Can stage 3 ovarian cancer in a 76-year-old woman be successfully treated with surgery and chemotherapy? If a patient refuses any blood transfusions, will this hamper her recovery, or can synthetic blood products be used?

--Gloria

The success of treatment for ovarian cancer depends more on how advanced it is than it does on the age of the patient. In fact, stage for stage, a healthy, nonsmoking 76-year-old with a good attitude would likely do better than an overweight 55-year-old two-pack-a-day smoker.

Ovarian cancer often has no early signs or symptoms and frequently is not diagnosed until it has spread. Stage 3 means the cancer involves one or both ovaries and has spread to the peritoneum (the abdominal and pelvic lining), omentum (the fatty apron of tissue that covers the intestines), or lymph nodes. Ovarian cancer is treated by surgery followed by chemotherapy and/or radiation, depending on the exact type of cancer. Surgery involves removal of the uterus, ovaries, and omentum and sampling of lymph nodes in the abdomen and pelvis. Any obvious spread of cancer on the bowels or peritoneal lining is also removed. This surgery is best done by a gynecologic oncologist, or if one is not available in your area, a regular gynecologist and a general surgeon.

In terms of blood transfusion, yes, sometimes alternative blood "substitutes" may be used, but in the case of massive hemorrhage, they are not as good as the real thing. Refusal of blood transfusion can make a difference in recovery; anemia makes it more difficult to heal, and infection may be more common. If a patient refuses a blood transfusion for religious reasons, as Jehovah's Witnesses do, then that must be respected. However, if one is refusing blood out of fear, then that fear needs to be addressed by the doctor -- today, where I live, the chance of contracting hepatitis from a unit of blood is about one in 5,000 and the risk of HIV is about one in 700,000.