Surgery is the main treatment for most ovarian cancers. How much surgery you have depends on how far your cancer has spread and on your general health. For women of childbearing age who have certain kinds of tumors and whose cancer is in the earliest stage, it may be possible to treat the disease without removing both ovaries and the uterus.
For epithelial ovarian cancer, surgery has 2 main goals, staging and debulking. It is very important that this surgery is done by a doctor who’s experienced in ovarian cancer surgery.
It is recommended that patients see a gynecological oncologist for surgery. Gynecological Oncologists are specialists who have specific training and experience in treating, staging, and debulking ovarian cancer. If your cancer isn’t properly staged and debulked, you may need to have more surgery later. It has been shown that Gynecological Oncologists are most likely to provide optimal staging and debulk of ovarian cancer, when compared to general surgeons and gynecologists.
For other types of ovarian cancer (germ cell tumors and stromal tumors), the main goal of surgery is to remove the cancer.
Staging epithelial ovarian cancer
Surgery for ovarian cancer has 2 main goals. The first goal is to stage the cancer − to see how far the cancer has spread from the ovary. Usually this means removing the uterus (this operation is called a hysterectomy), along with both ovaries and fallopian tubes (this is called a bilateral salpingo-oophorectomy or BSO). In addition, the omentum is also removed (an omentectomy). The omentum is a layer of fatty tissue that covers the abdominal contents like an apron, and ovarian cancer sometimes spreads to this tissue. Some lymph nodes in the pelvis and abdomen are biopsied (taken out to see if the cancer has spread from the ovary).
If there is fluid in the pelvis or abdominal cavity, it will also be removed for analysis. The surgeon may “wash” the abdominal cavity with salt water (saline) and send that fluid for analysis. He or she may also remove tissue samples from different areas inside the abdomen and pelvis. All the tissue and fluid samples taken during the operation are sent to a lab to be examined for cancer cells.
Staging is very important because ovarian cancer at different stages is treated differently. If the staging isn’t done correctly, the doctor may not be able to decide on the best treatment.
Debulking epithelial ovarian cancer
The other important goal of surgery is to remove as much of the tumor as possible − this is called debulking. Debulking is very important in any patient with ovarian cancer that has already spread widely throughout the abdomen at the time of surgery. The aim of debulking surgery is to leave behind no tumors larger than 1 cm. This is called optimally debulked. Patients whose tumors have been optimally debulked, have a better outlook than those left with larger tumors after surgery (called sub-optimally debulked).
Sometimes the surgeon will need to remove a piece of colon to debulk the cancer properly. In some cases, a piece of colon is removed and then the 2 ends that remain are sewn back together. In other cases where the ends can’t be sewn back together right away, the top end of the colon is attached to an opening (stoma) in the skin of the abdomen to allow body wastes to get out. This is known as a colostomy. Most often, this is only temporary, and the ends of the colon can be reattached later in another operation.
Debulking surgery might also mean removing a piece of the bladder. If this occurs, a catheter (to empty the bladder) will be placed during surgery. This will be left in place until the bladder recovers enough to be able to empty on its own. The catheter can then be removed.
Debulking may also require removing the spleen and/or the gallbladder, as well as part of the stomach, liver, and/or pancreas.
If both ovaries and/or the uterus are removed, you will not be able to become pregnant. It also means that you will go into menopause if you haven’t done so already.
Most women will stay in the hospital for 3 to 7 days after the operation and can resume their usual activities within 4 to 6 weeks.