Ovarian cancer - biopsy and staging
Biopsy and staging
Ovarian cancer is diagnosed by taking a sample of the tumour ( biopsy). The tumour material is examined by a pathologist, a doctor who specialises in diagnosing diseases by looking at the cells under a microscope. There are several ways to collect a biopsy of an ovarian mass.
Laparoscopy is the usual first step in confirming the presence of a mass and obtaining a tissue sample for biopsy. Laparoscopic surgery uses small incisions and specially designed instruments to enter the abdomen or pelvis.
- If the mass is small, it may be possible to remove the entire mass during laparoscopy.
- If the mass is larger than 7cm (complex mass) or 8cm (solid mass) on ultrasound, removal will probably be through conventional surgery. This procedure, called exploratory laparotomy, involves making a larger incision in the skin and abdominal muscles to gain access to the pelvic region.
If the biopsy finding is positive for cancer, further staging procedures will be performed, usually using imaging studies, laboratory tests and exploratory laparotomy. Staging is a system of classifying tumours by size, location and extent of spread and is an important part of treatment planning, because tumours respond best to different treatments at different stages. Correct staging is also a good indicator of prognosis.
Exploratory laparotomy is a careful and thorough attempt to find the exact extent of cancer spread.
- During the surgery, removal of the ovarian mass usually includes the entire affected ovary.
- To identify possible invasion by the cancer, samples are taken of other structures in the pelvis and abdomen including the diaphragm (the muscle that separates the organs of the chest from the organs of the abdomen), the peritoneum (the membrane that lines the abdomen), the omentum (a fatty membrane that covers the organs of the abdomen), lymph nodes, bladder and bowel.
- The goal is to remove as much cancerous tissue as possible (debulking). This may involve removing one or both ovaries (oophorectomy), the uterus ( hysterectomy), fallopian tubes (salpingectomy) and other organs.
- Typically, the surgeon does not know ahead of time exactly which organs and structures will require removal. If a woman plans to undergo exploratory laparoscopy or laparotomy, she should discuss the possible full extent of the operation with her surgeon before consenting to the procedure. Gynaecological oncologists are specialists trained to treat ovarian cancer. If a high suspicion of a gynaecological cancer exists, a gynaecological oncology consultant may provide input into the surgery.