Surgery for ovarian cancer
Surgery is one of the main treatments 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 the cancer and whether it has spread. Sometimes this information only becomes available during the operation itself, so it’s important to discuss all the possible options with your doctor and/or specialist nurse before the operation.
Surgery for ovarian cancer can be complicated and should be done by a specialist gynaecological oncologist.
Surgery to remove the ovaries and womb
The aim of this operation is to remove all of the cancer.
It involves removing:
the ovaries and fallopian tubes (called a bilateral salpingo-oophorectomy
the womb and cervix (called a total abdominal hysterectomy or TAH)
the omentum, which is the fatty layer that covers the bowel (called an omentectomy).
During the operation the surgeon takes biopsies from other tissues and may also remove some of the lymph nodes in the abdomen and pelvis. This is done to check whether the cancer has spread. The surgeon will also put fluid into the abdomen, then remove the fluid and send it to be checked for cancer cells. This is known as an abdominal or peritoneal washing.
When cancer has spread to other areas in the pelvis or abdomen, the aim of surgery is to try to remove as much of the cancer as possible. This is called debulking.
If scan results show that the cancer has spread, debulking surgery is planned in advance. Or sometimes the surgeon may be operating to remove the ovaries and womb when they find that the cancer has spread. In this situation they will carry out debulking surgery as well.
Some women need to have some of their bowel removed as part of debulking. This may be done if cancer has begun to grow on the outside of the bowel. If possible, the surgeon removes the affected piece of bowel and rejoins the two remaining pieces of bowel together.
Rarely, the two ends of bowel can’t be rejoined, and the upper end of the bowel is brought out onto the skin of the abdomen to form a stoma. A bag is then worn over the stoma to collect stools (bowel motions). If part of the small bowel is brought out on to the abdomen, it’s called an ileostomy. If part of the large bowel (colon) is brought out onto the abdomen, it’s called a colostomy.
If you’re likely to need bowel surgery, your doctor or specialist nurse will discuss this with you before the operation.
Some women who want to preserve their ability to have children may be able to have an operation to remove just the affected ovary and fallopian tube. This means that after the operation they’ll still have a womb and one ovary, so may be able to become pregnant and have children in future. This type of operation is usually only suitable for women who have a borderline tumour or a low-grade ovarian cancer at stage 1a.
After removing the ovary and fallopian tube, the surgeon checks the other ovary and may take a sample from it. They’ll also remove lymph nodes and take a number of washings and samples (biopsies) from the pelvis and abdomen. This is done to make sure that there’s no sign the cancer has spread.
Sometimes the results of the washings and biopsies show that the cancer has spread beyond the ovary. Unfortunately in this situation a second operation is needed to remove the womb, omentum and remaining ovary and fallopian tube.
If you smoke, try to give up or cut down before your operation.
This will help reduce your risk of chest problems, such as a chest infection, and will help your wound heal after the operation. Your GP can give you advice, and you may find it helpful to read our leaflet Giving up smoking.
You’ll meet a member of the surgical team and a specialist nurse to discuss the operation. This may be at a pre-assessment clinic before you’re admitted for your operation. Make sure you ask any questions or talk over any concerns you have about the operation. If you think you may need help when you go home after your surgery, for example because you live alone or are a carer for someone else, bring this up as soon as possible.
This will help the staff make arrangements in plenty of time.
You may have tests to check you’re fit for the operation, such as:
a chest x-ray
a urine test
an ECG (a recording of your heart).
You’ll usually be admitted to hospital on the morning of the operation. You’ll meet a member of the surgical team and nursing team. You’ll also meet the doctor who’ll give you your anaesthetic (the anaesthetist). They’ll be able to answer any questions you have about the anaesthetic and pain control after the operation.
You’ll be given elastic stockings (TED stockings) to wear during and after the operation, to prevent blood clots in your legs.
Some hospitals follow an enhanced recovery programme, which aims to reduce the time you spend in hospital and to speed up your recovery. It also involves you more in your care. For example, you’ll be given information about diet and exercise before surgery, and any arrangements needed for you to go home will be put in place for you. Your doctor will tell you if an enhanced recovery programme is suitable for you and if it’s available – not all hospitals follow this.
You’ll be encouraged to start moving about as soon as possible. You’ll usually be helped to get out of bed the day after your operation. While you’re in bed, it’s important to move your legs regularly and do deep breathing exercises to help prevent chest infections and blood clots. You’ll be shown how to do the exercises by a physiotherapist.
