Surgery for ovarian cancer

 

Overview Back to top

Surgery is often the first treatment for cancer of the ovary, and may sometimes also be needed to make the diagnosis. Your doctor will discuss with you the most appropriate type of surgery, depending on the type and size of your cancer and whether it has spread. Sometimes this information only becomes available during the operation itself, and so it’s important to discuss all the possible options with your doctor before the operation.

Borderline and stage 1 ovarian cancer Back to top

If the cancer is in the early stages, surgery may be all the treatment that‘s needed. It‘s usually necessary to make a cut in the skin and muscle of the abdomen (a laparotomy ). The ovaries, fallopian tubes and the womb are then removed. This is called a total abdominal hysterectomy and salpingo-oophorectomy .

In young women with borderline tumours, or low-grade, stage 1a cancer (see staging and grading| ) it may be possible to remove only the affected ovary and fallopian tube, and leave the womb and unaffected ovary. This will mean that you will be able to have children in the future. Women with stage 1b and 1c cancer, or those who have had their menopause, or don’t want any more children, will usually be advised to have both ovaries and the womb removed.

The surgeon may remove a layer of fatty tissue called the omentum, which is close to the ovaries (an omentectomy). They will also take samples from other tissues, such as the lymph nodes, to see if the cancer has spread. The surgeon will also put fluid into your abdomen and send some of it to be tested for cancer cells. This is known as an abdominal washing .

If it is unclear before surgery what stage the cancer is, the surgeon may remove just the affected ovary and fallopian tube and take a number of biopsies and abdominal washings. Depending on the results of the biopsies and washings, further surgery to remove the womb and remaining ovary and fallopian tube - sometimes called completion surgery - may be needed.

Chemotherapy is usually given after surgery if it wasn’t possible to remove all the tumour, or if there is a risk that some cancer cells may have been left behind.

Stage 2 and 3 ovarian cancer Back to top

If ovarian cancer has already spread, an operation to remove both ovaries, the fallopian tubes and the womb (total abdominal hysterectomy and salpingo-oophorectomy), and as much of the tumour as possible will be done. This is known as de-bulking surgery . The surgeon will also take biopsies or remove some of the lymph nodes in the abdomen and pelvis. They may also have to remove the omentum, the appendix and part of the lining of the abdomen (the peritoneum). This operation can be complicated and should ideally be done by a specialist gynaecological oncologist.

If the cancer has spread to the bowel, a small piece of bowel may be removed and the two ends joined together. Rarely the two ends can’t be rejoined and the upper end of the bowel will be brought out onto the skin of the abdomen. This is known as a colostomy and the opening of the bowel is known as a stoma. A bag is worn over the stoma to collect the stool (bowel motions). Your doctor or specialist nurse will discuss this with you.

Chemotherapy is usually given after the operation to try to kill any cancer cells that couldn’t be removed.

Sometimes a second operation will be done after three or four cycles of chemotherapy, as it may now be possible to remove the remaining cancer. This is known as interval de-bulking surgery .

Stage 4 ovarian cancer Back to top

It may be possible to have an operation to remove some of the cancer. However, sometimes surgery isn’t possible if the cancer is very large or has spread (is advanced), or if a woman isn’t well enough for a major operation. Chemotherapy, and occasionally radiotherapy, are the main treatments used for women in this situation.