This page discusses the use of surgery for the treatment of ovarian cancer. For a thorough review of surgery, please see the
surgery treatment monograph
Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.
The American College of Obstetricians and Gynecologists (ACOG) recommends that all women with ovarian cancer have surgery performed by a gynecologic oncologist, a doctor with special training in the treatment of cancers of the gynecologic organs. Many studies have shown that surgery for ovarian cancer by non-cancer specialists results in poorer results. Even if your cancer is well advanced, as long as it is still in your belly, radical surgery is usually the best treatment for ovarian cancer. Generally, the fewer cancer cells left behind after surgery, the better your outcome.
Surgery for ovarian cancer generally begins with a laparotomy. An incision is made through the wall of the abdomen. Samples of tissue are then removed and examined under a microscope to check for cancer cells.
Description of the Procedure
Depending on your situation, your surgical procedure may involve:
Exploring to identify exactly how advanced the cancer is and how far it has spread
Removing only the diseased ovary (ovariectomy)
Removing both ovaries, both fallopian tubes, the uterus, and as much associated tissue as possible (if the cancer has visibly spread to other organs in the pelvis)
Removing both ovaries, both fallopian tubes, the uterus, and as much associated tissue as possible, as well as any suspicious-looking lymph nodes
For the lesser procedures, an incision will be made across your lower abdomen, through which the ovary or female organs will be removed. The vagina will be sewn closed from the inside in such a way that sexual intercourse will not be hindered.
For more radical procedures, the incision may extend the length of your abdomen. Every lymph node from the diaphragm to the anus will be inspected, and any that might contain cancer cells will be removed. Organs and lymph nodes that are removed will be sent to the pathologist for analysis under a microscope.
It is often not possible to remove all cancer during surgery, but this depends upon many factors. Among them are:
Whether the cancer is confined to one ovary and has not broken through the capsule of that ovary
How intimately and how extensively the cancer has invaded other organs
How widely the cancer has spread
Whether there is fluid in the abdomen which contains cancer cells
How difficult it is to access and remove cancerous tissue
How easy it is to locate each tumor mass
Surgery of any kind has its attendant list of complications that includes bleeding, infection, and medication and anesthetic complications. Abdominal surgery adds local complications such as ileus (paralysis of the bowel caused by handling it) and adhesions (scarring that can obstruct the bowel).
Expect to spend at least the better part of a week in the hospital after your surgery. Your bowel will need time to recover and handle food; you will need pain medication; the surgeon will want to watch you closely for reactions to medication and signs of bleeding and infection.
Once you leave the hospital you will need a few weeks to regain your strength and heal your incision. Expect to visit your surgeon at least once after surgery and to maintain contact with the doctors who are managing your cancer.
Tiny incisions are made in the abdomen, and a small fiberoptic tube with a lighted tip (a laparoscope) is inserted. This allows for a visual examination of the abdomen. Miniature surgical tools can also be inserted into the abdomen to remove tissue samples (biopsies). The tissue samples will be checked for cancer cells.
Description of the Procedure
You will most likely be put under anesthesia for the procedure, although it may be done in an outpatient surgical facility rather than a full-function hospital. Small abdominal incisions the size of buttonholes are made in strategic places. Through these are placed a lighted, pencil-thin telescope (laparoscope) and instruments that grab, cut, and cauterize, and pass air, fluids, and tissues. Your abdominal cavity is pumped full of (sterile) gas to allow room for the instruments and for the surgeon to see.
After a thorough look, pieces of cancer tissue will be removed through the instruments for examination (a biopsy). The air will be removed, the incisions closed, and you will be awakened.
The major limitation of laparoscopic surgery is the inability to access the far recesses of your abdomen and pelvis. Consequently a complete examination is not possible. Laparoscopy is usually adequate for examining the primary organs, in this case the ovaries, and for obtaining biopsy specimens.
The benefits of laparoscopy are a greatly reduced incidence of complications and shortened hospital stay. The list of complications is essentially the same as for open laparotomy, but their likelihood is less.
You may be able to go home the same day. At worst, you will ordinarily stay overnight in the hospital to recover from the anesthetic. You will have a few band-aid sized dressings on your incisions and perhaps some abdominal discomfort for a few days.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a