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Surgery Q & A

The Hospital Experience

Pre-Operative Instructions

Bowel Preparation

Post-Operative Instructions
Surgical Treatment Q & A
F. J. Montz, M.D., K.M.
Professor and Director, the Kelly Gynecologic Oncology Service

Can the type of surgeon selected and the place where surgery is done make a difference?
Yes. Studies have shown that women who undergo surgery by gynecological oncologists are more accurately diagnosed and staged. This is critical for receiving the appropriate and best treatment. Women are also more likely to be optimally debulked when surgery is performed by a gynecological oncologist. Having undergone optimal debulking has been shown to improve the chances of being cured and of obtaining a long-term survival.

The choice of hospital is also important. NCI-designated Cancer Centers will be up on the latest techniques. These special cancer centers will also be better able to deal with serious complications should they arise.

Is Johns Hopkins a Comprehensive Cancer Care Center?
Yes. As one of only 37 cancer centers in the United States designated by the National Cancer Institute (NCI) as a Comprehensive Cancer Center, Johns Hopkins has active programs in clinical and laboratory research, education and community outreach. Johns Hopkins is recognized around the world as an important center of excellence for the treatment of cancer.

Is it important to react fast if ovarian cancer is suspected?
Absolutely. Time is of the essence if ovarian cancer is suspected. Waiting two or three months to take action can allow the disease to grow and spread both of which make it harder to cure.

What if ovarian cancer is suspected?
At Hopkins, if we are concerned that there is a high possibility that a malignancy is present, we make the patient's case a high priority. First we do a complete evaluation. We want to make sure that the malignancy is definitely ovarian in origin and not another type of cancer that has spread to the ovaries. An accurate diagnosis is important so that the best type of treatment can be selected. In an attempt to limit the possibility of another cancer existing ,we make sure that a woman has had a recent mammogram, colonoscopy, abdominal CT scans and as necessary other studies prior to surgery Then we schedule a date for surgery and a final visit prior to surgery that we call the "Consenting Visit."

What is the "Consenting Visit"?
At Hopkins we have instituted what we call the "Consenting Visit." The "Consenting Visit" is very important as it allows us, after all the studies have been completed but prior to surgery, to outline our specific goals and strategies for each individual patient. We summarize what is going on — where we are in our knowledge about your disease, what we can do, what you can expect from surgery. We will explain the critical roles of optimal debulking, surgery, chemotherapy and wellness recovery in the treatment of ovarian cancer.

We have found it takes time for patients to digest everything that they are being told. The "Consenting Visit" helps patients, their caregivers and loved ones develop a comfortable understanding about what they are about to go through.

Why is surgery important?
Almost all ovarian cancer patients go through surgery. Surgery is important to (1) confirm the diagnosis of ovarian cancer, (2) precisely determine the extent of the disease (comprehensive staging), (3) debulk as much of the disease as possible.

What will surgery entail?
Prior to surgery we will discuss everything you will be going through from pre-op to recovery so you and your caregivers will know before hand what will take place. The actual surgery will be a procedure called laparotomy. The laparotomy, in most instances, begins with a midline incision in the abdomen that goes from the pubis (the top of the bone that forms the pubic area) to just above the umbilicus (navel). On entering the abdominal cavity the surgeon collects any fluid and then sends the fluid for microscopic examination (cytological testing). The diaphragm is scraped and the abdomen lining sampled. Cancer cells from the pelvis, abdomen and diaphragm are important in determining the exact stage of the tumor. If ovarian cancer is diagnosed both ovaries, the fallopian tubes and the uterus would be removed. This is called a total hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO). Many ovarian cancer patients have cancer deposits in other parts of the pelvis or abdomen. This may necessitate the removal of the omentum (omentectomy), appendix (appendectomy), or even a possible resection of the bowel (intestine), sampling of the lymph nodes and removal of any nodules in the diaphragm or other organs, in addition to the hysterectomy.

All or the largest possible amount of tumor or suspicious areas in other parts of the pelvis or abdomen are removed. The goal is to leave as little tumor as possible. Patients with no residual tumor or with only tumor nodules less than 1 cm. have the greatest chance for a cure and long-term survival. Therefore it is important that surgery be performed by a gynecological oncologist trained to perform this type of surgery.

How long will surgery take?
Anywhere from 2 1/2 - 5 1/2 hours depending on what needs to be accomplished.

How long will I stay in the hospital?
Length of stay in the hospital varies from patient to patient. Five days is average. However if the bowel is resected, it could be a week to ten days.

What limitations will I have?
We put minimum limitations on our patients. Being up and fully active, walking stairs helps you to heal much faster. We limit lifting to no more than 25 lbs and ask that you not drive a car for a while. If there is also a suture line in the vagina, such as what happens when a hysterectomy is performed, we ask that you refrain from sex until you have healed. While you are recovering from surgery, it is important to build a rest period into your day. It will take one month to recover. Our eventual goal is to get you back to where you were before the disease even began. We tell our patients to plan that, including chemotherapy, it will take a year to get back to normal.

Why is a "bowel prep" important?

It is important to do a thorough bowel preparation before surgery to minimize the bacterial load in the intestine. This will facilitate surgery and make it easier to operate. In the event of a bowel injury or resection, the bowel prep helps avoid contamination, reducing the risk of infection and maximizes healing.

Can I preserve my fertility?
Some women with early ovarian cancer can have a procedure performed where one ovary and the uterus are left behind. This decision is made based upon patient desires and what is found inside the abdomen.

When will chemotherapy start?
Chemotherapy will start usually in the first 10 days to 2-5 weeks after surgery. Your doctor will use the information gathered during surgery on stage and grade of your tumor to select the most effective treatment for you. Of course, this will be extensively discussed with you prior to treatment beginning. Chemo is an integral part of the treatment for advanced ovarian cancer. The surgery combined with the chemo is to prepare you to have an optimal response.

Chemotherapy Q & A by a Hopkins Oncology Nurse

When will the intravenous catheter for chemo be placed?
A temporary central line will be placed before you leave the hospital. Waiting until you are through the post op phase for the placement of these lines, lowers the risk for infection. At Hopkins, this is done in the Cardiovascular Diagnostic Lab. You will find the temporary catheter will make getting chemo and having blood drawn more "convenient" and less uncomfortable.

The Johns Hopkins Hospital Gynecologic Oncology guide for patients.

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