Surgery

During ovarian cancer surgery, doctors attempt to remove all visible tumors (tumor debulking). Patients whose surgery was performed by a gynecologic oncologist have better outcomes than patients whose surgeons were not oncologists, including improved survival and longer disease-free intervals.

To remove a suspicious mass, a doctor makes a long incision in the wall of the abdomen in a surgical operation called a laparatomy. If ovarian cancer is found, the doctor will remove, depending on the extent of the spread:

• Both ovaries and fallopian tubes (salpingo-oophorectomy)
• The uterus (hysterectomy)
• The omentum, a thin fatty pad of tissue that covers the intestines
• Nearby lymph nodes
• Samples of tissue from the pelvis and abdomen
• Fluid in the abdomen for analysis
• As much cancer that has spread, as possible, in a process called debulking
• If the stage appears early, laparoscopy or minimally invasive surgery may be appropriate

For a younger woman with earlier ovarian cancer, she may elect, with the guidance of her physician, to have only one ovary and fallopian tube removed along with the omentum, so she can remain fertile, if she wants children.

Some women who are elderly, too weak or have other medical conditions are treated with chemotherapy before surgery to shrink the tumors as much as possible. If the woman improves with the chemotherapy, surgery is then done to remove as much cancer as possible. Chemotherapy then follows.

Pain medications are available after surgery to address discomfort. The time it takes to heal after surgery can vary among women, but usually you will spend several days in the hospital. It can take several weeks before you can return to normal activities and until chemotherapy will begin.

Removing the ovaries will cause early menopause in younger women who have not yet gone through menopause and occurs because the ovaries are no longer present to make female hormones. Menopausal symptoms include hot flashes, vaginal dryness and night sweats. Drugs and lifestyle changes can help symptoms, which mostly will go away or lessen in time.

The National Cancer Institute suggests asking your doctor these questions about surgery

• What kind of surgery do you recommend for me? Will lymph nodes and other tissues be removed? Why?
• How soon will I know the results of the pathology report? Who will explain them to me?
• How will I feel after surgery?
• If I have pain, how will it be controlled?
• How long will I be in the hospital?
• What are some of the possible long-term effects of the surgery?
• How might the surgery affect my sex life?
• How much will the surgery cost? Will my health insurance cover it?

Tips from our community about what to expect during and after surgery

Sometimes the most helpful hints come from patients who been through it already. We asked OCRA’s Woman to Woman peer support program mentors, and Staying Connected virtual support series participants, what they wish they know before surgery. Here are their tips.

• Most will have numb abdomen post- surgery, feel little discomfort on the first day. 
• Hospitals are busy, noisy, with lots of bedside visits but try and rest as much as possible.
• Some need a lot of help the first days after surgery while others are able to get around on their own. Consider planning for a family member or friend to stay with you the first days after surgery. 
• Ask your doctor if an abdominal binder would be helpful.
• At discharge, plan on wearing a waist-free dress or larger elastic pants with a button up shirt. A pillow in between yourself and seatbelt can make the ride home easier. 
• Stay ahead of the pain- take your medications on time.
• Keep a log of symptoms, when you take your medication, and when the next dose is. 
• Light meals like smoothies and soup can be helpful and nourishing. 
• Pelvic floor Physical Therapy is helpful. Your body had trauma post-surgery. 
• Radical surgery may result in surgical menopause- link here
• Surgery shut bowels down and it takes time for things to return to normal. 
• Walk, walk, walk