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.
It's best for women with ovarian cancer to be treated by a gynecologic oncologist.
This is a doctor who specializes and is an expert in the diagnosis and treatment of
gynecologic cancers. These include ovarian cancer. Surgery is often needed for an
accurate diagnosis and proper staging of the disease. 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 general health
In some cases, if the cancer was found at an early stage and hasn’t spread, your surgeon
may be able to leave your uterus and one ovary and fallopian tube intact. This is
called fertility-sparing surgery. Then you may be able to get pregnant in the future.
If you have both of your ovaries, fallopian tubes, and uterus 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. That means you
will no longer have menstrual periods. You may have symptoms such as hot flashes soon
You may have more than one 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 have another type of treatment. These may include chemotherapy,
which may be done before or after surgery.
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 disease. To do this, a healthcare provider
checks tissue samples (biopsies) that have been removed during surgery. Your surgeon
may also remove one or more lymph nodes. This is called a lymph node biopsy. Your
healthcare provider checks these samples to see if they contain cancer cells.
Types of surgery used to treat ovarian cancer
Total hysterectomy with bilateral salpingo-oophorectomy
This surgery is the one most often done for ovarian cancer. The following will be
Your surgeon may also remove your omentum. This is a fatty apron of tissue in the
front of your belly (abdomen). It’s attached to your large bowel. It’s a common site
of spread for ovarian cancer. This may be called an omentectomy.
In an oophorectomy, your surgeon takes out one or both of your ovaries. This 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 more than one ovary,
your surgeon may only take out one ovary and one fallopian tube. This is called salpingo-oophorectomy.
This would allow you to get pregnant in the future. Removing both ovaries and both
fallopian tubes is called a bilateral salpingo-oophorectomy. You can no longer become
Lymph node biopsy
Your healthcare provider may remove one or more lymph nodes 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. Cancer
often spreads to them. Your surgeon removes nodes close to the ovaries. He or she
checks them right away for signs of cancer.
During this surgery, your surgeon removes as much of the cancer as possible. This
is also called debulking. Your healthcare provider may suggest this surgery when the
cancer has spread throughout your belly.
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, your colon can be reattached
during this surgery. But you may need a colostomy. A colostomy means that the surgeon
diverts a piece of your bowel through your abdomen. This lets the remaining intestines
heal. Your stool will then drain into a pouch that sticks on the skin of your abdomen.
This is often short-term (temporary). Later on, it may be reversed by another surgery.
You may also need other organs partly or fully removed during a cytoreduction. These
can include your small intestine, appendix, stomach, spleen, bladder, liver, or ureter.
Debulking can also be done after chemotherapy. When chemotherapy is given before surgery,
it is called neoadjuvant chemotherapy. Most people have cytoreductive surgery done
first. This is to remove as much of the tumor as possible. Then chemotherapy is given.
But some people may need another treatment approach. These include people with extensive
disease, older adults, and those with many health issues. They may get neoadjuvant
chemotherapy to shrink the tumor. After that, surgery may be done to remove as much
of the cancer as possible. Then they may get more get chemotherapy later.
Risks of ovarian cancer surgery
All surgery has risks. The risks of ovarian cancer surgery include:
Damage to internal organs
Organs bulging under the incision (incision hernia)
Air in the chest cavity (pneumothorax)
Your risks depend on your overall health, what 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 checkups. Write
down questions you want to ask about surgery. Make sure to ask the following:
What type of surgery you’ll have
What will be done during surgery and which organs will be removed
Will 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 and what they will 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. This is to make
sure you’re not taking medicines 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. You can ask questions about the anesthesia
and how it will affect you. Just before your surgery, an anesthesiologist or a nurse
anesthetist will give you medicine called anesthesia. This is so that you fall asleep
and don’t feel pain.
After your surgery
You may have to stay in the hospital for a few days. This depends on the type of surgery
you had. For the first few days after surgery, you’re likely to have pain from the
incision. Your pain can be controlled with medicine. Talk with your healthcare provider
or nurse about your options for pain relief. Some people don’t want to take pain medicine,
but doing so can help your healing. If you don’t control pain well, for instance,
you may not want to get out of bed, cough, or turn over often. You need to do these
things as you recover from surgery.
You’ll likely have a urinary catheter for a few days. This is a tube put through your
urethra and into your bladder so that your urine goes into a bag outside your body.
In some cases, you may 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. 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 will also talk with you about problems you
should watch for and report to them. They’ll also let you know how to take care of
the incision. Ask them when you can have sex again after your surgery
Your healthcare team will tell you when to see your surgeon again for a checkup and
maybe to have stitches (sutures) or staples removed.
You may need chemotherapy after surgery. Your healthcare provider will talk with you
about this type of treatment. It's often 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 the following:
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.