The answer to that question is that until fairly recently, recurrent ovarian cancer was always treated with chemotherapy. There have been some studies looking at use of surgery in selected groups of patients and there is certainly some evidence out there now that in selected patients, the use of surgery combined with chemotherapy may give a better outcome. We do have to be very careful about who is offered that type of surgery as there is a great risk of operating because you feel it’s the right thing to do. Such surgery carriers a significant risk complications as well as adversely affecting people’s quality of life without any real benefit. Because it is risky surgery and there are complications, we have to be sure that that surgery is going to be of benefit.
The patient group which benefit most, are those who are firstly, well enough for surgery. They also need to have disease in areas that we think we can remove. We would be reluctant to operate on a patient if we think the area where the cancer has come back isn’t somewhere that we can reach with surgery. Also, if the cancer is very widespread, surgery is, in recurrent settings, really difficult. Therefore, we have to be very selective in who we offer that surgery to. Certainly where I work in Norfolk and Norwich, we assess patients who have had recurrent ovarian cancer very carefully, looking very closely at their scans and blood tests and how they are physically. This information is crucial in determining whether further surgery would be in a woman’s best interests.