Surgery for ovarian cancer

Surgery for ovarian cancer is complex. It is recommended that a gynaecological oncologist who is at a hospital that does a lot of these operations (high-volume centre) performs the surgery. To find out more, visit The Australian Society of Gynaecologic Oncologists (ASGO).

Learn more about:

• Overview
• How the surgery is done
• Having a surgical biopsy
• Debulking
• Types of surgery
• What to expect after surgery
• Taking care of yourself at home after surgery

Overview

Surgery allows your gynaecological oncologist to confirm the diagnosis of ovarian cancer and work out how far the cancer has spread. Your gynaecological oncologist will talk to you about the most suitable type of surgery, as well as the risks and side effects. These may include infertility. If having children is important to you, talk to your doctor before surgery and ask for a referral to a fertility specialist.

How the surgery is done

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 vertical cut from around your bellybutton to your pubic line). A laparoscopy may be used to see if a suspicious mass is cancerous; if the cancer is advanced, you will usually have a laparotomy.

Having a surgical biopsy

You may have a biopsy during surgery if you cannot have an image-guided biopsy, or to remove and check a suspicious tumour. The tissue samples are sent to a pathologist, who checks them for signs of cancer. The results will help decide if you need debulking surgery.

Debulking

If cancer is found, the surgeon will remove as much cancer as possible. This is called debulking or cytoreductive surgery. You may also have chemotherapy before or after surgery.

Debulking usually means removing the ovaries, fallopian tubes, uterus and cervix. Depending on how far the cancer has spread, other organs or tissue may also be removed during the same operation.

Omentectomy – The omentum is a sheet of fatty tissue that hangs down in front of the large bowel like an apron. If the cancer has spread to the omentum, it will need to be removed.

Lymphadenectomy – 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 has spread to the bowel, some of the bowel may need to be removed. Rarely, a new opening called a stoma might be created (colostomy or ileostomy).

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 so.

Types of surgery

If ovarian cancer is found, all or some of the reproductive organs will be removed. The type of surgery you have will depend on how certain the gynaecological oncologist is that cancer is present and where the cancer has spread.

	Total hysterectomy and bilateral salpingo-oopherectomy In most cases, surgery for ovarian cancer means removing the uterus and cervix, along with both fallopian tubes and ovaries. Removing the uterus will mean you cannot carry a child.
	Unilateral salpingo-oophorectomy If cancer is found early and it is in one ovary, you may have only one ovary and fallopian tube removed. This is suggested for some young women who still wish to have children.

→ READ MORE: What to expect after surgery