Surgery for ovarian cancer

Surgery for ovarian cancer is usually quite a big operation. The surgeon needs to make sure that as much cancer as possible has been removed. You will be in hospital for 3 to 5 days. And recovering at home afterwards for at least another month or so.

There is more detail about the operation for each stage of ovarian cancer in the section about types of treatment for ovarian cancer. If you are young and have a borderline tumour or a low grade, early stage cancer you may have just the affected ovary and fallopian tube removed. But otherwise if you have stages 1 to 3 ovarian cancer you are most likely to have your ovaries, fallopian tubes and womb removed, including the cervix.  This is called a total abdominal hysterectomy and bilateral salpingo-oophorectomy.  You may hear your doctor call this operation TAH and BSO, for short.  The surgeon will also remove a layer of fatty tissue that is close to the ovaries.  This is called the omentum.  It is important to have it removed as ovarian cancer can spread there.  Removing the omentum is called omentectomy.

Your surgeon may also remove lymph nodes from around the womb and ovaries, in the pelvis, and from your tummy (abdomen). They will send these to the laboratory to see if they contain cancer cells.

If your surgeon finds any cancer elsewhere in your pelvis or abdomen during your operation, they will remove as much as possible. This is sometimes called debulking. The less cancer there is, the easier it is for chemotherapy to kill off any cells left behind.

More extensive surgery

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 on the outside of the tummy (abdomen) for bowel movements to come out into a bag. This opening is called a stoma. Sometimes the stoma is only temporary. The surgeon can do another smaller operation to close it 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.

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. Chemotherapy before surgery is called neo adjuvant chemotherapy (this is pronounced nee-oh-ad-joo-vent).

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.

You may also have interval debulking if you had surgery as your first treatment, before chemotherapy. You have this done if your surgeon couldn't remove enough of the cancer during your first operation. 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.

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 also help to prevent blood clots in your legs. You may also have blood thinning drugs, called anticoagulants, to help prevent blood clots. And you may 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.

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

You may also have one or more fine tubes (wound drains) into your abdomen to drain away fluid and help your wound to heal.

As soon as you are fully awake you will be able to wet your mouth with sips of water. Your nurses will advise you about gradually increasing the amount you drink. When you can drink normally you will be able to start eating light foods. You should be able to eat and drink normally again within a couple of days.

Feeling sick

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 as you won't be able to start eating and drinking. Then you may have a drip up for longer. 

Painkillers

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.

Getting up

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.

Going home

You usually go home about 3 to 5 days after your operation. You will have your stitches or skin staples taken out 7 to 10 days after surgery, often by the nurse at your GP surgery. 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.

It takes time to get over a hysterectomy. It is a big operation. And it can affect you emotionally as well as physically. There is more about recovering from hysterectomy in the section about living with ovarian cancer.