Ovarian cancer results from the abnormal growth of cells in the ovaries. The affected cells, which are cancerous, may spread, destroying both nearby and distant areas in the body. Surgery is the primary treatment in the diagnosis and management of ovarian cancer.
Research suggests that almost 1 in 5 people with ovarian cancer do not receive surgery, despite the fact that a lack of surgery is associated with less positive outcomes.
When people present with symptoms of ovarian cancer, doctors use a biopsy to confirm the diagnosis, stage the cancer, and remove as many cancerous cells as possible. The extent to which the cancer has spread will determine the type of surgery that a person will undergo. Doctors will also take into account whether the person wishes to have a child.
This article provides an outline of how best to prepare for ovarian cancer surgery. It also looks at the details of the procedure and considerations for life after surgery.
Before surgery, a doctor will run several tests to ensure that a person is fit for surgery. These tests may include:
- urine and blood tests to check liver and kidney function
- chest X-ray of the heart and lungs
- electrocardiogram (EKG) and echocardiogram to check heart health
- breathing tests
During a clinic appointment or hospital stay, a surgeon and anesthesiologist will explain the details of the procedure, confirm relevant health history, and answer any outstanding questions.
The individual will need to sign a consent form confirming that they give their permission to receive an operation. At this point, the doctor may recommend trying to increase stamina through exercise and proper nutrition, as this may aid postoperative recovery.
If the person smokes, the doctor will also suggest stopping smoking a few weeks before surgery to prepare the body for the operation. They may also prescribe antibiotics and suggest drinking certain fluids to prepare the intestines. Instructions from the doctor are likely to include refraining from eating or drinking anything after midnight on the night before the surgery.
A person should also check with the doctor whether they need to stop using any medications, supplements, or therapies before the surgery.
Several procedures can help diagnose, stage, and treat ovarian cancer.
Laparoscopy vs. laparotomy
An anesthesiologist administers a person’s general anesthetic before surgery.
Gynecologic oncologists, who are doctors specializing in cancers of the reproductive tract, perform a minimally invasive procedure called laparoscopy to evaluate and accurately stage ovarian cancer. For early stage ovarian cancer, in which the tumor has not spread beyond the ovaries, a traditional form of open surgery called laparotomy can take place.
Research comparing the survival rates of laparoscopy and laparotomy procedures remains largely varied. However, a recent
Diagnosis and staging
Doctors may use several methods to diagnose the present stage of ovarian cancer, including a physical examination of the abdomen and the collection of tissue and fluid samples. They may also administer a peritoneal washing, which involves removing fluid from the abdomen to check for malignant, or cancerous, cells.
Upon collection, a technician will test the samples in a lab to determine whether the cells are cancerous. Reproductive specialists examine the samples and relay the results back promptly.
Depending on the diagnosis, doctors may elect to proceed with the surgery and remove as many cancerous cells or tumors as possible. This process is called debulking.
Where necessary, doctors may also elect to administer chemotherapy after surgery. Doctors typically use chemotherapy to shrink tumors after surgery and debulking to eliminate any remaining cancerous cells.
Surgical approaches
Depending on the stage and extent of ovarian cancer, several surgical approaches are available for treatment. Doctors may choose to do two or more procedures throughout the same surgery. Common surgical approaches include:
- Unilateral salpingo-oophorectomy: In cases of early stage ovarian cancer, where the cancer is limited to one ovary, doctors may remove only that ovary and fallopian tube. This is a type of fertility preservation.
- Bilateral salpingo-oophorectomy: This procedure involves removing both ovaries and fallopian tubes.
- Hysterectomy: A hysterectomy can be partial, removing only the uterus, or total, removing the cervix and uterus.
- Omentectomy: This surgery involves removing the large intestines and the layer of tissue covering the stomach.
- Lymph node dissection: Lymph node dissection is the removal of lymph nodes from the abdomen and pelvis.
In cases of advanced ovarian cancer, surgeons may perform cytoreductive surgery or debulking to remove as many tumors as possible while maintaining safety. This surgery may include the removal of various tissues or parts of nearby organs, including the:
- bladder
- colon
- liver
- stomach
- spleen
- pancreas
- appendix
These methods can improve symptoms and the effectiveness of combined treatments.
After surgery, the person will remain in the recovery room until they are fully conscious and then return to their room. The
Doctors may recommend or prescribe pain relievers to manage any pain or tenderness at the surgical site. If the person feels nauseated, a healthcare professional may administer antinausea medication.
It is not uncommon to experience symptoms of menopause, including vaginal dryness and hot flashes. Some vaginal bleeding may also occur. However, this is likely to stop within 2 weeks.
Physical therapists may suggest performing breathing and leg exercises to aid in the recovery process and prevent blood clots. A healthcare professional may also inject blood thinners to reduce the risk of blood clots further.
Additionally, a person may elect to wear compression stockings to improve circulation.
Recovery time depends on general health, the type of surgery, and the support available in the home. Most people fully return to their usual activities within 4–6 weeks of surgery.
Those who undergo the removal of part of their colon may need to wear a colostomy bag temporarily. Similarly, following the removal of part of the bladder, a person may need to use a catheter to drain urine. This is often also temporary.
Individuals should rest as much as possible, eat a well-balanced diet, exercise lightly, and avoid strenuous activities, including driving and lifting. Depending on the nature of their work, people may need to stop working following surgery until they have recovered.
It is important to avoid swimming and taking baths during the recovery period. Doctors advise that people take showers instead. People should also avoid having sex for at least 6 weeks after the operation to allow the body to heal.
Other treatments are also available to address ovarian cancer. These can include:
- Chemotherapy: Most people start chemotherapy 2–4 weeks after surgery to remove any remaining cancer. A 2018 study found that delaying the initiation of chemotherapy after surgery led to less favorable outcomes. Doctors may also use chemo to shrink larger tumors and kill any cancer in distant sites. They can administer one or multiple chemotherapy drugs either orally or intravenously.
- Hormone therapy: This treatment involves agents that block hormones. These include aromatase inhibitors and luteinizing hormone-releasing hormone agonists. Doctors mainly use hormone therapy to treat ovarian stromal tumors.
- Hyperthermic intraperitoneal chemotherapy (HIPEC): This type of chemotherapy pumps warm chemo drugs into the abdomen through a catheter. A
2020 study found that combining HIPEC with cytoreductive surgery improved overall survival rates for those with stage 3 epithelial ovarian cancer. Learn more about stage 3 ovarian cancer. - Targeted therapy: Targeted drugs, such as bevacizumab and PARP inhibitors, can identify and attack cancerous cells. This type of treatment is beneficial for people with specific gene mutations, such as those affecting BRCA.
- Radiation therapy: Doctors occasionally use this to treat ovarian cancer that has spread to the pelvis or distant areas. They may use radiation therapy in combination with chemotherapy or alone.
In some instances, surgery may cause complications. A person should inform their healthcare team if they experience any of the following, which may be signs of infection:
- high fever or chills
- swelling or change of skin coloration near the site of operation
- leg swelling
- heavy bleeding that soaks more than two pads within an hour
- severe abdominal pain
- nausea and vomiting
Surgery is the main treatment for most types of ovarian cancer. It is useful in diagnosing, staging, and removing cancerous cells. The type of surgery that a person undergoes depends on numerous factors, including their general health and how much cancer has spread.
People should discuss their options with a doctor and tell them if they are interested in giving birth in the future.