Surgery for ovarian cancer

Surgery is usually used to treat ovarian cancer. It may also be used to treat fallopian tube and primary peritoneal cancer, which are very similar to ovarian cancer. These cancers start in the same type of tissue as most ovarian cancers and are staged and treated the same way.

The type of surgery you have depends mainly on the type of tumour and stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age, overall heath and whether you want to get pregnant in the future. Surgery may be the only treatment you have or it may be used along with other cancer treatments.

You may have surgery to:

• accurately diagnose and stage the cancer
• completely remove the tumour
• lower the chance of the cancer coming back (recurring)
• remove as much of the cancer as possible (called surgical debulking)
• reduce pain or ease symptoms (called palliative surgery)

The following types of surgery are used to treat ovarian, fallopian tube or primary peritoneal cancer.

Ovarian, fallopian tube and primary peritoneal cancers are staged during surgery and treated at the same time. During surgical staging, the surgeon removes multiple tissue and fluid samples. These are sent to the lab to be checked for cancer cells. If doctors think you have early-stage cancer (stage 1) based on diagnostic tests, you may be given a higher stage (stage 2 or 3) after samples have been analyzed in the lab. Surgical staging can include:

• rinsing the abdomen with salt water (saline) and collecting a sample (called pelvic washing)
• collecting fluid that has built up in the abdomen (called ascites)
• looking at all surfaces in the pelvis and abdomen
• scraping the surfaces of the diaphragm to check for cancer cells
• biopsy of any areas that look like cancer, and from all areas inside the abdomen and pelvis
• removing some lymph nodes in the pelvis and abdomen
• removing most or all of the omentum (the fatty tissue that covers the abdominal organs)

A cystectomy removes only the tumour and preserves the ovary. It's sometimes done for early-stage cancer. 

You can still get pregnant after this surgery.

A salpingo-oophorectomy removes an ovary and fallopian tube. It can be unilateral or bilateral.

• A unilateral salpingo-oophorectomy removes only the ovary that has the tumour in it and the fallopian tube on the same side.
• A bilateral salpingo-oophorectomy removes both ovaries and both fallopian tubes.

A unilateral salpingo-oophorectomy is only done if the cancer hasn't spread outside of 1 ovary.

If the other ovary appears non-cancerous, the surgeon won't remove it if you wish to get pregnant in the future. If the ovary looks like it may be cancerous, the surgeon will recommend removing it.

A total hysterectomy and bilateral salpingo-oophorectomy is the most common surgical procedure used to treat ovarian, fallopian tube and primary peritoneal cancers. This surgery removes the uterus, cervix, both ovaries and both fallopian tubes.

A total hysterectomy and bilateral salpingo-oophorectomy will be done if the cancer has spread outside of the ovary. But even if the tumour hasn't spread outside of the ovary, it may also be done to lower the chance of the cancer recurring. After this surgery, you won't be able to get pregnant.

Some types of hysterectomies can also remove just the uterus. This may be done for stage 1 cancer. Find out more about a hysterectomy.

Ovarian, fallopian tube or primary peritoneal cancer can spread to different parts of the body, including the abdomen and pelvis. Surgical debulking removes as much of the cancer as possible from these areas. It's also called tumour debulking.

You may have primary or interval surgical debulking. If it’s not possible to completely remove the cancer, you may have more debulking surgeries with chemotherapy treatment in between surgeries. This is called interval surgical debulking.

Primary surgical debulking removes as much of the cancer as possible in the first surgery. Surgeons will try to leave as little of the tumour behind as they can (usually less than 1 cm). Primary surgical debulking may include removing:

• the uterus, cervix, ovaries and fallopian tubes (called a total hysterectomy and bilateral salpingo-oophorectomy)
• the omentum (called an omentectomy)
• small tumours from the surface of the diaphragm
• part of the stomach, liver, or pancreas
• the spleen
• the gallbladder
• part of the large or small intestine (called a bowel resection)
• lymph nodes in the pelvis and abdomen

During primary surgical debulking, the surgeon may also place a port under the skin near your lower rib cage. This will deliver chemotherapy drugs directly into the abdominal cavity (called intraperitoneal or IP chemotherapy).

If primary surgical debulking did not remove most of the cancer, you may be offered chemotherapy followed by more debulking surgery. This is called interval surgical debulking. It's done after several cycles (usually 3 or 4) of neoadjuvant chemotherapy. If chemotherapy shrinks the tumour, it can be easier for the surgeon to completely remove it with a lower chance of complications.

Certain procedures may be done to reduce symptoms and relieve pain from cancer that has spread. Palliative surgeries that may be offered for ovarian, fallopian tube or primary peritoneal cancer include:

• paracentesis to remove fluid from the abdomen
• thoracentesis to remove fluid from around the lungs
• placing a feeding tube into the stomach or intestines
• placing a tube (stent) in the large or small intestine or ureter to relieve a blockage caused by a tumour

Side effects of surgery will depend mainly on the type of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for ovarian, fallopian tube or primary peritoneal cancer may cause these side effects:

• bleeding and the need for blood transfusion
• bladder problems
• lymphedema
• fertility problems
• treatment-induced menopause
• blood clots
• wound or blood infection
• bowel obstruction

Find out more about surgery and the side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.