USPC:Surgical removal of Omentum ?

nancygt

At my surgery I had not done all the research like I have now and did not see how many articles recommended removal of the Omentum-I have shown excerpts about surgical treatment below. I guess at some point I will ask my new oncologist what he thinks bit I would imagine it would be of limited benefit now and is major surgery, I had bilateral and oopharectomy and hysterectomy with 13 pelvic lymph noes negtive but no paras aortic lymph nodes tested - numerous articles I hjave seen lately recomment testing osf para-aortic lymph nodes-the site of my first recurrence. Also I did not have peritoneal washing, as many of the ovarian cancer patients do.
My questions are for USPC patients mainly ?

Did your gynonc discuss removal of the omentum and did any of you have it ?
Did they do peritoneal wash ?
Did they biopsy para-aortic lypmh nodes ?
Did these procedures necessiate abdominal incision as opposed to DaVinci type surgery ?

If you did not, have any of you had discussions with doctors in this arena since surgery (e.g. second surgery as seems to me more common for ovarian) ?


Excepts froma few of the articles":
(1)
The primary treatment is surgical. Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal hysterectomy, and removal of both ovaries (bilateral salpingo-oophorectomy). Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the omentum is also performed.
Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer.
(2)
Endometrial Carcinoma in its early stages is considered highly curable. The first treatment undertaken is a surgical procedure, particularly if the tumors that have grown exhibit the high-risk features of clear-cell tumors, or pathologic grade 3 serous tumors. This is also true if the cancer has taken up nearly half of cervix extension known as the myometrium. In such cases, omentum removal is also undertaken during surgery.

In some cases, the surgeon may perform abdominal hysterectomy, the surgical removal of the uterus. This surgical method will enable the surgeon to check for any evidence that the cancer has spread to other neighboring tissues.

(3)
Treatment of all endometrial cancers begins with surgery, including a total hysterectomy; removal of ovaries, fallopian tubes, and aortic and pelvic lymph nodes; and examination of the abdomen for evidence of extrauterine disease. For UPSC, the surgery may be more extensive, and like the surgical staging of ovarian cancer, it includes removal of the omentum, scrutiny of all peritoneal surfaces for evidence of tumor, excision of all noted disease (“debulking”), and washings and biopsies for pathologic examination. This is an extensive operation that, like many operations for gynecologic cancers, should be performed by a gynecologic oncologist.
Early Uterine Papillary Serous Carcinoma: Primary Treatment Options
(Opens in new window)
When UPSC is confirmed by surgical-pathologic staging to be stage I, standard options for further treatment range from observation to adjuvant chemotherapy and/or radiation therapy.
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lindaprocopio

all 'yes's' to your questions
Yes, my omentum was removed during initial de-bulking surgery. Yes, they also removed a couple para-aortic lymph nodes amoung the 25 nodes they removed at that time. & yes they did a wash to look for loose malignant cells. I had open abdominal surgery.

I know that some of the women here had a 2nd surgery for lymph node removal for staging when their cancer was discovered by surprise when they were having hysterectomies for other reasons.

Good research. Thanks!

upsofloating

I had abdominal surgery -
I had abdominal surgery - not sure I would have been that comfortable going with davinci procedure although I imagine it is the experience level of the surgeon that would make the difference. My surgeon just told me he was going in and would examine and remove whatever was necessary to optimize my prognosis. This did include removal of omentum but a prior biopsy during 'appendectomy' surgery had shown cancer. I had had a PET/CT as part of staging for presumed metastatic breast ca due to aforementioned surgery which did show hot spot in spleen. Probably this resulted in the extensive debulking surgery which included pelvic and para aortic lymph nodes, removal of omentum and spleen as well as numerous tumors on large and small intestines. I expect extent of surgery is to some degree based on expectations of what would be found. I was diagnosed UPSC pre-surgery by endometrial biopsy. Although I am still curious as to why biopsy at 'appendectomy' was just 'adenocarcinoma' without specification. If it was UPSC it should have shown papillary serous cell histology. Oh, the questions never end. (sigh) Btw, I don't believe they examined washings but perhaps that is unnecessary if visible tumors exist within abdominal cavity.

Kaleena

Nancy,
I'm one of the ones
Nancy,

I'm one of the ones that had to do a 2nd surgery for staging because I was getting a hysterectomy for other reasons. I had adominal surgery for both. During the staging, they also removed lymphs, omentum, appendix and did the washings (happy to report all were negative).
Although they found nothing else, I still did the regular chemo protocol then 3 brachytherapies.

daisy366

Kaleena said:

Nancy,
I'm one of the ones
Nancy,

I'm one of the ones that had to do a 2nd surgery for staging because I was getting a hysterectomy for other reasons. I had adominal surgery for both. During the staging, they also removed lymphs, omentum, appendix and did the washings (happy to report all were negative).
Although they found nothing else, I still did the regular chemo protocol then 3 brachytherapies.

all yes to your questions
In addition tissue also tested for chemosensitivity and immunoperoxidase.

culka

I have 3 yes
and 1 no. I still have my para-aortic nodes. They palpate them and decided to leave it.

nancygt

Thanks for responses
Thank you so much for all your responses. I could not have chemo Thursday (WBC .9 so it is back om Neupogen shots) but because of the MDA article and your responses), I spent that time talking to my new oncologist about whether it was too late or water over the dam to think about second surgery. I had already parted ways with the original gynoncologist over several questionable judgments and total lack of communication - I am somewhat depressed to now think that list is extended to much less than optimal surgery. But my new doc is sending me for surgical consult at Moffett- probably Dr. Apte whom I believe has been mentioned before. But your responses helped me to use my non chemo time on Thurday to disucss the surgical consult.

Ro10

nancygt said:

Thanks for responses
Thank you so much for all your responses. I could not have chemo Thursday (WBC .9 so it is back om Neupogen shots) but because of the MDA article and your responses), I spent that time talking to my new oncologist about whether it was too late or water over the dam to think about second surgery. I had already parted ways with the original gynoncologist over several questionable judgments and total lack of communication - I am somewhat depressed to now think that list is extended to much less than optimal surgery. But my new doc is sending me for surgical consult at Moffett- probably Dr. Apte whom I believe has been mentioned before. But your responses helped me to use my non chemo time on Thurday to disucss the surgical consult.

Nancy I had Dr Apte for my surgery
Dr Apte did robotic surgery on me 1/09. I did have the omentum removed, a peritoneal wash (which showed metastatic cells), did have the para aortic nodes biopsied (negative) but had 5 of my 21 nodes that were removed (positive). I was diagnosed with stage 3- C UPSC. I had the sandwich treatment with my last chemo 8/09. MY CA 125 started rising immediately after I stopped chemo.

Dr. Apte suggested the "watch and see approach." So I had lab and CAT scans every 2 - 3 months. We watched the CA 125 continue to increase, but a very very slow growth in lymph nodes. He always said the CA 125 was just a number, and unless there was significant growth in the nodes, or I became symptomatic we would continue to observe. My last CA 125 was 1510, so he felt it was time to start chemo. There are 4 different nodes they have been watching. He wanted to hold off on chemo, and let my body recover from the previous treatments. He wanted to use the chemo when it was really needed.

I hope my body has recovered enough to handle this round of chemo of Taxol/Carbo every three weeks. Good luck with your appointment with Dr. Apte. He is very straightforward in what he tells you. He has not ever given me any statistics, but let me know upfront this cancer was not curable, but treatable. He says there are many options if one thing does not work. In peace and caring.