Types of surgery for ovarian cancer

Most women have surgery to remove their womb, ovaries and fallopian tubes. The surgeon also examines the inside of your tummy (abdomen) to confirm the stage of your cancer.

A specialist surgeon called a gynaecological oncologist does the operation. They will talk to you about your operation and the possible complications.

Staging your cancer

During surgery, the surgeon examines you to see where the cancer is in your abdomen. 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 removal 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

Some women might have a build up of fluid in their abdomen. This fluid build up is called ascites. If this is the case, the surgeon may send a sample of fluid to the laboratory to check for cancer cells.

Surgery to remove the womb, ovaries and fallopian tubes

Your surgeon needs to make sure that they remove as much cancer as possible. So most women have surgery to remove:

• both ovaries
• the fallopian tubes
• the womb, including the cervix

This operation is called a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO).  

Having children in the future

For some low grade stage 1A cancers, it might be possible to remove the affected ovary and fallopian tube. The unaffected ovary and your womb are not removed. This means you might be able to become pregnant and have a baby afterwards.

Cytoreductive surgery

The aim of cytoreductive surgery is to remove as much of the cancer as possible if it has spread to other areas in your pelvis or abdomen. This is sometimes called debulking surgery.

You may have cytoreductive surgery if your cancer is stage 2, 3 or 4. Your surgeon removes your ovaries, fallopian tubes, womb and cervix. They also try to remove other tissue in the pelvis or abdomen that they think might be cancer.

You have chemotherapy into your vein (intravenously) after cytoreductive surgery. The less cancer there is after surgery, the easier it is for chemotherapy to kill the remaining cancer cells.

You might have chemotherapy intravenously before and after surgery. This is called interval cytoreductive surgery.

Hyperthermic intraperitoneal chemotherapy (HIPEC)

If you have interval cytoreductive surgery, your surgeon might suggest you also have a treatment called hyperthermic intraperitoneal chemotherapy (HIPEC). You have this as part of your operation.

HIPEC treatment means having warm chemotherapy pumped into your abdominal cavity. They usually use a chemotherapy drug called cisplatin. It aims to kill any remaining cancer cells.

Once the surgeon has removed the cancer, they put some small plastic tubes (drains) into your abdomen. These are connected to a special HIPEC machine. The HIPEC machine warms the chemotherapy and pumps it around your abdomen. The chemotherapy stays in your abdomen for around 90 minutes. It is then drained back out of the abdomen into a drainage bag outside of your body. 

Surgery to your bowel

Sometimes surgeons have to remove part of your bowel if the cancer has spread there. 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.

A stoma is often only temporary. The surgeon can do a smaller operation to close the stoma up again. This happens 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.

Most people have open surgery. This means that the surgeon makes on large cut in your tummy to remove the cancer. Sometimes your surgeon might make some small cuts and use a laparoscope to look inside your abdomen first.

You might have laparoscopic (keyhole) surgery if you have stage 1 cancer. The surgeon makes some small cuts (incisions) in your abdomen. They put a narrow telescope (laparoscope) into one of these cuts. The laparoscope shows pictures of the inside of your abdomen on a video screen. The surgeon puts surgical instruments into the other incisions to carry out your operation. 

Depending on the surgery you have, you are generally in hospital for up to 7 days. You recover at home afterwards for at least a month. Your healthcare team will explain your operation and what to expect in more detail.