Surgical treatment of ovarian cancer during the COVID 19 pandemic

  • Ovarian cancer patients may be at greater risk during the pandemic
  • Surgery can be done safely, but doctors may recommend postponement and using chemotherapy first, depending on local COVID-19 conditions and the specifics of your cancer
  • Ovarian cancer patients should follow the same CDC recommendations as the general population: staying home, social distancing, frequent handwashing, avoiding touching the face

The COVID-19 pandemic makes many people feel at-risk and vulnerable, but there are special considerations for cancer patients—especially cancer patients facing surgery. “In general cancer patients do fall into a high-risk group,” says Dr. Marta Crispens, a gynecologic oncologist with Vanderbilt University Medical Center in Nashville. Dr. Crispens performs ovarian cancer surgery as well as surgery for other gynecological malignancies. “And because of our surgical expertise, gynecologic oncologists also serve as backup for general gynecologists who have difficult cases, or sometimes for obstetricians who are dealing with challenging obstetrical cases that involve cancer.”

While women with ovarian cancer may be at increased risk of complications from infection with the new coronavirus, the precautions that are recommended are the same ones that the CDC encourages the general population to follow. “That includes physical distancing, staying home, good hand hygiene, avoiding touching your face,” says Dr. Crispens. “All the things that the CDC is recommending for the population at large should be done even more vigorously in the cancer population.”

The additional risks from COVID-19 are even more concerning when a patient is facing surgery, as most ovarian cancer patients do, whether after the initial diagnosis or as part of continuing treatment. The initial surgery after diagnosis is especially important both for staging the cancer–determining how advanced it is–and removing visible tumors. While doctors usually recommend surgery within a few weeks of an ovarian cancer diagnosis, the pandemic makes that decision less clearcut. A patient and her doctor must decide whether the need for surgery is urgent enough that it should be performed immediately, taking all possible precautions to avoid infection with the coronavirus. Or whether it’s safe to postpone surgery, using chemotherapy or other treatments to control the cancer until the pandemic has subsided.

There are cases when surgical delay is the medically optimal course. For instance, patients who have other medical conditions may need to get those treated and under control before surgery can be safely performed. And there are patients, generally elderly, who are considered too frail to operate on safely until they are treated with nutritional therapy or physical therapy in order to gain strength for a good surgical outcome and recovery.

“Most cancer surgery would be considered at least semi-urgent,” says Dr. Crispens. But she adds that during this pandemic “there may be situations in which surgery can be safely delayed a little bit.” Patients have to discuss their own condition with their doctors to determine which course of action would be wisest for them.