How Is Surgery Used to Diagnose Ovarian Cancer?

Surgery is the main option for both the diagnosis and treatment of ovarian cancer. The kind of surgery your doctor uses may depend on the type and stage of your cancer, your overall health, and whether you want to preserve your fertility.

Knowing more about the types of surgeries for ovarian cancer and when they are used can help you make informed decisions about your care and better understand your treatment plan.

Surgical biopsy for ovarian cancer

For many cancers, a biopsy is the main way of accurately diagnosing cancer. A biopsy is when a piece of the growth or tumor is removed from the body. It is then studied under a microscope in a lab. For ovarian cancer, this biopsy is usually done during a larger surgery that aims to remove all of the visible cancerous tissue.¹

A biopsy may be done during a laparoscopy or with a needle guided by a CT scan, though this is rare. Some doctors may do this with early-stage ovarian cancer if the cancer is confined to the ovary. In other cases, these types of biopsies may be done if you cannot have surgery due to advanced cancer or another illness. Since there is a chance that biopsies done this way can spread the cancer, your doctor will talk with you about the risks and benefits.^1,2

If you have abdominal ascites (excess fluid in the abdominal area), a biopsy of the fluid may be done. During a procedure called paracentesis, a needle attached to a syringe is inserted into the numbed abdominal wall. This may be guided by ultrasound. A sample of the fluid is taken up into the syringe. It is then sent to a lab so it can be examined for cancer cells.¹

Surgical staging for ovarian cancer

After your doctor has diagnosed you with ovarian cancer, the next step is to stage the cancer. Staging means to see how far the cancer has progressed, determine if it has spread from the ovaries, and to assign it a category.³

Staging often involves removing the uterus (a hysterectomy) along with both ovaries and fallopian tubes. This procedure is called a bilateral salpingo-oophorectomy, or BSO. During a BSO, the omentum is also removed. The omentum is a layer of fatty tissue that lies on top of the abdominal organs. Ovarian cancer can spread to this tissue.³

Any fluid found in the abdomen during surgery will also be tested for cancer cells. Sometimes a surgeon will also take biopsies of areas from the abdomen and pelvis to ensure there is no cancer in these areas.³

The size of the tumor and any potential spread of the cancer will determine the stage of your ovarian cancer. The stage will then help to guide your course of treatment.

Surgical treatment for ovarian cancer

The surgery for staging is also part of the surgical treatment for ovarian cancer. During this surgery, debulking is usually done. Debulking means removing as much tumor as possible. The goal of debulking is to leave behind no visible cancer. If that is not possible, the goal is to have tumors no larger than 1 centimeter left behind. This is known as optimal debulking.³

Research shows that people with optimal debulking have a better outcome than people who have larger tumors that remain after surgery (suboptimal debulking).³

If the cancer has spread to other organs, debulking surgery sometimes also involves removing those organs or parts of them. This may include removing the spleen or gallbladder, or sections of organs like the liver or intestines.³

Some women whose ovarian cancer responded well to chemotherapy may have surgery a second time. This usually includes a laparotomy and laparoscopy. These are minimally invasive surgeries that allow doctors to view the inside of the abdomen. The goal of these surgeries is to see whether there is any cancer left in the abdomen after treatment.⁴

Some people may also need additional surgeries during treatment. This can include surgery to remove more cancer if it has spread or to treat a bowel obstruction. If there is a recurrence (return of the cancer following treatment), removing more cancerous tissue may improve the response to chemotherapy.⁴

Talk with your doctor if you have any questions about the surgery that is being recommended for you.