Back on the ward
To begin with you’ll be given fluids into a vein in your hand or arm, called a drip or an intravenous infusion. Once you’re eating and drinking normally again, it’s taken out. You’ll usually have a tube (catheter) put in during the operation, to drain urine from your bladder. This will be taken out once you’re eating and drinking normally and are able to walk to the toilet.
The wound is usually covered with a dressing for the first few days. Unless you’re having an operation to remove just one ovary and fallopian tube, you’ll have a wound that extends from your bikini line to just above your belly button. The skin is closed with staples or stitches. A nurse will take these out after about seven days. Sometimes dissolving stitches are used and these don’t need to be taken out.
You’ll have some pain and discomfort after your operation, which will be controlled with painkillers. If you’re in pain or feel sick, let the nurses know. They can give you medicines to relieve sickness and adjust your dose or type of painkiller to suit you.
To start with you may be given painkillers through a pump attached to a fine tube (cannula) in a vein in your hand or arm.
This is called patient-controlled analgesia (PCA), because you can give yourself an extra dose of painkiller when you need it by pressing a button. The machine is set so you get a safe dose and can’t have too much.
Alternatively, you may have an epidural – a fine tube in your back that gives a continuous dose of anaesthetic. This stops you feeling pain in your tummy and pelvic area without making you drowsy.
Wind and constipation
Some women have difficulty opening their bowels or have uncomfortable wind for a few days after the operation.
Tell the nurses if you have this. They can give you medicines to relieve discomfort and constipation. Constipation and wind usually get better once you’re up and moving around more.
Drinking plenty of fluids and eating high-fibre foods can also help ease constipation.
How long you’re in hospital for will depend on the type of operation you have and the speed of your recovery. Most women are able to go home 3–10 days after their operation. Before you leave hospital you will be given an appointment to attend an outpatient clinic for your post-operative check-up. This is a good time to discuss any problems you may have. If you have any problems or worries before your appointment, phone your ward nurses or hospital doctor.
You’ll still be recovering for some time after you go home and will need to take things easy for several weeks. It can take three months or more to fully recover, and longer if you’re having chemotherapy as well.
Your energy levels and what you can do will improve with time.
Build up your activity gradually. It’s fine to do gentle activities like making cups of tea or doing the washing-up to begin with.
But avoid more strenuous activities like vacuuming, lifting heavy weights or jogging for at least the first six weeks after you go home. Your physiotherapist or specialist nurse will give you advice about this.
Keeping active will help you build up your energy. Taking regular walks is a good way of doing this. You can gradually increase the amount you do as you feel better.
How soon you can drive will depend on the extent of the surgery you’ve had and how quickly you recover. You’ll need to feel comfortable wearing a seatbelt and be able to carry out an emergency stop if necessary. Some insurance policies give specific time limits, so it’s a good idea to contact your insurance company to check you’re covered before driving again.
You may not feel physically or emotionally ready to start having sex again for a while. Most women are advised to wait until at least six weeks after the operation. It may take longer than this for your energy levels and sex drive to return.
If you have any worries or concerns, you can discuss them with your specialist nurse. You can also call the Macmillan Support Line for free or you may find it helpful to use our search tool to find other support organisations.
One common fear is that cancer can be passed on to your partner during intercourse. This is not true and it’s perfectly safe for you to continue to have a sexual relationship.
If you were still having periods before your operation, having your ovaries removed will bring on an early menopause. This may cause physical changes such as:
reduced sex drive.
Some women may be prescribed hormone replacement therapy (HRT) following treatment for ovarian cancer. This can help reduce some of the problems caused by the menopause. You can discuss with your doctor whether taking HRT would be helpful.
If you have vaginal dryness, creams and lubricants such as Replens®, Aquagel®, Sylk® and Vielle® can ease discomfort during intercourse. You can get them on prescription from your doctor, or they can be bought from most pharmacies.
There’s also an organic lubricant (Yes®) available. You can order this online.
After your ovaries and womb have been removed you’ll no longer be able to have children. If this is a concern for you, it’s important to discuss it with your cancer specialist before your treatment starts. Some women with low grade, early-stage cancer may be able to have fertility-conserving surgery (see above).
Fertility is a very important part of many people’s lives, and not being able to have children can seem especially hard when you already have cancer to cope with. It can help to discuss your feelings with a partner, relative or close friend, or with your GP.
You can use our search tool to find other support organisations that can help.
We have more information available about cancer and fertility.