Surgery is one of the main treatment tools used for ovarian cancer. It is often used along with other types of treatment to help remove or shrink the cancer. Surgery may also reduce the risk of the cancer coming back in the future (known as recurrence).1
Surgery for epithelial ovarian cancer
There are 2 main goals of surgery for epithelial ovarian cancer: staging and debulking. Surgery may involve the removal of one or both ovaries and fallopian tubes. In most cases, a gynecologic oncologist performs the surgery because they are specially trained in working with these cancers.1
Staging the cancer is vital because it helps categorize the cancer and guides treatment. During surgery, the doctors will usually remove:1
- Both ovaries and fallopian tubes (a bilateral salpingo-oophorectomy)
- The uterus (a hysterectomy)
- The omentum (a layer of fatty tissue that covers the abdominal organs)
Ovarian cancer may sometimes spread to the omentum. Lymph nodes in the pelvis and abdomen may also be biopsied.1
During surgery, any fluid in the pelvis or abdominal cavity will be removed and tested for cancer cells. Sometimes the surgeon will do a peritoneal washing. This is a procedure in which a salt-water solution is used to wash the abdominal cavity. The solution is then removed and checked for cancer cells. The surgeon may also biopsy areas in the abdominal cavity and pelvis if they think the cancer has spread. All of these procedures help doctors stage the cancer.1
Debulking is the other main goal of surgery. For advanced ovarian cancer, or anything past Stage I, optimal debulking is ideal. This is when no visible cancer is left behind after surgery, or any cancer that is left over is less than 1 centimeter in diameter. Optimal debulking has been shown to provide a better prognosis (or likely outcome), but it is not always possible.1,2
Sometimes debulking will mean that parts of other organs or tissues need to be removed. This can include parts of the colon, small intestine, bladder, stomach, liver, or pancreas. Depending on where the cancer has spread, the extent of the surgery can vary.1
If both ovaries are removed, this will put you into immediate surgical menopause. Talk with your doctor before the surgery about what to expect, especially if you are not in menopause before the surgery.
A typical hospital stay after ovarian cancer surgery involves staying in the hospital for approximately 3 to 7 days. In most cases, you may be able to resume normal activities within 4 to 6 weeks.1
If the advanced ovarian cancer recurs (returns after treatment), sometimes secondary debulking is necessary.
Surgery for ovarian germ cell tumors and ovarian stromal tumors
For ovarian germ cell and stromal tumors, the main goal of surgery is removing the cancer.1
The majority of ovarian germ cell tumors are treated by removing both ovaries and fallopian tubes, as well as the uterus. If the cancer is in only one ovary, your doctor may remove only that ovary and the fallopian tube on that side.1
In most cases of ovarian stromal tumors, the cancer is located only in one ovary. Surgery may require the removal of only that ovary. However, if the cancer has spread, more tissue may need to be removed. This may include both fallopian tubes, both ovaries, and/or the uterus.1
After childbearing, it may be recommended that women who have had ovarian germ cell or stromal tumors have the other ovary and fallopian tube removed, as well as the uterus.1
Fertility-sparing surgery
Most surgery for ovarian cancer means a loss of fertility. This is because it often involves the removal of both ovaries and/or the uterus. For women who want to have children in the future, they may want to explore whether fertility-sparing surgery is an option.
Women with early-stage ovarian cancer and cancer that is only in one ovary with no other spread may have surgery to remove that ovary and the fallopian tube on that side. Your doctor will also remove a small sample from the uterus to make sure there are no cancer cells there.3
The surgeon may also take biopsies to make sure there are no cancer cells anywhere else. This may include pelvic and abdominal tissue, lymph nodes, and the omentum.3
If fertility preservation is important to you, talk with your doctor and treatment team about this before surgery.3