Surgery for ovarian cancer

Surgery is the most common treatment for ovarian cancer. The type of surgery you have depends mainly on the type of the tumour and stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age, overall heath and whether you want to get pregnant in the future.

Surgery may be done for different reasons. You may have surgery to:

• accurately diagnose and stage the disease
• completely remove the tumour
• remove as much of the cancer as possible (called surgical debulking) before other treatments
• reduce pain or ease symptoms (called palliative surgery)

The following types of surgery are used to treat ovarian cancer. You may also have other treatments before or after surgery.

Ovarian cancer is staged during surgery and treated at the same time. All of the tissue and fluid samples that are removed are sent to the lab to be checked for cancer cells. Some people who appear to have early stage disease (stage 1) based on diagnostic tests are assigned a higher stage (stage 2 or 3) after their samples have been analyzed in the lab.

Surgical staging includes:

• washing the abdominal cavity to see if there are cancer cells or removing ascites (an abnormal buildup of fluid in the abdomen) for examination to see if there are cancer cells
• examining all surfaces in the pelvis and abdomen
• scraping the surfaces of the diaphragm to check for cancer cells
• biopsy of any areas that look like cancer and from all areas inside the abdomen and pelvis
• removing some lymph nodes in the pelvis and abdomen
• removing most or all of the omentum (the fatty tissue that covers the abdominal organs)
• examining or removing the ovary that doesn’t contain cancer

If the other ovary appears normal, the surgeon will leave it alone if you wish to get pregnant in the future. But if it looks abnormally large, the surgeon will recommend removing it to rule out any cancer spread.

A total hysterectomy and bilateral salpingo-oophorectomy is the most common surgical procedure used to treat ovarian cancer. This surgery removes the uterus, both ovaries and both fallopian tubes.

Find out more about a hysterectomy.

A salpingo-oophorectomy removes the ovary and fallopian tube. Salpingo-oophorectomy may be bilateral (the ovaries and fallopian tubes on both sides are removed) or unilateral (only one ovary and one fallopian tube on one side are removed).

A cystectomy may be done for some types of early stage ovarian cancers if you want to get pregnant in the future. A cystectomy removes only the cyst that contains the tumour and leaves the remaining ovary intact.

Surgical debulking removes as much of the cancer as possible. It is also called tumour debulking. Ovarian cancer spreads by seeding cancer cells throughout the abdomen and pelvis. Removing these cancerous areas can happen at different times.

Primary surgical debulking (also called cytoreductive surgery) removes as much of the ovarian cancer as possible during the first surgery to treat it. The goal is to leave as little of the tumour behind as possible after surgery (ideally less than 1 cm in size). Primary surgical debulking may include removing:

• the uterus, ovaries and fallopian tubes (called total hysterectomy and bilateral salpingo-oophorectomy)
• the omentum
• small tumours from the surface of the diaphragm
• part of the diaphragm
• part of the stomach, spleen or pancreas
• the gallbladder
• part of the large intestine or small intestine (called a bowel resection), bladder or liver
• lymph nodes in the pelvis and abdomen

During this surgery the surgeon may also place a port in the abdominal wall so that chemotherapy drugs can be given directly into the abdominal cavity (called intraperitoneal or IP chemotherapy).

Interval debulking surgery may be done after several cycles (usually 3 or 4) of successful chemotherapy. If chemotherapy shrinks the tumours, this can make it safer and easier for the surgeon to remove them. You may be offered interval surgical debulking if primary debulking surgery did not remove all or enough of the cancer.

Some surgical procedures may be done to reduce symptoms and relieve pain from ovarian cancer that has spread:

• paracentesis to remove fluid from the abdomen
• thoracentesis to remove fluid from around the lungs
• placing a feeding tube into the stomach or intestines
• placing a tube (stent) in the large or small intestine or ureter to relieve a blockage caused by a tumour

Side effects can happen with any type of treatment for ovarian cancer, but everyone’s experience is different. Some women have many side effects. Other women have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery and your overall health.

Surgery for ovarian cancer may cause these side effects:

• bleeding and the need for blood transfusion
• bladder problems
• lymphedema
• fertility problems
• treatment-induced menopause
• blood clots
• wound or blood infection
• bowel obstruction

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.