Ovarian Cancer Surgery

Ovarian cancer starts in the ovaries. Ovaries are part of the female reproductive system. Normally, women have two ovaries, one on each side of the uterus. These produce eggs and the hormones estrogen and progesterone.

Ovarian cancer is most common in women who have had the menopause (usually over the age of 50), although it can affect women of any age. If ovarian cancer is left untreated, it can spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

There are basically three types of ovarian cancer, depending on the type of cell where cancer begins:

  • Epithelial tumours, which affect the thin surface layer of the ovaries. About 90 per cent of ovarian cancers is epithelial tumours.
  • Stromal tumours, which affect the hormone-producing cells of the tissue lining the ovaries. About 7 per cent of ovarian tumours is stroma.
  • Germ cell tumours, which affect the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

Surgery and chemotherapy are generally used to treat ovarian cancer.

 

Symptoms of ovarian cancer

Ovarian cancer may not show specific symptoms in early stages. These symptoms may be similar to those of less severe conditions such as irritable bowel or pre-menstrual syndrome.
Signs and symptoms of ovarian cancer may include:

  • Abdominal bloating or swelling.
  • Quickly feeling full when eating, or feeling nauseous.
  • Weight loss.
  • Persistent pelvic and abdominal pain.
  • Changes in bowel habits, such as constipation.
  • A frequent need to urinate.
  • Bleeding from the vagina.
  • The build-up of fluid around the lungs, which may cause shortness of breath.

If any of these symptoms persist, try keeping a diary to record how many of these symptoms you have over a longer period. Consult your GP if you have these symptoms regularly (on most days for three weeks or more).

 

Diagnosis of ovarian cancer

If your doctor suspects that you might have ovarian cancer based on your symptoms, he/she is likely to perform the following tests:

  • Pelvic exam coupled with an ultrasound examination.
  • Blood test for cancer-related markers [a protein (CA 125) found on the surface of ovarian cancer cells].
  • A biopsy is usually done by a gynecologic oncologist. The doctor takes a sample of the suspected ovary and the stage or presence of the condition is then analyzed by a pathologist.

 

Staging ovarian cancer

Your doctor usually uses a biopsy sample to determine the stage of cancer and how far cancer has spread. The stage of the cancer is determined by the following markers:

  • Stage I- Cancer is confined to one or both ovaries.
  • Stage II – Cancer has spread to other parts of the pelvis.
  • Stage III – Cancer has spread to the abdomen.
  • Stage IV – Cancer has spread to organs outside the abdomen.

Staging is extremely important because ovarian cancers at different stages are treated differently. If the staging is not done correctly, your doctor may not be able to decide on the best treatment.

 

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

  • Bleeding.
  • Infection.
  • Bone thinning.
  • Difficulty in urinating and bowel movements.
  • Premature menopause (if both ovaries are removed).
  • Hot flashes.
  • Vaginal dryness.
  • Lingering risk of cancer.
  • Increased risk of heart disease.
  • Decreased sex drive.
  • Depression or anxiety.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

 

Before the procedure

  • Your doctor will explain the surgical procedure to you. Ask any questions that you might have about the procedure. The surgery helps in determining the stage of your cancer, and the treatment options based on it. Be sure you understand what the extent of the surgery is likely to be and what you should expect afterwards. For instance, hysterectomy (removal of the uterus) ends your ability to become pregnant.
  • If you have to take chemotherapy after surgery, talk to your doctor before surgery to discuss benefits and risks.
  • You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • Your doctor will go through your full medical history. Based on your medical condition, your doctor may request other specific tests or examinations.
  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anaesthetic agents (local and general).
  • Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • You will be asked to fast for eight hours before the procedure, generally after midnight. This is because the procedure is performed using a general anaesthetic (you are put to sleep). You may be able to have occasional sips of water until two hours before the operation.
  • Your doctor may request a blood test before the procedure to determine how long it takes your blood to clot.
  • If you smoke, you should stop smoking as soon as possible prior to the procedure. Quitting smoking may improve your chances for a successful recovery from surgery and benefit your overall health status.

Based on your medical condition, your doctor may request other specific preparation.

 

During the procedure

Ovarian surgery requires a stay in the hospital. Procedures may vary depending on your condition and your doctor’s practices.

