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, 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 borderline or in the early stages, surgery may be the only 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, the womb and cervix 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, it may be possible to remove only the affected ovary and fallopian tube, and leave the womb and unaffected ovary. This means you may be able to have children in the future. Women with stage 1b and 1c cancer and those who have had their menopause or don’t want any more children, will usually be advised to have both ovaries, fallopian tubes, the womb and cervix removed.

The surgeon will also remove the layer of fatty tissue called the omentum, which is close to the ovaries (an omentectomy). They may 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 or peritoneal washing.

If it’s 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, fallopian tube and omentum – sometimes called completion surgery – may be needed.

Chemotherapy is usually given after surgery if it wasn't possible to remove all of 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, the womb and the cervix (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 may also take biopsies or remove some of the lymph nodes in the abdomen and pelvis. They will also remove the omentum and may remove the appendix and part of the lining of the abdomen (the peritoneum). This operation can be complicated and should 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. If this is the case, the upper end of the bowel will be brought out onto the skin of the abdomen to form a colostomy or ileostomy. The opening of the bowel is known as a stoma. A bag is worn over the stoma to collect stools (bowel motions). Your doctor or specialist nurse will discuss this with you.

Some women may have chemotherapy both before and after surgery. The course of chemotherapy will be started and then, halfway through, a CT scan| will be done. If this shows that the tumour is shrinking well, an operation is carried out.

The chemotherapy course is then completed after the surgery. This is known as interval de-bulking surgery. Giving chemotherapy before surgery (neo-adjuvant chemotherapy) helps to shrink the tumour so that surgery is more successful. Afterwards, the chemotherapy is given to try to destroy any cancer cells that couldn’t be removed.

Stage 4 ovarian cancer Back to top

It may be possible to have an operation to remove some of the cancer (de-bulking surgery). Chemotherapy may be given before and/or after surgery. 

For some women surgery isn’t possible; for example if the cancer is very advanced or if a woman isn’t well enough for a major operation. Chemotherapy is the main treatment for women in this situation. It may be followed by surgery if there is a good response to treatment.