Surgery for ovarian cancer is the primary treatment and diagnostic tool for most ovarian cancers. The goal is to see how far your cancer has spread and to remove as much of the tumour as possible.
The type of operation you'll have depends on the stage of your cancer and your health. Usually, the surgeon will remove your uterus, ovaries, and both fallopian tubes. They may also need to remove other tissue in your abdomen if cancer has spread. Your surgeon will do the procedure to give you the best result with the fewest side effects.
Who is a candidate for surgery for ovarian cancer
Surgery is often the initial treatment of choice for ovarian cancer, provided patients are medically fit. Patients who are not candidates for optimal debulking should be considered for neoadjuvant chemotherapy followed by interval debulking surgery and further chemotherapy. Patients who are not suitable for surgery may be given chemotherapy and evaluated for surgery later or treated primarily with chemotherapy.
Surgery aims to confirm the diagnosis, define the extent of the disease, and resect all visible tumours.
Preparation for surgery for ovarian cancer
A week or two before surgery, your doctor will do some tests to ensure you are healthy enough for the procedure. These might include:
- Blood and urine tests
- Chest X-ray of your heart and lungs
- Electrocardiogram (EKG or ECG) to check your baseline heart rhythm
Ask your doctor if you need to stop taking any medicines, supplements, or herbal products before your surgery. The doctor will tell you not to eat or drink anything after midnight on the night before your procedure.
Types of Surgery
The type of operation you have depends on where the cancer has spread to.
Most women have surgery to remove their wombs, ovaries, and fallopian tubes. During the operation, the surgeon examines the inside of your abdomen and your abdominal organs. This is to check for signs of cancer.
The surgeon aims to remove as much cancer as possible if it has spread to other areas in your pelvis or abdomen.
Your ovarian cancer surgical oncology team will discuss the recommended approach for you, which may include the following:
- A partial hysterectomy removes the upper part of your uterus.
- A total hysterectomy removes both your uterus and cervix.
- Bilateral salpingo-oophorectomy (BSO) removes your ovaries and both fallopian tubes.
- Unilateral salpingo-oophorectomy removes just one ovary and one fallopian tube.
- Omentectomy eliminates the layer of tissue that covers your stomach and large intestine.
- Lymph node dissection removes some lymph nodes in your pelvis and abdomen.
Staging ovarian cancer through surgery
The first goal of ovarian cancer surgery is to stage cancer. This means to see how far cancer has spread from the ovary. Usually, it involves removing the uterus (this operation is called a hysterectomy), along with both ovaries and fallopian tubes (this is called a bilateral salpingo-oophorectomy or BSO). In addition, the omentum is also removed (an omentectomy). The omentum is a layer of fatty tissue that covers the abdominal contents like an apron, and ovarian cancer sometimes spreads to this area. Some lymph nodes in the pelvis and abdomen might also be biopsied (taken out to see if cancer has spread from the ovary).
The surgeon may "wash" the abdominal cavity with salt water (saline) and send that fluid to the lab for testing. They may also take biopsies from different areas inside the abdomen and pelvis.
Surgery for ovarian cancer based on cancer stage
Mainly, there are some cancer stages;
Surgery for early-stage ovarian cancer
Early-stage ovarian cancer means cancer has not spread beyond your ovaries (stage 1).
In this case, you have surgery to remove your ovaries, fallopian tubes, cervix, and womb.
During surgery, the surgeon examines you closely to see if the cancer has spread. This helps them to fully stage cancer and decide if they need treatment after surgery.
To find out if your cancer has spread, the surgeon:
- Takes samples of tissue (biopsies) from several areas within the abdomen and pelvis
- Might remove some lymph nodes from around the womb and ovaries, in the pelvis, and from your abdomen
Surgery for advanced ovarian cancer
Advanced cancer means your cancer has spread away from the ovary (stages 2, 3, and 4).
In this case, you have to undergo surgery to remove your ovaries, fallopian tubes, womb, and cervix. Your surgeon aims to remove as much cancer as possible if it has spread to other areas in your pelvis or abdomen through 'debulking'.
You have chemotherapy after the debulking surgery. The less cancer there is after surgery, the easier it is for chemotherapy to kill the remaining cancer cells.
You might have chemotherapy before and after surgery, through interval debulking surgery.
Debulking surgery for ovarian cancer
Debulking is the surgical removal of as much of a tumour as possible. It may increase the chance that chemotherapy or radiation therapy will kill all the tumour cells. It relieves symptoms or helps the patient live longer. They are also called tumour debulking.
Debulking is very important when ovarian cancer has already spread throughout the abdomen (belly) during surgery. Debulking surgery aims to leave behind no visible cancer or no tumours larger than 1 cm (less than 1/2 an inch). Then, the tumour is optimally debulked.
It is a standard treatment procedure for ovarian cancer. The goal of debulking is to remove as much cancerous tissue in the patient's abdomen as possible, leaving behind no tumour nodules that measure more than 1 centimetre in diameter.
Getting pregnant after surgery for ovarian cancer
If your ovarian cancer is diagnosed in its early stages or if you have a type of ovarian cancer called a germ cell tumour, you may need to have only one ovary removed and preserve your uterus. You may still be able to get pregnant. Surgery to remove tumours near your reproductive organs may cause scarring that blocks eggs from moving into your ovaries for fertilization.
Some chemotherapy drugs can cause your ovaries to stop making estrogen or releasing eggs.
Frequently Asked Questions (FAQ)
To prepare for ovary removal, your doctor may ask that you:
- Stop eating a certain number of hours before your surgery and limit liquids.
- Stop taking certain medications.
- Undergo imaging tests, such as ultrasound and blood tests, to help surgeons plan for the procedure.