When is surgery used?

Surgery is one of the main treatments for cancer of the ovary, fallopian tube or peritoneum. It is also sometimes used to diagnose the cancer and to find out more about the type and stage of the cancer. A surgeon called a gynaecological oncologist will do your operation.

The type of surgery you have may depend on:

  • the stage of the cancer
  • the areas affected by cancer
  • whether you want to be able to get pregnant in the future.

Before you have surgery, your surgeon and nurse will explain what to expect and answer any questions you have. It may help to look at the diagrams of organs close to the ovaries when reading this section.

Female pelvic lymph nodes

Side view of the female pelvis

 

Surgery to remove the ovaries and womb

The aim of this operation is to remove all of the cancer.

The surgeon usually removes:

  • the ovaries and fallopian tubes (called a bilateral salpingo‑oophorectomy or BSO)
  • the womb and cervix (called a total abdominal hysterectomy or TAH)
  • the omentum (called an omentectomy).

During the operation, the surgeon:

  • takes samples (biopsies) from other areas nearby
  • may remove some of the lymph nodes in the abdomen and pelvis
  • puts fluid into the abdomen and collects it again (called abdominal or peritoneal washing).

After the operation, everything that the surgeon removed is sent to the laboratory and carefully examined. This gives more information about the type and stage of the cancer. This information helps your team decide if you are likely to need further treatment.

If you are still having periods, this surgery will bring on your menopause and you will not be able to get pregnant. Your surgeon or nurse will explain what to expect before you have surgery. Ask them for advice if you are worried about your fertility.

Fertility-sparing surgery

Some women choose to have surgery that protects their fertility (ability to get pregnant). This may be possible if cancer or a borderline tumour is only affecting one ovary or fallopian tube.

In fertility-sparing surgery the surgeon only removes the affected ovary and fallopian tube. They leave the other ovary, fallopian tube and the womb. This means you may still be able to get pregnant in the future.

During the operation, the surgeon checks the other ovary and may take a sample from it. They will also take washings and samples (biopsies) from other nearby areas. They may remove some lymph nodes from the pelvis or abdomen.

If the washings, biopsies or lymph nodes show the cancer has spread, you may need another operation. This usually involves removing the womb, omentum and remaining ovary and fallopian tube.

Removing as much of the cancer as possible

When cancer has spread to other areas in the pelvis or abdomen, it is not always possible to remove it all. Instead, the surgeon aims to remove as much of the cancer as they can. This is called debulking or cytoreductive surgery. It helps keep the cancer under control and may improve any symptoms you have.

Removing part of the bowel

If the cancer has spread to the outside of the bowel, you may also need a section of bowel removed. If possible, the surgeon removes the affected piece of bowel and joins the two remaining pieces together.

Rarely, the surgeon cannot safely join the bowel back together. Instead, they bring the upper end of the bowel out onto the skin of the abdomen. This is called a stoma. After the surgery, you wear a bag over the stoma to collect poo (stools).

If you are likely to need part of your bowel removed, your surgeon will talk to you about this before your surgery. If you need a stoma, your hospital team and a stoma nurse will give you support and advice.

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