon may remove all or most of the tumor mass, it will be scheduled for surgery to chemotherapy. But when the surgeon is hard to do, you may need to first treatment with cytostatics. In this case, a tumor biopsy to confirm the diagnosis, followed by chemotherapy and surgery. This is called neoadjuvant treatment with cytostatics or primary.
Chemotherapy can reduce the tumor so that the surgeon can remove it. After surgery, cytostatics treatment will continue. Such an operation is called an interval or intermediate cytoreduction.
After surgery for ovarian cancer
When the patient wakes up, it will be attached a number of tubes:
- Intravenous drip, through which the liquid flows, while the woman will not be able to eat and drink on their own.
- Catheter into the bladder to drain urine.
Nurse will advise when you can start eating and drinking.
Sometimes after general anesthesia the patient feel nauseous and after some painkillers. In this case, the doctor will prescribe the necessary drugs, eliminating the symptom. If you do not have some effect, may be useful in others.
A woman will feel some pain after the surgery for a few days. There is a wide variety of painkillers. About the symptoms should be reported to your doctor as soon as possible. With most patients, he will choose the correct type and dose of analgesic.
Often used epidural anesthesia after surgery for ovarian cancer. It is set in the region of the back, the end effect of anesthesia.
Nurses and physical therapist will help the patient to get up as soon as possible, perhaps even to-day operations. Staying in bed, it will be necessary to carry out exercises for the legs and breathing, to reduce the risk of infections and blood clots.
3-4 days after surgery for ovarian cancer, it will be possible to leave the hospital. The wounds are closed with soluble sutures, so there is no need to remove them. If used standard stitches or staples, your doctor will mark the date for their removal. This usually occurs after 7-10 days after surgery.