Ovarian Cancer: Surgery
Surgery is a common part of ovarian cancer treatment. It's used to take out as much
of the cancer as possible. There are many different types of surgery that can be done.
It's best for women with ovarian cancer to be treated by a gynecologic oncologist.
This is a doctor who specializes in the diagnosis and treatment of gynecologic cancers,
such as ovarian cancer.
Surgery can also be used to diagnose and stage ovarian cancer. The type of surgery
you have depends on these factors:
The type of ovarian cancer you have
Whether the cancer is just in your ovary or has spread
If you plan to become pregnant in the future
Your overall health
In some cases, if the cancer is found when it's small and hasn’t spread (early stage),
your surgeon may be able to leave your uterus and 1 ovary and fallopian tube intact.
This might be called fertility-sparing surgery. You may be able to get pregnant in
If you have both of your ovaries and fallopian tubes, and your uterus and cervix removed,
you can no longer become pregnant. This surgery is called a hysterectomy with bilateral
salpingo-oophorectomy. You’ll enter sudden menopause, if you have not already reached
it. This means you'll no longer have menstrual periods. You may have symptoms like
hot flashes soon after surgery.
You may have more than 1 type of surgery. These may be done as part of the same procedure
or as separate procedures. Depending on the type and stage of your cancer, you may
or may not need more treatment, like chemotherapy, later.
No matter what type of surgery you have, it’s important for the cancer to be surgically
staged. This is done to tell the extent of the cancer – how big it is and if/where
it has spread. To do this, a healthcare provider checks tissue samples (biopsies)
that removed during surgery. Your surgeon may also remove 1 or more lymph nodes. This
is called a lymph node biopsy. These, too, are checked to see if they contain cancer
Types of surgery used to treat ovarian cancer
Total hysterectomy with bilateral salpingo-oophorectomy
This surgery is the 1 most commonly done to treat ovarian cancer. These tissues are
Both of your ovaries
Both of your fallopian tubes
Your cervix. This is the narrow end of the uterus that connects it to your vagina.
If the cervix isn't removed, it's called a partial hysterectomy. If it's removed, it's a total hysterectomy.
Your surgeon may also remove your omentum. This is a fatty apron of tissue in the
front of your belly (abdomen). Ovarian cancer often spreads to it. This surgery may
be called an omentectomy.
In an oophorectomy, your surgeon takes out 1 or both of your ovaries. It depends on
how likely it is that the cancer will spread. It may also depend on if you want to
become pregnant in the future.
If the cancer has not spread to both ovaries, your surgeon may only take out 1 ovary
and 1 fallopian tube. This is called unilateral salpingo-oophorectomy. It allows you to get pregnant in the future. Removing both ovaries and both fallopian
tubes is called a bilateral salpingo-oophorectomy. You cannot become pregnant after this surgery.
Lymph node biopsy
One or more lymph nodes may be removed at the same time as a salpingo-oophorectomy.
This may be done with or without a hysterectomy. These small glands are part of your
immune system. They help your body fight infections. The body has many lymph nodes,
so removing these nodes as part of the treatment for ovarian cancer has little effect
on your immune system. Cancer often spreads to nearby lymph nodes. Those close to
the ovaries are taken out and checked right away for signs of cancer.
During this surgery, your surgeon removes as much of the cancer as possible. This
is also called debulking. This surgery may be done if the cancer has spread throughout
If you have this surgery and cancer has spread to your colon, you may need to have
part of your colon removed as well. Most of the time, the ends of your colon can be
reattached. But you may need a colostomy. A colostomy means that the surgeon attaches
a piece of your bowel to a hole (stoma) in your abdomen. Your stool will then drain
into a pouch that sticks on the skin of your abdomen. This is done to let the reattached
intestines heal. Later on, another surgery can be done to reverse it.
Sometimes other organs need to be partly or fully removed during cytoreduction. These
can include your small intestine, appendix, stomach, spleen, bladder, liver, or ureter.
Your surgeon will talk with you about this and how it might affect the way your body
Most women have cytoreductive surgery done first to remove as much of the tumor as
possible. Then they get chemotherapy. But debulking can also be done after chemotherapy.
