Cytoreduction Surgery for Ovarian Cancer

Why is Cytoreduction Done for People with Ovarian Cancer?

What is cytoreductive surgery for ovarian cancer?. Credit: Istockphoto.com/Stock Photo©Andrei Malov

What does cytoreduction mean in the context of ovarian cancer?

Definition - Cytoreduction

Cytoreduction literally means a reduction in the number of cells. So cytoreductive surgery refers to a treatment of advanced ovarian cancer in which surgery attempts to remove as many cancerous cells as possible. 

Philosophy for Cytoreduction

Cancerous tumors are composed of millions of cells. In fact, it's estimated that when someone has stage III or stage IV ovarian cancer, they have 1010  or 1011 cancer cells in their body.

  When surgeries are done at this stage of cancer, it's almost impossible to remove all of the cancer cells.  And even if all visible cancer cells could be removed, it's likely that many microscopic areas of cancer would still remain.  We know this because cancers at this stage have a very high rate of recurrence - meaning that with surgery at least some cancer cells are left behind.

Cytoreduction is a process of "clean up" which can take place during ovarian cancer surgery to get as many of these cells as possible.  With some cancers, it's not recommended to do surgery if the cancer is stage III or stage IV, and instead, treatments of choice are usually chemotherapy and radiation therapy alone.  With many of those other cancers, it's been found that doing an extensive surgery at those stages does not result in people living any longer.

With ovarian cancer, that's different.  People do live longer if extensive surgery is done, even if all of the cancer isn't removed.

It may help to understand how this works with chemotherapy.  Nearly anyone who has cytoreduction done has this followed up with chemotherapy.  A problem with chemotherapy is that cancer cells become resistant to the treatment.  By reducing the work that chemotherapy has to do, it's hoped that it can finish the job before that resistance develops.

Extent of Cytoreduction

Cytoreduction can be defined in different ways depending on the extent of cytoreduction. 

  • Complete - This is when no visible disease is left, though microscope cells are almost certainly still present.
  • Optimal - Nodules that are 1 cm or less are left over.
  • Suboptimal - Nodules more than 1 cm are left over.

Why Wouldn't Complete Cytoreduction Be Best?

On paper, it would seem that complete cytoreduction would be best.  The problem is when the surgeon is operating.  This surgery involves removing portions of cancer from several organs - some of which cannot be removed in their entirety.  Surgeons often remove organs such as the spleen and gallbladder, as well as parts of the stomach, liver, pancreas, colon, bladder, and omentum - the lining of tissues that is like a hammock in the abdominal cavity.

It is also a lengthy meticulous surgery, and we know that the longer a patient is under a general anesthetic, the more risk there is to the surgical procedure. 

Timing of Cytoreduction

Cytoreduction can also be:

  • Primary - The first part of cancer treatment.
  • Interval - Done after some chemotherapy has been given.
  • Secondary - Done after someone has had a recurrence of their cancer.
  • Tertiary - Done after several recurrences of the cancer.

Your Surgeon

Just as all plumbers, bankers, therapists, and painters vary in their expertise and ability, surgeons do as well.  One of your first decisions will be to choose the surgeon who will perform your surgery.  With a surgery such as cytoreduction, it's important that you see a gynecologic oncologist.  There are different types of surgeons who can perform this surgery, but studies have actually found that outcomes are better if you have the surgery done by a gynecologic oncologist.

Then you will need to choose your gynecologic oncologist.  Just as you may get a few opinions if you were to have your house painted, you can get a few opinions from gynecologic oncologists.  What many people don't realize is there can be value in this even if you talk to two surgeons who completely agree on the best approach for you.  With a disease like advanced ovarian cancer, it's almost inevitable that you'll play the game of "I wish I would have..." If your outcome isn't what you hoped, at least you can look back and know that you didn't leave any leaves uncovered.

Making Decisions

When your doctor talks to you about cytoreduction, there will be a lot for you to think about.  Check out these tips on weighing the risks and benefits to help you make decisions about your ovarian cancer treatment.  Also, take a little time to learn about clinical trials for ovarian cancer

Coping, Support, and Empowerment

Learn as much as you can about your cancer.  Here are some tips on researching your cancer using the internet.  Connect online.  There is a wonderful ovarian cancer community online   The connections can provide not just support, but education about the latest advances in ovarian cancer treatment.  Reach out for support among your family and friends, and be aware of how the emotions that go along with a diagnosis of cancer affect every relationship.  Most importantly, learn how to advocate for yourself as a cancer patient.   

Pronunciation: SIGH-toe-ree-duck-shun

Also Known As: debulking

Common Misspellings: sitoreduction

Examples: She was found to have a lot of cancer, but cytoreduction was performed and only microscopic cancer cells were left behind.

Sources:

Chern, J., and J. Curtin. Appropriate Recommendations for Surgical Debulking in Stage IV Ovarian Cancer. Current Treatment Options in Oncology. 2016. 17(1):1.

Chiva, L, Lapuente, F., Castellanos, T., Alonso, S., and A. Gonzalez-Martin. What Should We Expect After a Complete Cytoreduction at the Time of Interval or Primary Debulking Surgery in Advanced Ovarian Cancer? Annals of Surgical Oncology. 2015 Dec 29. (Epub ahead of print).

Fanfani, F., Fagotti, A., Ercoli, A. et al. Is There a Role for Tertiary (TCR) and Quaternary (QCR) Cytoreduction in Recurrent Ovarian Cancer? Anticancer Research. 2015. 35(12):6951-5.

Liu, Z., Beach, J., Agdjanian, H. et al. Suboptimal cytoreduction in ovarian carcinoma is associated with molecular pathways characteristic of increased stromal activation, Gynecologic Oncology. 2015. 139(9):394-400.

Vidal, F., Al Thani, H., Haddad, P. et al. Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis: Beyond Gross Residual Disease Considerations. Annals of Surgical Oncology. 2016. 23(2):434-42.

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