Although ovarian cancer can be treated in different ways, for most people, surgery is the main treatment. 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 purposes when treating ovarian cancer. One goal is to diagnose ovarian cancer. Imaging tests may detect a mass in or near the ovaries, but doctors may not 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

Treatment for ovarian cancer may involve several different types of surgery, and in some cases, more than one procedure.

Initial Surgery

Surgery may begin with a minimally invasive procedure to diagnose an ovarian tumor. Minimally invasive surgeries involve making tiny incisions (cuts) in the abdomen. These procedures include laparoscopy (a surgery in which doctors view the inside of the abdomen using a small camera) or robotic surgery (a surgery in which doctors use robotic controls to make precise movements and guide cameras and instruments). People who have laparoscopic or robotic surgery often heal faster than those who need a large incision. That said, these procedures should only be considered for people who have a low risk of ovarian cancer or to evaluate if people with advanced ovarian cancer could be candidates for debulking surgery (discussed below).

During this initial surgery, doctors may take biopsies and have them tested immediately to check for cancer. 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 the 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 the initial surgery, or it may happen later, during a second procedure. The surgeon uses debulking surgery to take out tumors and remove all or part of any organs that have cancer. Taking out all visible tumors can lead to better treatment outcomes.

The names of surgeries vary depending on which organ or tissue is removed. 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)
• 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 with donor eggs or previously frozen eggs through procedures like in vitro fertilization.

Some ovarian cancers — such as stromal tumors and early-stage epithelial and germ cell tumors — often affect just one ovary. In some cases, these cancers may be treatable with a unilateral salpingo-oophorectomy (which leaves the uterus, one ovary, and one fallopian tube in place), so you may still be able to get pregnant. This procedure is called fertility-sparing surgery.

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

Surgery To Insert a Chemotherapy Port

Having a port implanted is sometimes helpful for people who are going to go through chemotherapy treatments. Some forms of chemotherapy are given as liquids that need to be injected into a vein. Repeated chemotherapy treatments may mean many needle sticks. In some cases, doctors can instead use surgery to implant a small port that gives direct access to a vein, so you don’t need needle sticks with each chemotherapy treatment.

The port is a thin tube attached to a small reservoir or chamber that sits under your skin. On one end, the port is inserted into a vein. On the other end, the port contains an opening underneath the skin. A port is much less painful than repeated punctures of a vein to get blood for testing or to administer chemotherapy drugs.

Another chemotherapy modality is 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’s so worth it. It’s 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’s even there.”

What To Expect Before Ovarian Cancer Surgery

Before making the decision 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’ll 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, smoking, blood thinners, and alcohol may increase the risk of complications during surgery. Your doctor may ask you to avoid these before your procedure.

Surgery can lead to problems for people with underlying health conditions. To make sure you’re 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’re 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 isn’t 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 healthcare team to learn more. Instructions may include:

• Not eating at a certain time before surgery
• Not drinking liquids after a specific time
• Taking a laxative before surgery
• Cleaning your skin with a special cleanser

Once you arrive at the hospital or surgical center, your healthcare team will tell you what you need to do. You’ll need to change into a hospital gown and may receive additional medications. Once it’s time for surgery, you’ll receive anesthesia. General anesthesia puts you to sleep while local anesthesia numbs you. Your healthcare team will discuss your anesthesia options ahead of time based on the type of ovarian cancer surgery.

Recovering From Ovarian Cancer Surgery

After waking up from surgery, you’ll 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, 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 same day as your 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 heavy lifting for several weeks or months after surgery.
• Avoid driving for a specific length of time.
• Stop having sexual intercourse for up to eight weeks.
• Care for any wounds in your skin 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 a lot of tissue 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’ve had both ovaries removed, you’ll immediately go into menopause if you haven’t already. The ovaries are responsible for making reproductive hormones, so once they’re 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 (weakening of the bones)

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 healthcare 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 after surgery. People with advanced-stage ovarian cancer or with tumors that contain certain gene changes may also receive targeted therapy medications.

Chemotherapy is also generally recommended after surgery for those with ovarian germ cell tumors. People with stage II, stage III, or stage IV 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 I 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, your doctor might recommend 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

On MyOvarianCancerTeam, the social network for people with ovarian cancer and their loved ones, 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? Which type of ovarian cancer surgery are you going to have? Share your experiences in the comments below, or start a conversation by posting on your Activities page.