What comes first, surgery or chemotherapy?

My wife, 30yrs old, was diagnosed with stage IV squamous cell carcinoma.  It seems to have started in the right ovary, spread to the uterus, and little to the left ovary (one mass on the uterus had the size of 6*7cm).  At least 10 nodules in the liver (biggest nodule is about 2.5 cm) and over 100 nodules in the lungs.  8 months ago, she had a laparascopy of an endometriosis on the left ovary and she did a CA125 test (= 34.6), after that she did 2 IVF cycles.  One month ago, after her unsuccessful 2nd IVF cycle, she had severe abdominal pain for 2 weeks, so admitted to the ER, performed a CT scan for the pelvis, and the nodules were visible on the ovaries, uterus, liver, and lower segments of the lungs.  A surgery was decided for the next day before consulting an oncologist.  She went for a full clean up surgery! and now on Cisplatin-taxol/3 weeks and Erbitux 400-700mg/week.
My question is should her Dr have started her on chemotherapy before operating or was the surgery before chemotherapy a wise decision?
What shall we expect?

[Annekathryn Goodman, M.D.]

Hi  There,
it sounds like your wife has been managed very well

For complex gynecologic cancer conditions, an opinion at a major cancer center is appropriate.
if your wife is being seen at a major cancer center,
write down your questions and go over them in detail with her oncologist

if your wife is being cared for by a community medical oncologist, she is getting great care but a one time consultation can be very helpful to answer your questions

it also sounds like you would benefit from chemotherapy teaching. Usually there is a nurse or nurse practitioner in the group who will sit with you and comprehensively review the chemo drugs, the side effects, and how  to mange the side effects. this is usually a good hour teaching session.They usually have handouts and teaching materials for you to read.

Alos be sure to get copies of all her reports. She should keep her own records of tests,operations, pathology reports

best wishes