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Finding the Right Doctor Can Make a Real Difference for Patients with Ovarian Cancer

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Frequently, women diagnosed with gynecologic malignancies wonder who is the ideal doctor to treat their disease. The majority of patients are told of their initial diagnosis by their family practice physician or obstetrician gynecologist. Unfortunately, a large number of patients diagnosed with cervical, uterine or ovarian cancer aren't treated appropriately because they don't have access to a gynecologic oncologist.

Ramirez_surgery.jpgEarly-stage disease    
Many women with early stage ovarian cancer are inadequately staged. Frequently, patients are operated on by surgeons who lack the expertise to perform a lymphadenectomy (removal of the lymph nodes) and a complete staging -- essential procedures in the management of early ovarian cancer.

Previous studies of patients with early-stage ovarian cancer have shown that inadequate staging leads to decreased survival. In addition, it's been shown that up to 30% of women presumed to have early stage ovarian cancer have their disease upstaged during a re-staging procedure.

Several studies that have evaluated the relationship between surgical specialty and survival in patients undergoing initial surgical treatment for epithelial ovarian cancer have found a consistent improvement in outcomes when patients with early stage disease are operated on by a gynecologic oncologist.

One study compared a group of patients who underwent minimal staging performed by a general gynecologist with a group of patients who underwent comprehensive staging performed by a gynecologic oncologist. The authors found the risk of recurrence to be increased for patients operated on by the general gynecologist.

Advanced-stage disease
The majority of patients with ovarian cancer come in for initial treatment with disease that has spread beyond the pelvis, and nearly 75% of them have evidence of extensive upper abdominal disease. The routine recommendation for patients with advanced disease who are surgical candidates is to perform a total hysterectomy, removal of both tubes and ovaries, complete removal of the omentum (a fatty pad of tissue that overlies the bowel), and removal of all visible tumor.

A recent study describing surgery in patients with advanced ovarian cancer revealed that the strongest predictor of improved median survival was the proportion of patients undergoing optimal tumor removal surgery.

At the beginning of the 20th century, women with ovarian cancer were operated on primarily by general surgeons and general gynecologists. It wasn't until the 1970s that subspecialty training in gynecologic oncology was established in the United States.

Similar to the case in patients with early stage disease, there's ample evidence in the literature to support that patients with advanced disease operated on by gynecologic oncologists rather than non-specialists are more likely to have optimal tumor reduction (<1 cm residual disease) and have improved median and overall five-year survival.

It's extremely important for all women diagnosed with an ovarian mass considered to be malignant to be either referred to a gynecologic oncologist or to assure that there's one available at the time of their surgery, in case the intraoperative evaluation of the ovarian mass shows evidence of malignancy.

In patients with suspected advanced ovarian cancer, it's crucial that they're referred to a gynecologic oncologist so that the appropriate surgery and postoperative counseling can be performed.

All women with a suspected diagnosis of ovarian cancer should demand that their doctors refer them to a gynecologic oncologist.

Resources:
M. D. Anderson Guide for Referring Physicians
ASCO Cancer.Net Find an Oncologist


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The majority of ovarian cancer patients are told of their initial diagnosis by their family practice physician or obstetrician gynecologist. Unfortunately, a large number of patients diagnosed with cervical, uterine or ovarian cancer aren't treated app... Read More

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