On Cancer: Women with Ovarian Cancer Benefit from Treatment at High-Volume Centers

More than 60 percent of women diagnosed with ovarian cancer may not be receiving the appropriate care for this aggressive disease, according to a study presented this week at the Society of Gynecologic Oncology annual meeting.

The study of more than 13,000 women, led by experts at the University of California Irvine Medical Center, showed that only 37 percent received treatment that met the guidelines of the National Comprehensive Cancer Network, a group of leading cancer centers that includes Memorial Sloan-Kettering.

These women, who were typically cared for at high-volume hospitals by high-volume surgeons, also had better survival outcomes than those at institutions treating fewer women with ovarian cancer.

In an interview, Richard R. Barakat, Chief of Memorial Sloan-Kettering’s Gynecology Service, commented on the study’s results and the extensive experience of Memorial Sloan-Kettering’s ovarian cancer treatment team.

How did Memorial Sloan-Kettering’s ovarian cancer experts react to the results of the study?

We were not surprised. We have known for many years that ovarian cancer should be operated on by experienced gynecologic oncologists – not by general surgeons or gynecologists – who are trained to perform the complex operations required to remove as much of the disease as possible.

At Memorial Sloan-Kettering, we have more than 20 medical professionals dedicated exclusively to the treatment of ovarian and other gynecologic cancers. The volume of ovarian cancer procedures performed at Memorial Sloan-Kettering also ranks among the highest in the country.

What is the goal of Memorial Sloan-Kettering gynecologic oncologists when removing ovarian cancer?

Our strategy is to remove as much of the cancer as possible – and whenever possible, to remove the cancer completely.

Our physicians and researchers have authored numerous scientific publications about our improved outcomes achieved by performing a procedure known as radical debulking for advanced disease.^(1),(2) Radical debulking is a complex operation aimed at ideally leaving no significant amount of disease behind, or at most, no tumor that measures more than 5 millimeters.

This usually involves removing not only the ovaries but also the uterus, cervix, and fallopian tubes, as well as a portion of the intestines and any disease in the upper abdomen, including the diaphragm and the spleen.

Another advanced treatment for ovarian cancer is chemotherapy delivered directly into the abdomen. How do you determine if and when this treatment is appropriate?

At Memorial Sloan-Kettering, we are strong advocates for the use of intraperitoneal chemotherapy for the appropriate patients. This form of chemotherapy should be reserved for women who have had a successful debulking procedure with no disease remaining or who have remaining disease measuring less than 5 millimeters.

This treatment involves delivering chemotherapy directly into the internal lining of the abdominal area, known as the peritoneal cavity, through a surgically implanted catheter. It allows a high concentration of chemotherapy drugs to reach the cancerous tissue for a prolonged period of time.

Memorial Sloan-Kettering pioneered the first clinical trials that evaluated intraperitoneal chemotherapy in the late 1980s, and we are one of the most experienced centers to offer this type of chemotherapy.

What are the first steps a woman should take when diagnosed with ovarian cancer?

We recommend that women seek out a gynecologic oncologist who treats women with ovarian cancer on a regular basis. In addition, it is beneficial to be treated by a multidisciplinary team of surgeons and medical oncologists – like ours at Memorial Sloan-Kettering – with extensive experience in using the most-advanced, effective techniques.