Surgery for ovarian cancer

You will be given a general anaesthetic and will have either a laparoscopy (with 3–4 small cuts in your abdomen) or a laparotomy (with a long, vertical cut from your bellybutton to your bikini line). The type of surgery you have will depend on how certain the gynaecological oncologist is that cancer is present and how far they think the cancer has spread. A laparoscopy may be used to see if a suspicious mass is cancerous; however, most women with advanced cancer will have a laparotomy.

The gynaecological oncologist will look inside your pelvis and abdomen for signs of cancer, and take tissue and fluid samples (biopsy). During the operation, the samples are usually sent to a specialist called a pathologist, who immediately examines them for signs of cancer. This is called a frozen section analysis or biopsy.

If cancer is present, the gynaecological oncologist will continue the operation and remove as much of the cancer as possible. This is called surgical debulking.

All tissue and fluids removed during surgery are examined for cancer cells by a pathologist. The results will help confirm the type of ovarian cancer you have, if it has spread (metastasised), and its stage. It may not be possible to remove all the cancerous tissue. Surgery is often followed by chemotherapy, which will shrink or destroy any remaining cancer cells.

Depending on how far the cancer has spread, you may have one or more of the procedures listed below. 

Total hysterectomy and bilateral salpingo-oophorectomy

Most women with ovarian cancer will have an operation to remove the uterus and cervix, along with both fallopian tubes and ovaries.

Unilateral salpingo-oophorectomy

If the cancer is found early and it is only in one ovary, some young women who still wish to have children may have only one ovary and fallopian tube removed.

Omentectomy

The omentum is a sheet of fatty tissue attached to the stomach and bowel. It hangs down in front of the intestines. Ovarian cancer often spreads to the omentum and it may need to be removed.

Lymphadenectomy

The pelvis contains large groups of lymph nodes. Cancer cells can spread from your ovaries to nearby lymph nodes. Your doctor may suggest removing some in a lymphadenectomy (also called lymph node dissection).

Colectomy

If cancer spreads to the bowel, some of the bowel may be removed. A new opening called a stoma may be created (colostomy or ileostomy). This is usually temporary. See Bowel changes for more details.

Removal of other organs

Ovarian cancer can spread to many organs in the abdomen. In some cases, parts of the liver, diaphragm, bladder and spleen may be removed if it is safe to do.

When you wake up from surgery, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be taken back to your bed on the hospital ward.

Tubes and drips – You will have several tubes in place, which will be removed as you recover:

• a drip inserted into a vein in your arm (intravenous drip) will give you fluid, medicines and pain relief
• a small plastic tube (catheter) may be inserted into your bladder to collect urine in a bag
• a tube may be inserted down your nose into your stomach (nasogastric tube) to drain stomach fluid and prevent vomiting
• tubes may be inserted in your abdomen to drain fluid from the site of the operation.

Pain – After an operation, it is common to feel some pain, but this can be controlled. For the first day or two, you may be given pain medicine through a drip or via a local anaesthetic injection into the abdomen (a transverse abdominis plane or TAP block) or spine (an epidural). Some patients have a patient-controlled analgesia (PCA) system. This machine allows you to self-administer a measured dose of pain relief by pressing a button. Let your doctor or nurse know if you are in pain so they can adjust the medicine. Managing your pain will help you to recover and move around more quickly.

Injections – It is common to have daily injections of a blood thinner to reduce the risk of blood clots. These injections may continue for some time after the operation and while you’re having chemotherapy. A nurse will show you how to give this injection to yourself before you leave hospital.

Compression devices and stockings – Some women have to use compression devices or wear elastic stockings to keep the blood in their legs circulating. Once you are moving around, compression devices will be removed so you can get out of bed, but you may still wear the stockings for a couple of weeks.

Wound care – You can expect some light vaginal bleeding after the surgery, which should stop within two weeks. Your doctor will talk to you about how to keep the wound clean once you go home to prevent it becoming infected.

Length of stay – You will probably stay in hospital for 4–7 days for a big operation, less for a laparoscopy or smaller operation.

Your recovery time will depend on the type of surgery you had, your general health, and your support at home. Most women are able to fully return to their usual activities after 4–8 weeks.

Rest
Take things easy and do only what is comfortable. You may like to try meditation or some relaxation techniques to reduce tension.

Work

Depending on the nature of your work, you will probably need 4– 6 weeks leave from work.

Lifting

Avoid heavy lifting (more than 3–4 kg), hanging out the washing, or vacuuming for at least six weeks. Use a clothes horse or dryer instead of hanging the washing on a line. If you have a partner or children, ask them to help around the house. You can also check with a social worker if it’s possible to get help at home.

Driving

You will most likely need to avoid driving for a few weeks after the surgery. Check with your car insurer for any conditions regarding major surgery and driving.

Bowel problems

You may have constipation following the surgery. It is important to avoid straining when passing a bowel motion, so you may need to take laxatives. See Bowel changes for more details.

Nutrition

To help your body recover from surgery, focus on eating a balanced diet (including proteins such as lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds and legumes/beans). See Nutrition and cancer for more information.

Sex

Sexual intercourse should be avoided for about six weeks after the operation to give your wounds time to heal. Ask your doctor when you can resume sexual intercourse and explore other ways you and your partner can be intimate, such as massage. 

Exercise

Your health care team will probably encourage you to start walking the day after the surgery. Exercise has been shown to help people manage some of the common side effects of treatment, speed up a return to usual activities and improve overall quality of life. Start with a short walk and go a little further each day. Speak to your doctor if you would like to try more vigorous exercise. See Exercise during cancer treatment for more information.

Bathing

Take showers instead of baths, and avoid swimming for 4– 6 weeks after surgery.

Your doctor should have all the test results within two weeks of surgery. Further treatment will depend on the type of ovarian cancer, the stage of the disease and the amount of any remaining cancer. If the cancer is advanced, it’s more likely to come back, so surgery will usually be followed by chemotherapy, and occasionally by targeted therapy. Radiation therapy is not often recommended.

Watch this short video to learn more about surgery.