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.
Staging
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 taken out to see if they contain cancer 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 cancers at different stages are treated differently. If the staging isn't done correctly, the doctor may not be able to decide on the best treatment.
Debulking
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. Patients who have had successful debulking surgery have a better outlook than those left with larger tumors after surgery.
It is important that your surgeon is experienced in ovarian cancer surgery. Many gynecologists and surgeons are not trained to do the staging and debulking procedures that are necessary in treating ovarian cancer. For this reason, experts recommend that patients see a gynecologic oncologist for surgery. Gynecologic oncologists are specialists who have training and experience in treating ovarian cancer, and know how to stage and debulk ovarian cancer properly. Women with ovarian cancer who don't have the right surgery the first time may need to go back to the operating room for more surgery later to stage and debulk the cancer.
Sometimes the surgeon will need to remove a piece of colon in order 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, though, the ends can’t be sewn back together right away. Instead, the top end of the colon is attached to an opening (stoma) in the skin of the abdomen to allow body wastes 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. For more information, refer to our document, Colostomy: A Guide.
Debulking surgery may also involve 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 for a time after surgery until the bladder recovers enough to be able to empty on its own. Then, the catheter can be removed.
Debulking may also require removing the spleen and/or the gallbladder, as well as part of the stomach, liver, and/or pancreas.
Removing both ovaries and/or the uterus means that 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.
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