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Obstetrics & Gynecology

Answer 2
  1. Surgery with tumor debulking followed by chemotherapy. Primary surgery in patients with ovarian epithelial cancers serves 3 purposes: diagnosis, staging, and debulking. Surgery establishes a tissue diagnosis and also determines the stage or extent of the disease. Several studies have demonstrated that patients with optimal cytoreductive surgery (largest diameter of remaining tumor implants ≤ 1 cm) have a better survival than patients with larger residual tumor implants.1 The stage of disease and the effectiveness of cytoreduction (optimal versus nonoptimal) are major prognostic factors in patient survival. After optimal cytoreductive surgery, chemotherapy that includes a combination of paclitaxel and a platinum drug (either cisplatin or carboplatinum) should be initiated. Chemotherapy is most frequently administered intravenously; however, based on data suggesting improved survival, intraperitoneal chemotherapy may also be administered directly into the peritoneal cavity.3

    1.  Bhoola S, Hoskins WJ. Diagnosis and management of epithelial ovarian cancer. Obstet Gynecol 2006;107: 1399-410.

    3. Herbst AL, Mishell DR, Stenchever MA, Droegemueller W. Abortion. In: Comprehensive gynecology. 2nd ed. St. Louis: Mosby-Year Book; 1992:443-9.

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