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Surgery for ovarian cancer
Surgery is the primary treatment for all types of ovarian cancer. Surgery is used to:
- accurately stage the disease
- completely remove the tumour
- remove as much of the tumour as possible (debulking) before using other therapies
- lessen pain or ease symptoms (palliative treatment)
The type of surgery done depends mainly on the size and stage of the cancer. Other factors may also determine which type of surgery is done, such as the type of ovarian cancer and a woman’s wishes to have children in the future. Several different procedures may be done during surgery to remove as much of the ovarian cancer as possible. Surgical staging will be done along with these procedures. Side effects of surgery depend on the type of surgical procedure.
Ovarian cancer is staged during surgery. Accurate staging of ovarian cancer is very important because the stage will determine the type and length of treatment given after surgery. Some women who appear to have early stage disease (stage I) are assigned a higher stage (stage II or III) after surgical staging.
Surgical staging includes:
- removing ascites (an abnormal buildup of fluid in the abdomen)
- examining all surfaces in the pelvis and abdomen
- scraping the surface of the diaphragm for biopsy
- biopsy of any areas that look like cancer
- washing the abdominal cavity (peritoneal lavage) and sending the fluid to the laboratory to look for cancer cells
- Abdominal washing is done if there is no ascites present.
- removing some pelvic and abdominal lymph nodes for biopsy
- removing most or all of the omentum (the fatty tissue that covers the abdominal organs)
- examining the ovary that doesn’t contain cancer
- In early stage ovarian cancer, the other ovary (the one that doesn’t have cancer) may be left in place if a younger woman wishes to have children in the future.
- If the other ovary appears normal on careful inspection, it is left undisturbed.
- If the other ovary looks abnormally large, the surgeon will take a biopsy sample or remove the cystic area, while leaving as much of the normal ovarian tissue as possible.
A total hysterectomy and bilateral salpingo-oophorectomy (BSO) is the most common surgical procedure used to treat ovarian cancer. This surgery removes the uterus, cervix, both ovaries and both Fallopian tubes.
Ovarian cancer spreads by seeding cancer cells throughout the abdomen and pelvis. Reducing the amount of cancer left behind after surgery improves a woman’s prognosis.
Primary surgical debulking
Primary surgical debulking (also called cytoreductive surgery) removes as much of the ovarian tumour as possible during the first surgery to treat ovarian cancer. The goal is to reduce any remaining ovarian tumours to less than 1 cm. Primary surgical debulking may include:
- bilateral salpingo-oophorectomy with total hysterectomy
- removing the omentum (omentectomy)
- removing small tumours from the surface of the diaphragm
- removing part of the diaphragm
- removing the spleen (splenectomy)
- removing the gallbladder (cholecystectomy)
- removing part of the following:
- large intestine or small intestine (called a bowel resection)
- removing pelvic and abdominal lymph nodes
The surgeon may also place a catheter in the abdominal wall so that chemotherapy drugs can be given directly into the abdominal cavity (intraperitoneal or IP chemotherapy).
Interval surgical debulking
Interval debulking surgery may be done after 2–4 cycles of chemotherapy, if the ovarian cancer responded to the drugs. It may be offered to women:
- if primary debulking surgery did not remove all or enough of the tumour
- who have advanced ovarian cancer and there is too much cancer to remove with primary debulking surgery
- Chemotherapy may shrink the tumours to make it safer and easier for the surgeon to remove them.
A salpingo-oophorectomy removes the ovary and Fallopian tube. Salpingo-oophorectomy may be bilateral (the ovaries and Fallopian tubes on both sides are removed) or unilateral (only one ovary and one Fallopian tube on one side are removed).
A cystectomy is removal of a cyst. This type of surgery may be done in women who have some early stage tumours in one ovary and a cyst in the other ovary and who want to have children in the future.
Some surgical procedures may be done to reduce symptoms and relieve pain from advanced or metastatic ovarian cancer:
- paracentesis – a thin needle or tube is inserted through the skin into the abdominal cavity to remove fluid
- thoracentesis – a hollow needle is inserted through the skin and between the ribs into the pleural cavity (the space between the lungs and the walls of the chest) to remove fluid
- placement of a gastrostomy (feeding) tube – a thin, flexible tube is placed into the stomach or intestines
- placement of a tube (stent) in the small or large intestine to relieve a blockage caused by a tumour (a colostomycolostomyA surgical procedure to create a stoma (artificial opening) from the colon to the outside of the body through the abdominal wall. may be done if the colon cannot be repaired after a blockage is removed)
- placement of a stent in the ureter to relieve a blockage caused by a tumour (a ureterostomyureterostomyA surgical procedure to create a stoma (artificial opening) from the ureter to the outside of the body through the abdominal wall. may be done if the ureter cannot be repaired after the blockage is removed)