The type of operation you have depends on where the cancer has spread to.
Most women have surgery to remove their womb, ovaries and fallopian tubes. During the operation, the surgeon examines the inside of your abdomen and your abdominal organs for signs of cancer.
The surgeon aims to remove as much of the cancer as possible if it has spread to other areas in your pelvis or abdomen. This is called debulking.
Surgery to remove the womb, ovaries and fallopian tubes
Surgery for ovarian cancer is usually quite a big operation. Your surgeon (gynaecological oncologist) needs to make sure that they remove as much cancer as possible.
Most women with ovarian cancer will have surgery to remove:
- both ovaries and fallopian tubes
- the womb, including the cervix
This operation is called a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO).
Your surgeon might be able to leave your unaffected ovary and fallopian tube if you have a low grade very early stage cancer (stage 1a).
Surgery for early stage ovarian cancer
Early stage ovarian cancer means the cancer has not spread beyond your ovaries (stage 1).
You have surgery to remove your ovaries, fallopian tubes, cervix and womb.
Staging your cancer
During surgery, the surgeon examines you closely to see if the cancer has spread. This helps them to fully stage the cancer and decide if you need treatment after surgery.
To find out if your cancer has spread, the surgeon:
- takes samples of tissue (biopsies) from several areas within the abdomen and pelvis
- removes a layer of fatty tissue close to the ovaries, called the omentum (this is called an omentectomy)
- puts some sterile fluid inside your abdomen and then removes it (this is called peritoneal or abdominal washings) - they send this fluid to the laboratory to see if it contains cancer cells
- might remove some lymph nodes from around the womb and ovaries, in the pelvis and from your abdomen
Having children in the future
For some low grade stage 1a cancers, it might be possible to just remove the affected ovary and fallopian tube, leaving behind the unaffected ovary and your womb. This means you might be able to become pregnant and have a baby afterwards.
Your doctor might advise that you have both ovaries and your womb taken out if you have had your menopause, or do not want to have any more children.
Surgery for advanced ovarian cancer
Advanced cancer means your cancer has spread away from the ovary (stages 2, 3 and 4).
You have surgery to remove your ovaries, fallopian tubes, womb and cervix. Your surgeon aims to remove as much of the cancer as possible if it has spread to other areas in your pelvis or abdomen. This is called debulking.
You have chemotherapy after the debulking surgery. The less cancer there is left after surgery, the easier it is for chemotherapy to kill the remaining cancer cells.
You might have chemotherapy before and after surgery. This is called interval debulking surgery (IDS).
Staging your cancer
As with early stage ovarian cancer, during the operation your surgeon might take several tissue samples (biopsies) from within the abdomen and pelvis. This is to check where else the cancer may have spread to. If you have a build up of fluid in your abdomen (ascites), they might send a sample to the lab to check for cancer cells.
Surgery to your bowel
Sometimes surgeons have to remove part of the bowel if the cancer has spread there and is blocking the bowel. They may have to create an opening (stoma) on the outside of the abdomen for bowel movements to come out into a bag. This is called a colostomy.
It is often only temporary. The surgeon can do a smaller operation to close the stoma up again once everything has settled down from your first operation.
How your surgeon does your operation
You have surgery for ovarian cancer under general anaesthetic. So you are asleep the whole time.
Depending on the surgery you have, you are generally in hospital for 2 to 4 days, and recovering at home afterwards for at least a month or so.