Although ovarian cancer can be treated in different ways, surgery is the main part of the treatment process for most people. Surgery is also used to treat cancers of the fallopian tubes or the peritoneum (the inner lining of the abdomen), which are often grouped together with ovarian cancer.

Doctors use surgery for several main purposes when treating ovarian cancer. One goal is diagnosing ovarian cancer. Imaging tests may detect a mass in or near the ovaries, but doctors don’t know whether the mass is cancerous until they perform surgery.

Another goal is determining the ovarian cancer stage (how far the cancer has spread). During surgery, doctors may perform several biopsies, in which they remove small samples of tissue to be more closely studied under a microscope. This helps doctors know whether cancer cells have spread and determine which tissues contain cancer.

Finally, doctors may use surgery to remove as much cancer as possible.

Types of Ovarian Cancer Surgery

A person with ovarian cancer may have several different types of surgery during the treatment process. Sometimes, a person may need multiple surgeries.

Initial Surgery

Surgery may begin with a minimally invasive procedure to diagnose a mass. Minimally invasive surgeries involve making tiny incisions in the abdomen. These procedures include a laparoscopy (a surgery in which doctors view the inside of the abdomen using a small camera) or a robotic surgery (a surgery where doctors use robotic controls to make precise movements and guide cameras and instruments). A laparoscopic or robotic surgery often heals more quickly than a surgery that requires a large incision.

During this initial surgery, doctors may take biopsies and have them immediately analyzed to find out whether cancer is present. If no cancer or suspicious area is found, then the surgery is complete. If pathologists see cancer cells or other concerning areas, doctors may continue with additional surgery right away to remove more tissue and check how far tumors have spread.

One MyOvarianCancerTeam member shared their experience with initial surgery: “I went into surgery thinking it was only a cyst on my ovary and woke up from the biopsy with the doctor saying to me that I had ovarian cancer.”

Debulking Surgery

The process of removing as much cancer tissue as possible is called debulking surgery. Debulking may happen during initial surgery, or it may occur later, during a second procedure. The surgeon uses debulking surgery to take out tumors and remove all or part of any organs that contain cancer cells. Taking out all visible tumors can lead to better treatment outcomes.

Surgeries to remove specific organs or tissues go by different names. People with ovarian cancer may need:

• Unilateral salpingo-oophorectomy — Removal of one ovary and one fallopian tube
• Bilateral salpingo-oophorectomy — Removal of both ovaries and fallopian tubes
• Hysterectomy — Removal of the uterus
• Omentectomy — Removal of the omentum (fatty tissue that covers the abdominal organs)
• Appendectomy — Removal of the appendix
• Colectomy or small bowel resection — Removal of part of the large intestine or small intestine
• Lymphadenectomy or lymph node dissection — Removal of lymph nodes (small structures that help filter out germs and cancer cells)

Doctors may also need to remove parts of the bladder, liver, diaphragm, or spleen.

Some of these procedures affect fertility. If you have surgery to remove your uterus, you will no longer be able to become pregnant. If you have both ovaries and fallopian tubes removed, you may still have the option of getting pregnant through procedures like in vitro fertilization.

Some ovarian cancers — such as stromal tumors and early stage epithelial and germ cell tumors — often occur in only one ovary. These cancers may be able to be treated with a unilateral salpingo-oophorectomy, which leaves the uterus, one ovary, and one fallopian tube in place, preserving the ability to get pregnant.

If you are interested in having children in the future, talk to your doctor about how ovarian cancer surgery will affect your fertility and if you are a candidate for fertility-sparing surgery.

Surgery To Insert a Chemotherapy Port

Chemotherapy port surgery is sometimes helpful for people who are going to go through chemotherapy treatments. Some forms of chemotherapy are liquids that need to be injected into a vein. Repeated chemotherapy treatments may mean many needle pricks. In some cases, doctors can instead use surgery to implant a small port that gives direct access to a vein, bypassing the need for needle sticks with each chemotherapy treatment. The port is a thin tube. On one end, the port is inserted into a vein. On the other end, the port contains an opening at the skin. A port is much less painful than repeated punctures of a vein to get blood for testing or to administer chemotherapy drugs.

Chemotherapy ports may also be used for intraperitoneal (IP) chemotherapy. IP chemotherapy involves delivering drugs directly into the abdominal cavity through a port. This treatment may be an option for people with advanced ovarian cancer who are in good health and have had all visible tumors removed during surgery.

Several members of MyOvarianCancerTeam have had surgery to implant a port. One recommended it to others: “This surgery is not too difficult, and it is so worth it. It is so much better than having to poke around looking for veins. Oncology nurses are so good at accessing the port, and no one else knows it is even there.”

What To Expect Before Ovarian Cancer Surgery

Before deciding to have surgery, your gynecologic oncologist should explain the procedure to you and inform you about possible benefits and risks. Then, you will have to give informed consent — you will have to sign documents saying that you understand the surgery and that you give your doctors permission to perform it. During this process, you should ask your doctor any questions you have about the procedure, side effects, or recovery process.

