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Medical Edge Newspaper Column from Mayo Clinic
LARGE MEDICAL CENTERS BEST FOR OVARIAN CANCER TREATMENT
DEAR MAYO CLINIC: I am a 49-year-old woman with ovarian cancer that has spread to the liver. I have confidence in my local doctors — they’ve given me chemotherapy and my maximum dose of radiation — but I’m concerned about their possibly limited resources here in rural Indiana. Are there new treatment options I might be missing? — Indiana
ANSWER: From what you report about your treatment, several things strike me as unusual — both in what you’ve received and in what you’ve apparently not received.
You don’t mention undergoing surgery. The best current practice is to remove — in a surgical procedure called debulking — as much of the malignant tissue as possible, leaving only the smallest tumors (less than 1 centimeter in diameter), which are typically too numerous and dispersed to excise.
That is where the chemo or radiation — aimed at destroying the remaining cancer cells — comes in. If debulking surgery is not performed, and radiation and/or chemo are applied instead, the tumor masses are likely to be too large for them to handle.
For these and other reasons, surgery — in fact, aggressive surgery — is the standard of care for ovarian cancer, particularly when it has spread elsewhere in the abdominal cavity. Because ovarian cancer manifests common symptoms easily associated with less serious problems, it typically is not diagnosed until the tumor has spread. Thus your case is not unusual, although spreading to the liver tends to occur late in the course of the disease.
I would recommend that you schedule a surgical evaluation at the nearest tertiary care center, where care is delivered by specialized providers having access to sophisticated technological and support facilities. Though your location may be rural, Indiana is not a large state and several such regional centers are likely to be located within a two-hour drive.
Tertiary medical centers typically employ gynecologic oncologists, specialists who are highly trained in the techniques of cancer surgery, and of debulking procedures in particular. These practitioners are not likely located in small, local hospital, but are the people to whom doctors should refer their ovarian cancer patients. Procedures performed by such experts are more likely to be successful and result in longer survival.
Another advantage: These specialized centers can perform chemotherapy that follows the National Cancer Institute’s new standard of care — intravenous chemo delivered via the bloodstream together with intraperitoneal chemo delivered directly into the abdominal cavity. This combination has been shown to be the most effective in lengthening patients’ lives, but it is also more difficult to administer. Because the drugs are delivered directly to the tumors within the abdominal cavity in high doses, short-term complications are greater. Therefore, such procedures should be provided by the most capable professionals in the best-equipped settings.
Cancer patients being treated at tertiary care centers are also more likely to have access to clinical trials of advanced treatments, such as new chemotherapy drugs, vaccines, gene therapy and immunotherapy (which boosts the body’s own immune system to help combat cancer).
Finally, organized support groups of ovarian cancer patients, which are more likely to come together on a regional rather than a local basis, can be especially helpful. Support groups often are a good source of practical information and, because they consist of women going through similar experiences, can lead to deep and lasting personal bonds.
— Brigitte Barrette, M.D., Obstetrics & Gynecology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Ovarian Cancer
Appointment Information
More Information on Ovarian Cancer
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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