Surgery

Surgery is the primary treatment for ovarian cancer. The first step in surgery is to take a sample of the suspicious tissue to find out whether it is indeed cancer. This is the surgical biopsy. Once cancer is confirmed, the surgeon, preferably a gynecological oncologist, determines how far the cancer has spread so a stage can be assigned to the cancer. The oncologist will also determine whether surgery can be continued to remove the cancerous tissues.

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If the disease appears to be limited to one or both ovaries, the surgeon will take samples of nearby tissues from the pelvis and abdomen to determine whether the cancer has spread.

If there is obvious spread, the surgeon will attempt to remove as much of the cancerous tissue as possible right away, if the patient's condition and the tumor's location allow it. This procedure is referred to as "debulking" or "surgical cytoreduction." The goal of debulking is to remove as much of the tumor as possible. This improves the patient's prognosis. Debulking involves removing the ovaries, the body of the uterus, the cervix, the fallopian tubes and the omentum (fatty tissue around these organs), and any other visible deposits of cancer in the pelvic and abdominal areas. This may include the removal or partial removal of other organs such as the spleen, lymph nodes, liver, or intestines. Reducing the size of the tumor helps chemotherapy and radiation therapy work better, because they have less tumor to treat.

While debulking is generally performed at the time of the surgical biopsy, this cannot always be done. Sometimes the patient's overall health is too poor to allow the surgery to continue. In other patients, the tumor may be attached to critical organs. For these patients, any remaining tumor will then be treated with chemotherapy. Your doctor will determine whether another attempt to remove the remaining tumor is an option after chemotherapy.

Surgery for ovarian cancer is an open procedure and is performed in the operating room. It requires general anesthesia, so you will be asleep during the surgery. Most women will remain in the hospital for three to seven days after the operation and can resume their usual activities within four to six weeks. Surgery usually causes some pain and tenderness in the area of the operation. Discomfort or pain after surgery is controlled with medicine. For several days after surgery, the patient may have difficulty emptying her bladder and having bowel movements.

Women who have had a hysterectomy will not be able to get pregnant. Women who have had the ovaries and fallopian tubes removed, but not the uterus, may be able to get pregnant with donor eggs or may wish to freeze their own ovarian tissue to use later for in vitro fertilization.

Removing the ovaries means removing the body's natural source of estrogen and progesterone, female hormones that the ovaries produce until menopause. The lack of estrogen may cause osteoporosis and menopausal symptoms such as hot flashes and insomnia. Several medicines and other treatments are available for preventing or treating osteoporosis and menopausal symptoms, so talk with your doctor about your options. You may wish to take hormones, for example, or learn special exercises to maintain bone mass.