Adnexal Tumors

Treatment

Surgery may be the only treatment necessary for noncancerous (benign) adnexal tumors. Treatment for cancerous (malignant) adnexal tumors may include chemotherapy, radiation, surgery and/or investigational treatments provided through clinical trials.

Surgery

Surgery to treat benign adnexal tumors differs, based on the tumor's location. Surgeons at Mayo Clinic provide the most recent advances and techniques.

Surgery to treat malignant adnexal tumors is complex. It requires a high level of specialized skill. Studies indicate that women whose surgery is performed by a gynecologic oncologist have significantly higher survival rates than women whose surgery is performed by surgeons with less specialized training. For malignant adnexal tumors, surgical treatment may require the removal of ovaries, the uterus, fallopian tubes, nearby lymph glands and a fold of fatty tissue (omentum), a common site for adnexal cancer to spread. The surgery is known as laparotomy.

When the surgeon cannot remove the entire tumor because of its size or location, surgical debulking (removal of as much of the tumor as possible) will be used. Mayo Clinic patients experience better outcomes than patients at most other medical centers in part because Mayo surgeons are able to achieve "optimal debulking" at significantly higher rates than the national average. Optimal debulking is achieved when less than 1 cubic centimeter of tumor remains in the abdomen after surgery. Research shows that the amount of residual tissue left after surgery is the most important factor for achieving the best long-term outcome. Mayo Clinic has long been known for pioneering the Frozen Section technique, which allows for rapid microscopic analysis of tissue removed from patients. Surgeons can determine in minutes whether tissue is benign or cancerous, dramatically increasing their ability to remove as much of the cancer as possible during the initial surgery.

Mayo Clinic leads the way in demonstrating that aggressive procedures to remove adnexal cancer that has spread to nearby tissue can be done safely and effectively. This may include the removal of tumors that have spread to the liver, spleen and diaphragm.

Minimally invasive surgery (laparoscopic surgery) may be used for some cases of adnexal tumors. Using miniature cameras with microscopes, tiny fiber-optic flashlights and high-definition monitors, Mayo Clinic surgeons can perform surgery through tiny incisions that require only a stitch or two to close. The benefits of this surgery include less trauma to the patient, less blood loss, smaller surgical scars and less need for pain medication. Patients leave the hospital sooner after minimally invasive surgery and return to normal activities sooner than with conventional open surgery.

For some patients, physicians may recommend "second-look" surgery after chemotherapy to determine whether the cancer has returned or spread. Patients who benefit most from second-look surgery are those who had more than 1 cubic centimeter of tumor remaining after their first surgery and who have responded well to chemotherapy.

Chemotherapy

After surgery for malignant adnexal tumors, medical oncologists treat most patients with chemotherapy, which uses powerful drugs and drug combinations to kill cancer cells. Medical oncologists call this adjuvant chemotherapy. There are many types of chemotherapy drugs, including platinum complexes (such as cisplatin and carboplatin), mitotic inhibitors (such as paclitaxel and docetaxel), alkylating agents (such as cyclophosphamide and ifosfamide), antimetabolites (such as methotrexate, gemcitabine, and capecitabine), antitumor antibiotics (such as doxorubicin and liposomal doxorubicin) and DNA topoisomerase inhibitors (such as etoposide, topotecan and irinotecan). Because these medications work differently when used together, they can be more effective against tumors than when used alone.

Mayo Clinic patients have access to new drugs through ongoing clinical trials. Mayo Clinic offers many randomized Phase III clinical trials through its membership in the Gynecologic Oncology Group, North Central Cancer Treatment Group, Eastern Cooperative Oncology Group, Children's Cancer Study Group and National Cancer Institute Phase I and Phase II Clinical Trials Programs. Patients also may access trials available only at Mayo Clinic.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. The use of radiation therapy to treat adnexal cancer has declined in recent years, in part because of improvements in chemotherapy, but radiation therapy may still have a role for some patients. For example, radiation therapy may be considered for women who can't tolerate chemotherapy. Radiation oncologists sometimes use whole abdominal radiation to treat tumors that remain localized in the abdomen, especially for recurrent cases of cancer. Mayo Clinic is one of a few medical centers that offers this treatment.