The BC Cancer Agency describes the objective of surgery as:
to reduce the residual disease to the lowest possible level. The literature has consistently shown that women who undergo optimal debulking surgery have a more favourable prognosis. Ideally the patient should be reduced to no visible residual disease after primary surgery. Survival advantage can also be seen for patients reduced to less than 2 centimetre size of largest residual nodule. Bowel resection and aggressive approach to peritoneal disease may be required to achieve this objective.
Surgery has usually been the first step in treating ovarian cancer.
- Surgery (laparotomy) helps the doctor identify the mass and whether it is malignant or benign
- The standard treatment for ovarian cancer is surgical removal or "debulking" of the cancer: the surgeon will try to remove as much of the tumor as possible – preferably less than 1cm should be left, because smaller tumors respond better to chemotherapy
Some possible outcomes for surgery for ovarian cancer:
- A non-cancerous pelvic mass – even a solid mass seen on an ultrasound can be benign
- Ovarian cancer that appears to be confined to the ovaries or pelvis; it has not spread to other organs such as the liver or small intestine
- A type of ovarian cancer called "low malignant potential"; this type of ovarian cancer has a high rate of cure, even if it is diagnosed at an advanced stage - this type is usually diagnosed in younger women
- Ovarian cancer that has spread to other organs
Knowledge is Power: Surgery
Depending on how much the cancer has spread, one or both ovaries will be removed along with one or both fallopian tubes. The uterus, cervix and omentum (the thin tissue that surrounds the stomach and other organs in the abdomen) may also be removed along with lymph nodes. Usually the surgeon removes as much of the visible tumor as possible (debulking). This reduces the amount of tumor that will be treated by chemotherapy or radiation later.
For additional information, the American Cancer Society has an excellent website that explains the surgery and treatment for ovarian cancer in simple, non-medical terms.
Surgery for ovarian cancer should be performed by a gynaecologic oncologist. You will need a referral from your family doctor or gynecologist to be seen by a gynecologic oncologist.
A gynecologic oncologist is a specialist with five years of postgraduate training in obstetrics and gynecology plus an additional two years of cancer training. He/she will manage the treatment (surgery and chemotherapy). Besides working at a cancer centre, gynecologic oncologists are likely to teach in association with a university and to be involved with research.
There are better outcomes for ovarian cancer when surgery is performed by a gynaecologic oncologist: time to possible recurrence and survival time are lengthened.
Preferably surgery will be performed by a Gynecological Oncologist, and is performed for the following purposes:
Diagnostic - The surgeon is able to identify the nature of the mass: whether it is malignant or benign.
Location - Where the disease is located, i.e. the ovaries, fallopian tube or liver.
Extent - The extent of the disease; if a malignancy is found, surgery will help to find out if the disease has spread. This is called staging.
Sample - A sample of the tumor can be taken which will enable the surgeon to find out more – the type of tumor and grade. Some tumors are more aggressive than others and this information will help the oncologist plan the best treatment.
Therapeutic - Women who undergo optimal debulking surgery – which means the cancer is removed completely or down to less than 2cm tumors have a more favorable prognosis. During surgery, the surgeon looks for all signs of cancer in the abdomen and tries to reduce as much of the tumor as possible. This makes it more likely that chemotherapy and/or radiation can kill the remaining cancer cells.
Surgery is usually the first step in treatment for ovarian cancer. Surgery (laparotomy) will help the doctor identify the mass and determine whether it is malignant or benign (not cancerous).
It will also determine the location of the tumor and the extent of its spread. This assists in staging the tumor. Biopsies will be taken to confirm the diagnosis and to assist in grading the tumor.
Questions to ask before your surgery
- What will the operation involve?
- What are the risks of this kind of surgery?
- What will be done to keep the risks at a minimum?
- What kind of scar can I expect?
- What can I expect to feel like after surgery?
- How long will I need to stay in the hospital after surgery?
- What kind of medication will I have for pain?
- If someone is waiting for me to come out of surgery, where do they wait and how are they notified?
- How soon after surgery can they be with me?
