When the disease is limited to one or both ovaries, surgical management may include:

• Bilateral hysterectomy with bilateral salpingo-oophorectomy (BSO): removal of the uterus, both ovaries, and fallopian tubes in order to eliminate all potential sites of disease spread or recurrence within the female reproductive tract.
• Peritoneal staging (e.g., omentectomy): removal of the omentum, an abdominal fatty tissue that may harbor occult metastatic disease.
• Retroperitoneal staging (pelvic and para-aortic lymphadenectomy): removal of lymph nodes in the pelvic and para-aortic regions to assess whether the disease has spread beyond the ovaries.

Surgical access

• Laparotomy: open surgical approach involving a large abdominal incision, allowing direct access to pelvic and abdominal organs.
• Operative laparoscopy: minimally invasive surgical technique performed through small incisions (typically ~5 mm), associated with reduced postoperative pain, shorter hospital stay, and faster recovery.

When the disease extends beyond the ovaries, the diagnostic and therapeutic pathway involves several steps:

• Diagnostic Laparoscopy: performed to directly assess intra-abdominal tumor spread, avoiding reliance solely on radiological imaging. It allows visualization of tumor distribution and enables biopsy sampling for immediate histological examination, supporting intraoperative diagnostic confirmation.
• Cytoreducibility Assessment: evaluation of the feasibility of optimal debulking using scoring systems such as the Predictive Index Value (PIV) or Fagotti score. This determines the likelihood of achieving optimal cytoreduction (complete macroscopic tumor removal or residual disease < 1 cm).
• If the score is favorable, Primary Debulking Surgery (PDS) is performed in the same operative session. Cytoreductive surgery involves removal of all macroscopically visible tumor, including the uterus, ovaries, omentum, and pathologically enlarged lymph nodes, as well as any other involved tissues or organs.
• If the tumor is not considered resectable, targeted biopsies are performed to define the histological, molecular, and genetic profile of the disease. Patients are then started on neoadjuvant chemotherapy to reduce tumor burden. After approximately 3 cycles of chemotherapy, surgery is typically reassessed and scheduled if operability improves.

Cancer patients often require ongoing medical support throughout their treatment journey. When symptoms arise, whether related to the disease itself or to treatment-related side effects, it is important that they can promptly access specialist advice through a dedicated fast-track pathway.

For this reason, the Candiolo Cancer Institute provides a dedicated support service Monday through Friday, from 8:00 a.m. to 5:00 p.m. Patients can contact the Oncology Day Hospital Secretariat at +39 011 993 3775 to request an urgent consultation. Following the request, the patient is promptly contacted by their specialist physician for assessment and guidance.

A cancer diagnosis affects not only physical health but also emotional and psychological well-being. Coping with cancer is often a profoundly challenging experience that can give rise to feelings of anxiety, fear, anger, and depression.

At the Candiolo Cancer Institute, psychological support is an integral part of the care pathway. Alongside advanced medical treatments, patients have access to qualified psycho-oncological support designed to help them navigate the emotional challenges associated with diagnosis, treatment, and recovery.

Patients may also participate in psychological support groups, providing an opportunity to share experiences, receive mutual support, and connect with others who are facing or have faced similar challenges.

To ensure timely support and provide prompt answers to questions or concerns, the Candiolo Cancer Institute offers a dedicated assistance service for all patients.

From Monday through Friday, between 8:00 a.m. and 5:00 p.m., patients can contact the Oncology Day Hospital Secretariat at +39 011 993 3775 to request an urgent consultation.

Patients are promptly connected with their specialist physician, ensuring rapid access to expert advice, clear information, and immediate support when needed.

Cancer patients often have complex needs that extend beyond the treatment of the disease itself and require comprehensive, multidisciplinary care.

At the Candiolo Cancer Institute, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.

The goal is to improve quality of life, promote overall well-being, and provide comprehensive care tailored to each patient’s individual needs.

The Social Work Service at the Candiolo Cancer Institute provides information, guidance, and support to patients and their families regarding access to community services and the welfare and social security benefits available under current legislation.

During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.

The service is available on Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m. and can be contacted at +39 011 993 3059.

Once treatment has been completed, patients enter the follow-up phase, during which regular clinical visits and diagnostic examinations are performed to monitor treatment outcomes, assess any side effects, and evaluate functional recovery.

Follow-up appointments play a crucial role in the early detection of any disease recurrence, allowing timely intervention when necessary. They also provide an important opportunity for patients to discuss concerns, ask questions, and receive ongoing guidance from their specialist physician.

Follow-up visits are scheduled by the patient’s specialist, who evaluates the patient’s overall health status and reviews the results of any required tests and examinations.

Thanks to the large number of liver cancer cases treated each year, the Candiolo Cancer Institute is a national reference center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a personalized approach, tailored to the clinical and individual profile of each patient.

Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.

Advanced laboratory tests, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.

When appropriate, surgeries are performed using minimally invasive, laparoscopic or robotic techniques. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma. Benefits to the patient include shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.

As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), the Candiolo Cancer Institute combines clinical care with a strong focues on scientific research. Patients can be considered for participation in active clinical trials, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.

The Interdisciplinary Care Group (GIC or MDT) supports the patient at every stage: from diagnosis, through treatment, to follow-up. Special attention is paid to nutritional support, psychological health and reintegration into daily life. The organization of checkups, examinations, and treatment is designed to ensure continuity, serenity, and a humane, caring approach to each patient’s needs.