Surgery for ovarian cancer
This page is about surgery for ovarian cancer. You can find the following information
Surgery for ovarian cancer
Surgery for ovarian cancer is usually quite a big operation. The type of surgery you have depends on the stage of your cancer. But you are most likely to have your ovaries, fallopian tubes and womb removed. This is called a total abdominal hysterectomy (TAH) and bilateral salpingo oophorectomy (BSO). The surgeon will also remove a sheet of tissue from inside the abdomen. This tissue is called the omentum, so this part of the operation is called an omentectomy.
If the cancer has spread to other areas of your pelvis or abdomen, your surgeon will remove as much of the cancer as possible. This is called debulking. The less cancer there is after surgery, the easier it is for chemotherapy to kill off any that is left behind.
Interval debulking surgery
You may have some chemotherapy before debulking surgery. The aim is to shrink the cancer so that it is easier to remove it. You have the rest of your chemotherapy once you have recovered from the operation.
After your operation
You usually go home about 3 to 4 days after your operation. Your doctors will contact you when they have the results of your surgery. They may give you these over the phone, or you may come in to the hospital. If you would rather have your results face to face, tell your nurses and doctors before you go home after your operation.
You can view and print the quick guides for all the pages in the treating ovarian cancer section.
Surgery for ovarian cancer is usually quite a big operation. The surgeon (gynaecological oncologist) needs to make sure that they remove as much cancer as possible. You will be in hospital for 3 to 4 days. And recovering at home afterwards for at least another month or so.
Most women with ovarian cancer will have surgery to remove
- Both ovaries and fallopian tubes
- The womb, including the cervix
This operation is called a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO).
If you have a borderline ovarian tumour or a low grade very early stage cancer (stage 1a) you may have just the affected ovary and fallopian tube removed.
During surgery to remove your ovaries and womb, the surgeon will take samples from several areas within the abdomen and pelvis to find out if the cancer has spread. This is so that they can fully stage the cancer. This helps the doctor decide if you need treatment after surgery.
Your surgeon will remove a layer of fatty tissue that is close to the ovaries, called the omentum. This is important as ovarian cancer can spread there. Removing the omentum is called an omentectomy.
Your surgeon will put some sterile fluid inside your abdomen and then remove it. They then send this to the laboratory to see if it contains cancer cells. This is called peritoneal or abdominal washings.
Your surgeon may remove some lymph nodes from around the womb and ovaries, in the pelvis and from your abdomen. They will also take samples of tissue (biopsies) from the lining of your pelvis and abdomen to check for cancer.
If the cancer has spread to other areas in your pelvis or abdomen, your surgeon will aim to remove as much of the cancer as possible. This is called debulking. The less cancer there is after surgery, the easier it is for chemotherapy to kill off any cells left behind. As above, your surgeon may take several samples from within the abdomen and pelvis to check where else the cancer may have spread to. If you have fluid in your abdomen (ascites), they may send a sample to the lab to check for cancer cells.
In some cases surgeons have to remove part of the bowel. They will usually only have to do this if the cancer has spread there and is blocking the bowel. They may have to create an opening (stoma) on the outside of the abdomen for bowel movements to come out into a bag. This is called a colostomy. This is often only temporary. The surgeon can do another smaller operation to close the stoma up again once everything has settled down from your first operation. There is more information about this in the section on treating advanced ovarian cancer. Below is a diagram showing a colostomy with a bag.
If your surgeon thinks it is possible to remove all or most of your cancer, you will have surgery before your chemotherapy. But if it would be difficult for the surgeon to remove enough of the cancer, you may have chemotherapy first. In this case, you have a biopsy of the tumour first to confirm the diagnosis, followed by chemotherapy and then surgery. This is called neo adjuvant chemotherapy (this is pronounced nee-oh-ad-joo-vent) or primary chemotherapy.
The chemotherapy may shrink the tumour so that it is then possible for the surgeon to remove it. You will have the rest of your chemotherapy after the operation. This operation is called interval debulking surgery (IDS).
You may also have IDS if you have already had surgery as your first treatment. You have this done if your surgeon couldn't remove enough of the cancer during your first operation or if it was done by a non specialist surgeon. So in this case, you have surgery first. Then you have some chemotherapy, followed by the second operation to remove the rest of the cancer, followed by more chemotherapy.
Your surgeon will need to be sure you are fit for your operation. You may have had some of these general tests when your cancer was being diagnosed. If so, you won't need to have them again. You will probably have
- A chest X-ray
- Blood tests
- Urine test
- ECG (heart monitor)
You will have an appointment before your operation where you meet the surgical team members and they will arrange any tests that you need. You will usually have these tests done 1 to 3 weeks before your surgery. During this appointment, the surgeon will explain the operation to you and ask you to sign a consent form to say that you agree to have the surgery. The doctor should explain the form fully to you before you sign it.
When you go into hospital for your surgery, your anaesthetist and one of the surgical doctors will come and see you. Your nurse or a physiotherapist will talk to you about the breathing and leg exercises that you will need to do after surgery to prevent chest infections and blood clots in your legs. They will give you a pair of white elastic stockings, called anti thrombotic stockings. These help to prevent blood clots in your legs. You will also have blood thinning drugs, called anticoagulants, to help prevent blood clots. And you will have antibiotics to help prevent infections.
Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.
View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)
If you have not emptied your bowels that day, your nurse may ask you to have suppositories or an enema to clear out your bowel. This helps to avoid constipation after your operation.
Your doctor or nurse will tell you when you need to stop eating or drinking before your operation. This is called being nil by mouth. As a general guide, you may not be able to eat for 6 hours before your operation. You may be allowed to drink water up to 2 hours before.
When you wake up after your operation you will have a few tubes in place. You may have
- A drip (intravenous infusion) into a vein in your arm to give you fluids until you are eating and drinking again
- A tube (catheter) into your bladder to drain your urine
Your nurses will advise you about when you can start drinking and eating again. You should be able to eat and drink normally within a couple of days.
Some people feel sick after a general anaesthetic. Painkillers can also make you feel sick. Do tell your nurse or doctor straight away. They can give you anti sickness medicines. If the medicines aren't working, it can help to change to another drug. Let the staff on the ward know if you feel sick.
You will almost certainly have some pain for the first few days after your operation. But there are many painkilling drugs you can have. If you are in pain it is important you tell the nurse or doctor as soon as possible. With your help, they will be able to find the right type and dose of painkiller for you.
Doctors often give painkillers by epidural after surgery for ovarian cancer. An epidural is a small tube into your back, which anaesthetic is pumped into. There is more information about different types of painkillers in our pain control section.
The nurses and physiotherapist will get you up as soon as possible, maybe even the day of your operation. You should have your painkillers before you have to get out of bed. While you are still in bed, do the breathing and leg exercises you have been taught. This helps to stop chest infections and blood clots.
You usually go home about 3 to 4 days after your operation. Your wound is usually closed with dissolvable stitches and so do not need to be removed. Your doctor will let you know if you do have stitches or staples that need taking out. This is usually about 7 to 10 days after your operation. The nurse at your GP surgery can normally do this for you. Before you leave the ward, your nurse or doctor should tell you if they will phone you with any results or give you an appointment to come back and see them. Do say if you would prefer to have your results in a face to face meeting, rather than over the phone.
If you live alone, or might have difficulty managing when you return home, let the doctors and nurses know during your clinic appointment before your surgery. Then plans can be made to help you cope until you have recovered from the operation.
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