Ovarian Cancer: Surgery

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Surgery

Surgery for ovarian cancer

Your doctor confirms that you have ovarian cancer and determines its extent (or stage) by taking biopsies during laparotomy surgery. Your long-term outcome (prognosis) is improved under the care of an experienced gynecologic oncologist whose expertise can help determine the best treatment choices at the time of surgery.¹² Your surgery may include:

• A hysterectomy, which removes your uterus, and salpingo-oophorectomies, which remove your ovaries and fallopian tubes.
• Taking a sample of peritoneal fluid (peritoneal washings) from the abdominal cavity to look for cancer cells.
• Removing and checking the pelvic and aortic lymph nodes, to see if the cancer has spread.
• Checking the abdominal organs and tissues for cancer cells. Biopsies may be done.
• Removing and checking the fatty tissue (omentum) attached to some of the abdominal organs, to see if the cancer has spread.
• An appendectomy, which removes your appendix.

Surgery to lower the chance of developing ovarian cancer

Having surgery to close or tie off your fallopian tubes (bilateral tubal ligation) will lower your chances of developing ovarian cancer.² But, you will not be able to become pregnant after having this surgery. Talk to your doctor about whether this choice is right for you.

A small number of women with ovarian cancer have a first-degree female relative—such as a sister, mother, or daughter—or a second-degree female relative—such as an aunt or grandmother—who has had ovarian cancer. Changes (mutations) in two major genes, BRCA1 and BRCA2, are most closely related to a higher lifetime chance for ovarian cancer in these families.⁵ You may consider a BRCA gene test if you have a family history of ovarian cancer. Most experts recommend that women with known BRCA mutations have their uterus, ovaries, and fallopian tubes removed while these organs are still healthy, to reduce their lifetime chance of developing ovarian cancer. You will not be able to become pregnant, but studies have shown that this surgery lowers your chance of getting ovarian cancer by about 95%.^{1 21} There is still a small chance of getting ovarian cancer, even after the ovaries are removed. This is because there can already be a tiny cancer growing before the ovaries are removed. Those cancer cells can remain in the body after the surgery and continue to grow.²²

Should I have my ovaries removed to prevent ovarian cancer?

Surgery Choices

If you have very early-stage ovarian cancer and wish to have children (preserve fertility), discuss your choices with your doctor.

Ovarian cancer does not cause many symptoms in its early stages, which is why about 70% of cases are not found until the cancer has spread.¹⁷ Most women who have advanced-stage cancer have a hysterectomy to remove the uterus and an oophorectomy to remove both ovaries. The fallopian tubes are usually removed also.

In advanced-stage surgery, your surgeon will take a sample of peritoneal fluid, remove lymph nodes and fatty tissue (omentum), and remove any abdominal tissue that is thought to have cancer.

What To Think About

Side effects from your surgery can include difficulty urinating or problems with bowel functioning, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

If your ovaries are removed, you may have symptoms of menopause. Talk with your doctor about medicines to manage these symptoms.

Ovarian cancer may grow and spread to the point that it blocks the bowel. Or, the first surgery to remove the cancer may cause problems, such as a blocked bowel. For more information, see the topic Bowel Obstruction.

Last updated:	July 10, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Anne C. Poinier, MD - Internal Medicine, Ross Berkowitz, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC