Surgery for ovarian cancer

When surgery is used

In some cases, surgery will be the initial treatment for ovarian cancer. This surgery can be complex. It is recommended that a gynaecological oncologist who is at a hospital that does a lot of these operations (a high-volume centre) does the surgery. The Australian Society of Gynaecologic Oncologists has a list of specialists by state and territory. Learn how find a specialist near you.

Surgery allows your gynaecological oncologist to confirm the diagnosis of ovarian cancer and also work out if the cancer has spread.

The gynaecological oncologist will talk to you about the most suitable type of surgery, as well as the risks and side effects. These may include infertility. If the option to have children is important to you, talk to your doctor before surgery and ask for a referral to a fertility specialist.

How the surgery is done

You will be given a general anaesthetic and will have either a laparoscopy (with 3–4 small cuts in your abdomen) or a laparotomy (with a vertical cut from around your bellybutton to your pubic line). A laparoscopy may be used to see if a suspicious mass is cancerous; if the cancer is advanced, you will usually have a laparotomy.

Having a surgical biopsy

You may have a biopsy during surgery if you cannot have an image-guided biopsy, or to remove and check a suspicious tumour. The tissue samples will be sent to a pathologist, who will check them for signs of cancer. The results will help decide if you need debulking surgery (see below).

Debulking

If cancer is found, the surgeon will remove as much visible cancer as possible. This is called debulking or cytoreductive surgery. You may also have chemotherapy before or after surgery.

Debulking usually means removing the ovaries, fallopian tubes, uterus and cervix. Depending on how far the cancer has spread, other organs or tissue may also be removed during the same operation.

I felt great relief after the surgery, as once the tumour had been removed, the pain that I had in my lower abdomen and hip was gone.

Ann

Types of surgery

If ovarian cancer is found, all or some of the reproductive organs will be removed. The type of surgery you have will depend on how certain the gynaecological oncologist is that cancer is present and where the cancer has spread.

Total hysterectomy and bilateral salpingo-oophorectomy

In most cases, surgery for ovarian cancer means removing the uterus and cervix, along with both fallopian tubes and ovaries. Removing the uterus will mean you cannot get pregnant and carry a child.

Unilateral salpingo-oophorectomy

If cancer is found early and it is in one ovary, you may have only one ovary and fallopian tube removed. This may be offered to some younger women with early-stage cancer who still wish to have children.

What to expect after surgery

When you wake up after the operation, you will be in a recovery room near the operating theatre or in the intensive care unit. Once you are fully conscious, you will be taken back to your bed on the hospital ward. The surgeon will visit you as soon as possible to explain the results of the operation.

Taking care of yourself at home after surgery

Your recovery time will depend on the type of surgery you had, your general health, and your support at home. If you don’t have support from family, friends or neighbours, ask your nurse or the hospital social worker if it’s possible to get help at home. In most cases, you will feel better within 1–2 weeks and should be able to fully return to your usual activities after 4–8 weeks. Ask your treatment team for more information about your particular circumstances.

Rest up

When you get home from hospital, take things easy and do only what is comfortable. You may like to try meditation or some relaxation techniques to reduce anxiety or tension.

Lifting

Avoid heavy lifting (more than 3–4 kg) or heavy work (e.g. gardening) for at least 6–8 weeks. This will depend on the method and kind of surgery you’ve had.

Work

Depending on the type of work you do, you will probably need time off work. Ask your treatment team how long this might be.

Driving

You will need to avoid driving after the surgery until pain in no way limits your ability to move  freely. Discuss this issue with your doctor. Check with your car insurer for any exclusions regarding major surgery and driving.

Exercise

Your treatment team will probably encourage you to walk on the day of the surgery. Research suggests that exercise helps manage some treatment side effects and speed up a return to usual activities. Speak to your doctor about suitable exercise and ask for a referral to a physiotherapist or exercise physiologist. To avoid infection, it’s best to avoid swimming for 5–6 weeks after surgery.

Eat well

To help your body recover from surgery, eat a well-balanced diet that includes a variety of foods. Include proteins such as lean meat, fish, eggs, milk, yoghurt, nuts and legumes/beans.

Bowel problems

You may experience constipation after having a hysterectomy and taking strong pain medicines. You will probably be offered stool softeners while you’re taking pain medicines and until your bowel movements return to normal.

Sex

Sexual intercourse should be avoided for up to 8 weeks after a hysterectomy. Ask your doctor or nurse when you can have sex again, and explore ways you and your partner can be intimate.

Further treatment after surgery

All tissue and fluids removed during surgery are checked for cancer cells by a pathologist. The results will help confirm the type of ovarian cancer you have, if it has spread (metastasised), and its stage.

Your doctor should have all the test results within 2 weeks of surgery. Further treatment will depend on the type, stage and grade of the cancer.

If the cancer is advanced, it’s more likely to come back, so surgery will usually be followed by chemotherapy, and occasionally by targeted therapy. Radiation therapy is recommended only in particular cases.