Your doctor may ask you to make some lifestyle changes before undergoing surgery. For example, cigarette smoke, blood thinner medications, and alcohol may increase risk of problems during surgery. Your doctor may ask you to avoid these things before your procedure.

Surgery can lead to problems for people with underlying health conditions. To make sure you are healthy enough for surgery, your doctor may have you undergo blood, urine, heart, or lung tests.

Usually, people undergo surgery before receiving other ovarian cancer treatments. However, some people may receive chemotherapy treatments before surgery. This treatment option helps shrink tumors before they are removed. Doctors may recommend chemotherapy before surgery for people who have advanced cancer, in cases where the tumors would be hard to remove with surgery alone, or if the person is not healthy enough to undergo a long surgery.

Preparing for Surgery

Your surgeon will give you instructions to follow in the days before surgery. If your instructions are unclear, contact your health care team to learn more. Instructions may include:

• Stopping eating at a certain time before surgery
• Avoiding drinking liquids after a specific time
• Taking a laxative before surgery
• Cleaning your skin with antiseptic solution

Once you arrive at the hospital or surgical center, your health care team will help you further prepare for surgery. You will need to change into a hospital gown and may receive additional medications. Once it is time for surgery, you will receive general anesthesia to help you fall into a deep sleep.

Recovering From Ovarian Cancer Surgery

After waking up from surgery, you will probably experience abdominal pain. Your doctor can prescribe medication to help control this pain. One MyOvarianCancerTeam member recommended staying on top of these medications: “My second surgery, I took my pain meds as prescribed the first 72 hours and recovery was much easier! The first time I tried to do without the pain meds and recovery was much harder.”

You may wake up with several tubes going into different parts of your body. Tubes could include an intravenous drip into your arm or hand, a catheter inserted in your bladder, or a tube in your abdomen. As you start to feel better, these tubes will gradually be taken out.

Some minimally invasive surgeries may come with a quicker recovery time. You may be able to leave the hospital the day of surgery. More extensive surgeries will require you to stay in the hospital for several days.

Your doctor will give you further instructions to help keep yourself healthy as you recover at home. It may take two months or more to heal from surgery. Your doctor may tell you to:

• Get plenty of rest.
• Take time off of work.
• Avoid physical activity, including lifting heavy objects or driving, for several weeks or months after surgery.
• Stop having sexual intercourse for six weeks or more.
• Care for any wounds in your skin and/or vagina that were caused by surgery.
• Eat nutritious foods to help your body recover.
• Take short walks to help avoid side effects and heal more quickly.

One MyOvarianCancerTeam member underwent a hysterectomy and had many tissues removed during debulking surgery. They wrote, “I healed pretty well. I made it a point to keep moving and went outside every day to breathe in fresh air.”

It may take a while to heal from surgery. However, some people feel so sick before surgery that they quickly have a better quality of life once the procedure is done. “I felt better after surgery, and I was so sick before for about six months,” reported one member. Another who had undergone surgery a month prior said, “I am healing well. I have a good day or two, then I need to rest a day … . I feel like myself most of the time and don’t even think about the word ‘cancer.’”

Surgery Side Effects

If you have had both ovaries removed, you will immediately go into menopause if you haven’t already. The ovaries are responsible for making reproductive hormones, so once they are removed, levels of the hormones estrogen and progesterone will drop. This may lead to menopause symptoms like:

• Hot flashes or night sweats
• Vaginal dryness
• Decreased sex drive
• Mood changes, including depression or anxiety
• Increased risk of heart disease or osteoporosis (a disease in which the bones are weakened)

Surgery also comes with other risks. Possible side effects include blood clots, infections, serious bleeding, or organ or tissue damage. These events are rare, but they do happen. Your surgeon can tell you more about potential health problems that may happen as a result of surgery.

During the recovery process, contact your health care team right away if you have a fever, chills, bleeding, breathing problems, changes in urination, pain in unexpected places, or pain that isn’t going away.

Receiving Other Cancer Treatments

After undergoing surgery, many people will need to have additional ovarian cancer treatments. People with epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer often receive chemotherapy following surgery. People with advanced-stage ovarian cancer or with tumors that contain certain gene changes may also receive targeted therapy medications. Occasionally, radiation therapy is also an option.

Chemotherapy is also generally recommended following surgery for those with germ cell tumors. People with stage 2, stage 3, or stage 4 stromal tumors may need chemotherapy or hormone therapy.

Some people with early-stage epithelial ovarian cancers, as well as early-stage fallopian tube and peritoneal cancers, may not need any additional treatments following surgery. Stage 1 stromal tumors are also usually treated with surgery alone. However, people with very large or high-grade (fast-growing) stromal tumors may need chemotherapy.

Follow-Up Visits

If ovarian cancer is successfully treated, you will need to have regular follow-up visits with your cancer care team. Your doctor may recommend regular exams and blood tests to look for signs that the cancer has returned.

Talk With Others Who Understand

MyOvarianCancerTeam is the social network for people with ovarian cancer and their loved ones. On MyOvarianCancerTeam, more than 3,300 members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Do you need surgery for ovarian cancer? Share your experiences in the comments below, or start a conversation by posting on your Activities page.