Generally, ovarian surgery follows this process:

  • You will be asked to remove clothing and put on a hospital gown.
  • You will be positioned on the operating table.
  • An intravenous (IV) line may be started in your arm or hand.
  • A urinary catheter may be inserted.
  • If there is excessive hair at the surgical site, it may be clipped off.
  • Ovarian cancer surgery is performed either under general anaesthesia (you are asleep throughout the procedure). The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  • The skin over the surgical site will be cleansed with an antiseptic solution.
  • Based on the stage of your cancer, the procedure will probably involve removing:

a). One or both ovaries and the fallopian tubes (a unilateral or bilateral salpingo-oophorectomy) – If the cancer is confined to one or both ovaries, you may only need to have the ovary or ovaries removed, leaving your womb intact. This means you may still be able to carry a pregnancy. During a traditional (open) oophorectomy, the surgeon makes an incision in your abdomen to access your ovaries. The surgeon separates each ovary from the blood supply and tissue that surrounds it and removes the ovary. The nearby fallopian tubes are also removed since they share a common blood supply with the ovaries. The procedure may also be done through laparoscopy using a tiny camera. Laparoscopic surgery involves making three or four small incisions in your abdomen.
b). The womb (a total abdominal hysterectomy)- To perform the hysterectomy, your surgeon makes a cut (incision) in your lower abdomen, using a vertical incision, which starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone. Your uterus and cervix are removed. It can also be performed through an incision in the vagina (vaginal hysterectomy) or by a laparoscopic or robotic surgical approach — which uses long, thin instruments passed through small abdominal incisions.
c). The momentum, a fatty layer of tissue within the abdomen (an omentectomy)– A long vertical incision is made on the abdomen.

  • The surgeon may also remove the lymph nodes from your pelvis and abdomen, and samples of nearby tissue, to find out whether cancer has spread. If it has spread, the surgeon will try to remove as much of it as possible. This is known as “debulking surgery”.Sometimes the surgeon will need to remove a piece of the colon to debulk cancer properly. In some cases, a piece of the 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 to get 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. Debulking may also require removing a piece of the bladder/spleen/gallbladder/stomach/liver/pancreas.
  • 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.
  • The incision will be closed with stitches or surgical staples.
  • A drain may be placed in the incision site to remove fluid.
  • A sterile bandage or dressing will be applied.

 

After the procedure

In the hospital

After the surgery, you will be taken to the recovery room for observation. Your blood pressure, pulse, and breathing will be monitored and depending on how stable and alert you are, you will be taken to your hospital room. Most women will stay in the hospital for 3 to 7 days after the operation.

At home

Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
You will be given medication by your doctor to relieve pain. Be sure to take only recommended medications.
Notify your doctor to report any of the following: Fever; redness, swelling, bleeding, or other drainages from the incision; increased pain near the incision; and numbness and/or tingling sensation at the surgical site. Your dietician will advise you on the diet if there are any changes.
You should not drive until your doctor tells you to. Full recovery from the surgery may take several weeks. Be prepared to take it very easy for the first couple of weeks at least. You should spend most of your time resting with your feet up and avoid standing for more than a few minutes at a time. Gradually build up a routine with gentle exercises to regain your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. But be aware that you will probably still get tired very easily. Discuss the types of exercise that are suitable for you with your gynaecological oncologist or physiotherapist.
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Recovery

How long it takes to recover from ovarian cancer surgery depends on the type of procedure performed. Expect to resume everyday activities within six to eight weeks of surgery.
You will probably have a follow-up with your surgeon about 7 to 14 days after the surgery to go over the results of your pathology report and talk about any further treatment. If you need more treatment, your doctor may refer you to:

  • A radiation oncologist to discuss radiation treatments, which may be recommended if there was a large tumour or traces of cancer were found in other areas.
  • A medical oncologist to discuss other forms of treatment after the operation, such as chemotherapy.
  • A counsellor or support group to help you cope with having ovarian cancer.

You should be able to start driving again anytime from a month after your surgery. You may also be having other cancer treatment, such as chemotherapy or radiotherapy, which may slow your recovery down. See how you feel and take things at your own pace.