Staging Ovarian Cancer
Staging determines how much cancer is present and how far it has spread. Many cancers are staged by doing a biopsy – taking a small sample from a tumor so a pathologist can study it under a microscope.
In a series of videos that starts with the one below, Dr. Dan Veljovich explains how robotic surgery is used to stage and treat ovarian cancer without subjecting patients to open procedures.
But staging ovarian cancer is different. It requires a more extensive procedure to check for cancer in the abdomen and beyond.
The conventional procedure for staging ovarian cancer is a laparotomy. With laparotomy, a surgeon:
- Makes an incision through the center of the abdomen, from the pubic bone to the belly button
- Takes fluid and tissue samples
- Removes the ovaries, fallopian tubes and uterus
- Looks inside the abdomen to see where else cancer may have spread
- Removes whatever cancer is visible
Recovery from this procedure can take several weeks. Robotic staging of ovarian cancer is now done regularly at Swedish for patients with early-stage ovarian cancer. It has several advantages for patients, including a much quicker recovery time.
Ovarian cancer is called a silent cancer because there are no clear symptoms in the early stages. That's why cancer specialists move aggressively to staging when ovarian cancer is suspected.
Robotic surgical staging is currently done for one of four circumstances:
1.) A woman has an adnexal mass on one of her ovaries.
Adnexal masses are growths or lumps found on the ovary during a routine pelvic exam. These masses are often benign, but can be cancerous.
2.) There is a very high clinical suspicion of ovarian cancer.
3.) For women who have genetic testing done that reveals a predisposition to ovarian cancer.
Women with BRC-A1 and RC-A2 have a 40 percent to 60 percent chance of developing ovarian cancer.
Studies show that removing the ovaries – and usually the fallopian tubes and uterus as well – drops the risk to less than one percent.
4.) For women who have a family or personal history of cancer.
Some women do not want to have genetic testing done, but do want to have their ovaries removed as a precaution.
Robotic surgery is done in an operating room with a specially trained support staff.
Patients are under general anesthesia, and constantly monitored by an anesthesiologist.
During the procedure:
- The surgeon makes five small incisions in the abdomen
- The abdomen is inflated with carbon dioxide to give the surgeon space to work
- A tiny camera and specially designed tools are inserted through the incisions
- The surgeon then sits at the console, controlling the robotic arms
- The blood supply to the ovaries is tied off
- The ovary is removed, along with fluid and tissues samples
While the surgeon operates, a pathologist is standing by. Samples taken during the surgery are rushed to the pathologist, who examines them under the microscope. What the pathologist finds determines the surgeon's next steps. Depending on the pathology report, the surgeon then may:
- Perform a robotic hysterectomy – removing the remaining ovary, fallopian tubes, uterus and cervix
- Remove nearby lymph nodes to further stage the cancer
- Remove other structures as needed
- Once the procedure is complete, the surgical instruments are removed, and the small incisions sutured closed.
Women who are having this surgery to lower their risk of getting ovarian cancer have a hysterectomy done during this staging procedure.
Robotic staging has many advantages over open laparotomy. Perhaps most dramatic is the difference in pain after surgery.
Women who have a laparotomy usually have an epidural or a patient-control pump to help control post-operative pain with narcotics. With robotic surgery, oral narcotics are typically needed only for the first 24 hours – if at all.
Other advantages include:
- Significantly less bleeding during surgery
- A shorter hospital stay – 24 hours or less instead of three to four days
- A quicker recovery – many women return to work in two weeks, compared to six weeks or more with laparotomy
The robotic system gives the surgeon:
- A magnified, 3-D view inside the abdomen
- Specially designed instruments that give the surgeon a high degree of dexterity
These advantages allow surgeons to do meticulous surgeries in the confined space of a woman's pelvis.
All surgeries involve some degree of risk, and discussing this with your doctor is an important part of preparing for any surgery.
With an open laparotomy, the risks revolve around the large incision through tissue and muscle. Open procedures have a higher risk of infection, of bleeding during surgery and of sutured incisions coming open.
Complications with robotic surgery are uncommon.
Robotic surgical systems are now widely available, but that does not mean every surgeon has the experience to successfully perform robotic surgery.
When you interview surgeons you are considering, be sure to ask:
- How much robotic surgery experience do they have?
- How many robotic staging procedures have they performed?
- How long has robotic surgery been available at the hospital?
- How many robotic thymectomies have been performed there?
Many of our gynecological surgeons are among the most experienced in the country. They have been performing gynecological surgeries robotically using the daVinci system since 2006.
Swedish is a regional center for performing – and teaching – robotic surgery. More than 4,000 robotic procedures have been performed here and everyone on our robotic surgery teams is specially trained and highly experienced.