When chemotherapy is given before surgery, it's called neoadjuvant chemotherapy . This might be done for women with a lot of cancer, tumors that would be hard to
remove, older women, and those with other health issues. Neoadjuvant chemotherapy
is used to shrink the tumor. After that, surgery may be done to remove as much of
the cancer as possible. Then more chemotherapy might be given later.
Risks of ovarian cancer surgery
All surgery has risks. The risks of ovarian cancer surgery may include:
Damage to internal organs
Organs bulging under the incision (incision hernia)
Air in the chest cavity (pneumothorax)
Damage to nerves
Your risks depend on your overall health, the type of surgery you need, and other
factors. Talk with your healthcare provider about which risks apply most to you.
Getting ready for surgery
Your healthcare team will talk with you about the surgery options that are best for
you. You may want to bring a family member or close friend with you to your visits.
Write down questions you want to ask about surgery. Be sure to ask:
What type of surgery you’ll have
What will be done during surgery and which organs will be removed
If there be changes in how your body works
The risks and side effects of the surgery
If you’ll be able to get pregnant after surgery
If you’ll go into menopause after surgery
When you can return to your normal activities
If the surgery will leave scars, where they'll be, and what they'll look like
Before surgery, tell your healthcare team if you’re taking any medicines. This includes
over-the-counter medicines, vitamins, herbs, and other supplements. It also includes
marijuana or street drugs. This is to make sure you’re not taking anything that could
affect the surgery. After you’ve talked about all the details with the surgeon, you’ll
sign a consent form that says that the healthcare provider can do the surgery.
You’ll also meet the anesthesiologist or nurse anesthetist. You can ask questions
about the anesthesia and how it will affect you. Anesthesia is the medicine you'll
be given just before surgery. They put you into a deep sleep and don’t feel pain.
After your surgery
You may have to stay in the hospital for a few days. It depends on the type of surgery
you had. For the first few days after surgery, the incision may cause pain. Your pain
can be controlled with medicine. Talk with your healthcare provider or nurse about
your options for pain relief. Some people don’t like to take pain medicine, but doing
so can help your healing. If you don’t control pain well, you may not want to get
out of bed, cough, or turn over often. You need to do these things to recover from
You’ll likely have a urinary catheter for a few days. This is a soft, thin tube put
through your urethra and into your bladder. It drains your urine into a bag outside
your body. Some women go home with the catheter still in.
You may have trouble moving your bowels. Talk with your healthcare provider, nurse,
or a dietitian about what you can eat to reduce the chance of constipation. It can
be caused by some pain medicines, from not moving much, or from not eating much. Talk
with your healthcare provider or nurse about getting more dietary fiber or using a
You may feel tired or weak for a while. This is normal. The amount of time it takes
to recover from surgery is different for each person.
Recovering at home
When you get home, you may get back to light activity. But don't do any strenuous
activity for at least 6 weeks. Your healthcare team will tell you what kinds of activities
are safe for you while you recover. They'll also talk with you about problems you
should watch for and when to call them. They’ll teach you how to take care of the
incision and the urine bag (if you still have it). Ask them when you can have sex
again after your surgery. It's very important to follow your surgeon's instructions
regarding activity and sex to help reduce your risk of complications.
Your healthcare team will tell you when to see your surgeon again for a checkup and
maybe to have stitches (sutures) or staples or the urine catheter removed.
You may need chemotherapy after surgery. Your healthcare provider will talk with you
about this. It's not started until your body has had time to heal from the surgery.
When to call your healthcare provider
Let your healthcare provider know right away if you have any problems after surgery.
These can include:
Redness, swelling, or fluid leaking from the incision
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Constipation or diarrhea
Trouble passing urine or changes in how your urine looks or smells
Nausea or vomiting
Rapid, irregular heartbeat
New chest pain
Trouble breathing or shortness of breath
Pain, redness, swelling, or warmth in an arm or leg
Know what problems to watch for and when you need to call your healthcare providers.
Ask who you should call and what number you should use. Know how to get help anytime,
including after office hours and on weekends and holidays.