Surgery for ovarian cancer

Whether an ovarian cancer patient is a candidate for surgery depends on several factors, including the extent of the cancer, pre-existing medical conditions, nutritional status, whether the patient has undergone previous surgeries to treat the cancer, and, in the case of a recurrence, when the last cancer treatment was performed.

Surgical procedures for ovarian cancer may be performed in one of two ways:

• With a laparotomy, which uses a larger incision to open the abdomen.
• With a laparoscopy (with or without robotic assistance), which uses small incisions in the abdomen.

Types of ovarian cancer surgery

The patient's ovarian cancer surgical oncology team will discuss the recommended approach for her, which may include the following:

Unilateral salpingo-oophorectomy: Surgical removal of one ovary and one fallopian tube

Bilateral salpingo-oophorectomy: Surgical removal of both ovaries and both fallopian tubes

Total hysterectomy: Surgical removal of the uterus, including the cervix

Omentectomy: Surgical removal of part or all of the omentum, a fold of fatty tissue inside the abdomen

Bowel resection: Surgical removal of part of the small or large intestine

Diaphragm surgery: Surgical removal of part of the diaphragm

Appendix surgery: Surgical removal of the appendix

Lymph node dissection: Surgical removal of multiple lymph nodes in the abdominal cavity

HIPEC: Some patients may be candidates for hyperthermic intraperitoneal chemotherapy (HIPEC), a highly concentrated, heated chemotherapy treatment delivered directly to the abdomen during surgery. Unlike systemic chemotherapy delivery, which circulates throughout the body via the bloodstream, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Heating the solution may also improve the absorption of chemotherapy drugs by tumors and destroy microscopic cancer cells that remain in the abdomen after surgery. 

Intraperitoneal chemotherapy: This treatment delivers chemotherapy directly to the abdominal cavity every few weeks via an intraperitoneal port placed either at the time of surgery, during a second surgery or by radiology.

Preventative options

Patients who are concerned about their risk of ovarian cancer may wish to talk to the care team about whether preventive surgery may be an option. A patient may be a candidate for preventive surgery to reduce her ovarian cancer risk if:

• She has a strong family history of ovarian or breast cancer.
• She has hereditary mutations that carry a high risk of ovarian cancer, such as Lynch syndrome or Peutz-Jeghers syndrome.
• She has a BRCA1 or BRCA2 mutation.
• She has a previous breast, colorectal or endometrial cancer diagnosis. 

Fertility preservation and ovarian cancer

Patients who wish to preserve their fertility should talk to the ovarian cancer surgical oncology team, who may be able to remove only the affected ovary if clinically indicated. Patients battling more complex diseases may not be candidates for this option. At City of Hope, we can discuss a variety of fertility-sparing procedures with patients, including retrieving and freezing eggs.

Recovering from ovarian cancer surgery

Patients may remain in the hospital for up to a week following ovarian cancer surgery. The care team will monitor the patient to ensure she doesn’t experience adverse effects, and pain control medications will be administered to make the patient comfortable.

How long it will take before resuming normal activities varies from patient to patient. In most cases, patients should avoid lifting anything heavy, exercising or having vaginal sex immediately after surgery, and until the care team says it’s acceptable to do these activities again. On average, this may take about six weeks.