Renowned Harvard-trained American cancer surgeon discusses common problems with ovarian cancer surgical treatment. Surgeons and oncologists must treat ovarian cancer more aggressively and more meticulously than they often do. “Debulking of ovarian cancer tumor is a bad concept in ovarian cancer treatment”. What is BANC, Bi-directional Adjuvant Normothermic Chemotherapy? Ovarian cancer best treatment options. Dr. Anton Titov, MD. Ovarian cancer surgery should be more aggressive. Dr. Paul Sugarbaker, MD. Best cancer surgeon for ovarian cancer must remove all signs of cancer cells in the abdomen and in the peritoneum. Ovarian cancer surgery today in many places is not adequate. Debulking of ovarian cancer tumor is not enough. Ovarian cancer patients should have meticulous cytoreduction with peritonectomy and visceral resections until there is no visible evidence of ovarian cancer. Ovarian cancer spreads in the abdomen and peritoneal cavity. Dr. Paul Sugarbaker, MD. Peritoneal metastases in advanced stage 4 ovarian cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [hot chemo bath, heated chemotherapy]. Medical second opinion clarifies ovarian cancer diagnosis. Medical second opinion confirms that cure is possible in metastatic ovarian cancer. Intraperitoneal chemotherapy treatment for advanced stage 4 ovarian cancer with metastatic lesions in the abdomen. Dr. Anton Titov, MD. Medical second opinion helps to select a precision medicine treatment for stage 4 ovarian cancer. Get medical second opinion on advanced ovarian cancer with peritoneal metastases. Best peritoneal metastatic advanced cancer treatment by surgical operation and regional chemotherapy. Video interview with Dr. Paul Sugarbaker. Leading expert in peritoneal metastatic cancer treatment (cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), hot chemo bath, heated chemotherapy. Ovarian cancer best treatment options. Best doctor for ovarian cancer treatment. Dr. Anton Titov, MD. Ovarian cancer affects 1 in 70 women. Dr. Anton Titov, MD. But those who have BRCA1 and BRCA2 mutations have much higher incidence of ovarian cancer. There are well-publicized ovarian cancer situations. Daughter of Pierce Brosnan (famous actor) and his wife passed away from ovarian cancer. Pierce Brosnan's daughter died from ovarian cancer at the young age of 42. Angelina Jolie's mother at 56 died from ovarian cancer. ovarian cancer is a very important disease for younger people. Dr. Anton Titov, MD. Peritoneal metastases in ovarian cancer are quite frequent. How do you treat patients with ovarian cancer and peritoneal metastases from ovarian cancer? You also also published studies showing that some patients with ovarian cancer have lower malignant potential of ovarian cancer cells. different malignant potential of ovarian cancer cells also affects selection of ovarian cancer patients with peritoneal metastatic disease for appropriate treatment. Treatment of ovarian cancer by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Dr. Anton Titov, MD. Could you please comment on the ovarian cancer treatment in your hands? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Ovarian cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a work in progress. There is now a single randomized controlled study of ovarian caner treatment. It shows that patients with recurrent ovarian cancer do better if they have cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Dr. Paul Sugarbaker, MD. Ovarian cancer patients did better when cytoreductive surgery was combined with HIPEC than when cytoreductive surgery alone was used to treat ovarian cancer. This is very important study. There are 4 randomized controlled clinical trials on ovarian cancer treatment currently active. These clinical trials in ovarian cancer ask this question. Dr. Anton Titov, MD. Should cytoreductive surgery alone be used to treat ovarian cancer? Dr. Anton Titov, MD. Or should cytoreductive surgery be combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)? Dr. Anton Titov, MD. Ovarian cancer treatment by Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in addition to cytoreductive surgery to resect ovarian cancer metastases in the peritoneal space? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Yes. Here is what what I would say about ovarian cancer surgery at this point in time. Today the concept of ovarian cancer treatment by surgery is tumor debulking. This is the standard of care for most surgeons performing ovarian cancer treatment by surgical operation. "Debulking" is removal of some but not all tumor. Surgeons just remove some ovarian cancer tumor. they expect the systemic chemotherapy to kill the rest of ovarian cancer tumor cells. It is true that chemotherapy in ovarian cancer is quite effective. Dr. Paul Sugarbaker, MD. Chemotherapy in ovarian cancer is more effective than chemotherapy of gastrointestinal cancer. But current treatment standard of surgical debulking of ovarian cancer is bad concept. It is a bad concept. Ovarian cancer patients should have the same meticulous cytoreduction with peritonectomy and visceral resections until there is no visible evidence of disease. Ovarian cancer patients should have a radical resection of all visible cancer. This is what we would have for peritoneal mesothelioma. That is not happening at this point. Radical surgical resection of all ovarian cancer tumor is the first and biggest step in the improved treatment of ovarian cancer. Dr. Paul Sugarbaker, MD. The goal is to bring these surgical oncology principles of peritoneal cavity cancer treatment into treatment of all patients with ovarian cancer. Primary ovarian cancer or recurrent ovarian cancer deserve best surgical treatment. Dr. Anton Titov, MD. аt the moment it is not happening. More patients with ovarian cancer should have better surgical resection of ovarian tumors? Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. No, no, it is not a current standard of care for ovarian cancer. At this point in time only a small number of ovarian cancer patients have this treatment. It is very meticulous surgery to remove all ovarian cancer tumor spread from peritoneum. Some of ovarian cancer patients are older women. Dr. Paul Sugarbaker, MD. They are not so fit. it is not appropriate to put them through 8 hour long surgical procedure. Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Of course, you have to be selective this ovarian cancer patient to take for radical resection of ovarian cancer. It doesn't pay to do a big ovarian cancer operation on someone. Then have them die after surgery. It is not appropriate to do such an extensive surgery (ovarian cancer cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) that they can never recover a reasonable quality of life. you have to be selective, of course. Dr. Anton Titov, MD. But the first step in improving the results of ovarian cancer treatment is this. Surgeon has to use peritonectomy with visceral resection to remove all visible evidence of ovarian cancer disease. My best recommendation for the treatment of patients with ovarian cancer at this point in time is this. It is the meticulous and complete cytoreductive surgery combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Also long-term ovarian cancer intraperitoneal chemotherapy should be added to cytoreductive surgery and HIPEC. We call such ovarian cancer long-term intraperitoneal chemotherapy BANC, Bi-directional Adjuvant Normothermic Chemotherapy. Dr. Paul Sugarbaker, MD. After the best intra-operative treatments the ovarian cancer patient has combined intraperitoneal and systemic chemotherapy usually for six months to treat ovarian cancer. For long-term intraperitoneal chemotherapy of ovarian cancer a combination of medications is used. Usually it is cisplatin, carboplatin and taxol. Taxol is paclitaxel. Paclitaxel is somewhat of a wonder medication in intraperitoneal chemotherapy of ovarian cancer. Paclitaxel (Taxol) is from a pharmacologic perspective the medication that is most likely to be effective in intraperitoneal chemotherapy of ovarian cancer. Paclitaxel (Taxol) remains within the peritoneal space for a long time. Paclitaxel does not have 60 min or 90 min activity while Hyperthermic Intraperitoneal Chemotherapy (HIPEC) takes place in abdomen of ovarian cancer patient. Taxol (paclitaxel) will have a 23 hour out of 24 hours that Paclitaxel remains in the abdominal cavity of ovarian cancer patient. Dr. Anton Titov, MD. Patients with ovarian cancer should really take initiative. Ovarian cancer patients should seek a surgeon who is willing to be more radical in treatment of ovarian cancer. Ovarian cancer patients should look for surgeon who has better skills in radical cytoreductive surgery in ovarian cancer. This may lead to better ovarian cancer treatment results for patients around the world. Dr. Paul Sugarbaker, MD. Renowned Gastrointestinal Cancer Surgeon. Yes. I am convinced that this method will bring better ovarian cancer treatment results. It is cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) followed by long term intraperitoneal chemotherapy. Dr. Paul Sugarbaker, MD. Ovarian cancer patients will often have two ports. One port for administering intravenous chemotherapy. Then another port for administering long-term intraperitoneal chemotherapy to treat ovarian cancer better. Ovarian cancer best treatment options - surgeons must be more aggressive. Dr. Anton Titov, MD. Leading cancer surgeon speaks about frequently inadequate treatment of ovarian cancer.