The doctor and nursing staff will be able to help you answer these questions.
Questions to ask after your surgery
- Where has the cancer been found?
- What organs have been removed?
- How will this affect me?
- When can you tell me about the grade and stage of cancer?
- What do you recommend for further treatment?
- What changes in my body can I expect in the weeks after surgery?
- When will I be able to carry on with normal activities after surgery – such as driving the car, going to work, lifting heavy objects, caring for children, and so on?
- What possible complications from surgery should I be aware of once I get home?
Recovery may take about 6-8 weeks, depending on a number of factors such as your general state of health before the operation, and how extensive and complex the surgery was.
Get all the rest you need – it will help your recovery.
Your recovery period will vary according to many factors, such as:
- Your general state of health prior to surgery
- The extent and complexity of your surgery
- Assuming you have no serious complications such as infection, you will normally go home within a week after the surgery
Post-op (two weeks after your surgery) you may experience:
- Vaginal bleeding or discharge
- Urinary tract frequency and urgency
- Incision problems
- Gastrointestinal problems
- Decreased libido
- Increased feelings of stress, anxiety or depression
- Increased depressive symptoms
- Pain and swelling
- Rash or itching
After Surgery Recommendations
After surgery for ovarian cancer, your treatment choices include:
- Chemotherapy and/or radiation; chemotherapy can also be given before surgery (neoadjuvant chemotherapy)
- Complementary therapies
- A combination of complementary therapy and chemotherapy
- Wait and see, monitor your symptoms and be closely followed by your physician
Some women may not need chemotherapy because their cancer was either:
- Low Malignant Potential (which is not as aggressive) or
- It was caught at an early stage and chances are extremely high that they will not have a recurrence
There are many different types of chemotherapy protocols. Your treatment will depend on the type of ovarian cancer and the stage – how far it has spread.
Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) is a very controversial topic for women and is something you need to discuss with your physician. There is a great deal of conflicting evidence and it is difficult to make a decision, especially as a recent study indicated that estrogen replacement therapy for ten or more years after menopause may indeed be a risk factor for ovarian cancer.
Scientific studies have indicated that estrogen replacement therapy does not adversely affect the disease-free interval or survival in women who have or have had ovarian cancer.
Estrogen replacement therapy (ERT) may have some advantages as it can improve quality of life with women after surgical menopause. In certain cases, ERT may be given to women with ovarian cancer who are suffering from or are at a high risk of debilitating menopausal symptoms, osteoporosis, and coronary heart disease. The benefit of ERT to those women in terms of their end quality of life appears to outweigh the risk of cancer recurrence.
Estrogen Replacement Therapy: Site Specific Information
The relationship between estrogen and ovarian cancer is obscure. It is known that there are both estrogen and progesterone receptors present in many epithelial ovarian tumours. Unfortunately, the effects of exogenous hormones on these receptors are not well known. There is no evidence that estrogen has either the potential to promote recurrence or to decrease the time to recurrence.
In the absence of scientific evidence to the contrary, it is not felt necessary to withhold estrogen replacement therapy from any symptomatic woman with ovarian malignancy regardless of risk category. - BC Cancer Agency
Depending on the spread of the disease, the cancer may have affected other abdominal organs. Speak with your surgeon about:
- the extent of the cancer,
- what was affected, and
- what was removed, i.e. one or both ovaries, other organs, etc.
Some helpful terms about gynecological surgery
The term "hysterectomy" refers to removal of the uterus only. Radical hysterectomy refers to removal of the uterus, the cervix, the upper part of the vagina, and supporting tissues.
Other gynecological surgery terms include:
- Salpingectomy - removal of the fallopian tubes
- Oophorectomy - removal of the ovary
- Bilateral Oophorectomy - removal of both ovaries
- Omentectomy - removal of the omentum, the layer of fat that hangs over the intestines
- Laparotomy - this procedure involves an incision through the abdominal wall and is essential to diagnose and stage ovarian cancer
Always ask your doctor to explain what has been removed and anything that is not clear about the surgery. The nurse assigned to you is also an excellent resource.