Gynaecological cancer surgery

Women who are referred with a confirmed gynaecological cancer or who have investigations concerning for this diagnosis often require surgery as part of their management. By providing the pathologist with tissue specimens to examine, surgery helps to determine the grade (how abnormal the cancer cells are) and stage (how far has the cancer spread) of the disease. It is important that you have up-to-date investigations (blood tests, scans) to help plan what type of operation is best suited to your individual case and to avoid unexpected findings.

If the cancer appears to be limited to one organ, then a staging operation will be recommended. This involves removal of the organ where the cancer has started and other surrounding organs which have been shown to have a higher chance of cancer cells spreading to. In these cases, the pre-operative scans will generally show no signs of abnormalities in these other tissues, but sometimes the pathologist may find cancer cells when they examine the specimen under the microscope. This is important information as it will influence whether any additional treatment (eg. chemotherapy, radiotherapy, other medication) is required to improve survival or reduce the chance of recurrence.

When a cancer has been shown to be in multiple areas of the abdomen and pelvis, it is considered as being at an advanced stage. In this scenario, the aim of treatment changes from staging to removing as much cancer as possible - this is called cytoreduction or debulking. Management in this situation usually uses a combination of both surgery and chemotherapy to try to reduce the amount of tumour within the body. In cases where the cancer is very widespread and involves other organs, chemotherapy may be used to shrink the amount of tumour prior to surgery to limit how extensive the surgery needs to be. This treatment is called neoadjuvant chemotherapy.

Cytoreduction or debulking surgery is generally performed by an open approach through a cut on the abdomen with the goal of leaving no visible tumour behind. It can be done at different points of your treatment - prior to chemotherapy (primary cytoreduction), half way through chemotherapy treatment (interval cytoreduction) or after the majority of chemotherapy is given (delayed cytoreduction). Regardless of when surgery is performed, the evidence shows that the best outcomes are seen when complete removal of the cancer is achieved.

Gynaecological oncologists may seek the assistance of other specialist surgeons during the operation if it is not possible to remove the cancer safely without affecting other organs or tissues. In these circumstances, consideration of all options is made prior to removal of all or part of other organs (eg. bowel, bladder, liver) and balanced with the patient’s health, quality of life and recovery in mind.