Ovarian cancer surgery
Surgery is one of the main treatments for ovarian cancer, fallopian tube cancer or primary peritoneal cancer. It also helps doctors to diagnose the type of cancer.
When is surgery used for cancer of the ovary, fallopian tube or peritoneum
Surgery is one of the main treatments for cancer of the ovary, fallopian tube cancer or primary peritoneal cancer. You have surgery to remove the cancer. But it also helps doctors to:
- diagnose the type of cancer
- find out more about its stage.
You usually have surgery to remove the following:
- the ovaries
- the fallopian tubes
- the womb (uterus)
- the layer of tissue that covers the stomach and part of the bowel (the omentum)
- lymph nodes.
If the cancer has spread to other areas in the pelvis, you may need more surgery.
We have more information on the ovaries, fallopian tubes and peritoneum.
Side view ovarian with ureter
Before your operation
Sometimes you have chemotherapy before surgery. This is to shrink the cancer. If the cancer comes back, it may be possible to have more surgery.
You may have chemotherapy into the tummy area (abdomen) during surgery. This is called hyperthermic intraperitoneal chemotherapy or HIPEC.
If you have very early stage cancer and want to get pregnant in the future, it may be possible to have only the affected ovary and fallopian tube removed. This is called fertility-sparing surgery. A specialist doctor does this type of surgery. They are called a gynaecological oncologist.
Before you have surgery, your surgeon and specialist nurse will talk to you and answer any questions. It is important you understand what your operation may involve.
Surgery to remove the cancer
The surgeon aims to remove all the cancer or as much of it as possible. They usually remove the:
- ovaries and fallopian tubes – this is called a bilateral salpingo‑oophorectomy or BSO
- womb and cervix – this is called a total hysterectomy
- omentum – this is called an omentectomy.
The surgeon will also check how far the cancer has spread. This is important because it tells them more about the stage of the cancer. During surgery, they will:
- take samples of tissue (biopsies) from other areas nearby
- remove some lymph nodes in the tummy and pelvis
- put fluid into the tummy and collect it to test for cancer cells – this is called abdominal washing or peritoneal washing.
You may also need surgery to other areas, to remove as much of the cancer as possible. This depends on where the cancer has spread in the pelvis.
Early menopause
If you still have periods, having a total hysterectomy and BSO will cause your periods to stop (the menopause). This can cause menopausal symptoms such as hot flushes and vaginal dryness.
Surgery if the cancer has spread
Many cancers of the ovary, fallopian tube or peritoneum have spread when they are diagnosed. If the cancer has spread to other areas in the pelvis or tummy, it may not be possible to remove it all.
Your surgeon will try to remove as much of the cancer as they can. Doctors sometimes call this debulking or cytoreductive surgery.
If at the time, the surgeon does not think that surgery will lead to a better result, they will not go ahead. You will have different treatment, such as chemotherapy.
Removing part of the bowel
If the cancer has spread to the bowel, you may also need a section of bowel removed. If possible, the surgeon removes the affected piece of bowel and joins the 2 remaining pieces together. This is called a bowel anastomosis or rejoin.
Sometimes the surgeon cannot safely join the remaining pieces of bowel together. Instead, they bring the upper end of the bowel out onto the skin of the tummy. This is called a stoma. After the operation, you wear a bag over the stoma to collect stools (poo). A stoma may be temporary to protect the bowel rejoin. Or it may be permanent if a bowel rejoin is not possible.
If you are likely to need part of the bowel removed, your surgeon will talk to you about this before your operation. If you need a stoma, your hospital team and a stoma nurse will give you support and advice.
We have more information on having a stoma.
Surgery to protect fertility (fertility-sparing surgery)
If you have very early stage ovarian cancer, it may be possible to have surgery that means you can still get pregnant. This is usually possible if the cancer is stage 1a and low grade.
The surgeon only removes the affected ovary and fallopian tube. They leave the other ovary, other fallopian tube and the womb. During the operation, the surgeon checks the other ovary and may take biopsies from it.
If any biopsies, lymph nodes or fluid removed from the pelvis show the cancer has spread, you may need more surgery. This may include removing the womb, remaining ovary and remaining fallopian tube. You may find this difficult to cope with if you were hoping to get pregnant in the future.
Your specialist nurse will give you lots of support. They may be able to refer you to a counsellor for further emotional support. They may also refer you to a fertility specialist before surgery to talk about options.
Related pages
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our ovarian cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Ovarian cancer: recognition and initial management. Clinical guideline [CG122] Published: 27 April 2011 Last updated: 02 October 2023 www.nice.org.uk/guidance/cg122 (accessed May 2024)
Ovarian cancer: identifying and managing familial and genetic risk. NICE guideline [NG241]. Published: 21 March 2024 www.nice.org.uk/guidance/ng241 (accessed May 2024)
A. González-Martín, P. Harter, A. Leary, D. Lorusso, R. E. Miller, B. Pothuri, I. Ray-Coquard, D. S. P. Tan, E. Bellet, A. Oaknin & J. A. Ledermann, on behalf of the ESMO Guidelines Committee. Newly diagnosed and relapsed epithelial ovarian cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Published August 17, 2023. www.annalsofoncology.org/article/S0923-7534(23)00797-4/fulltext (accessed May 2024)
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