Types of Ovarian Cancer Surgery
- Biopsy/Excision: To confirm whether a tumor is malignant
- Staging: To locate and determine whether or how far the cancer has spread inside the abdomen and pelvis
- Debulking: The goal is to remove all visible tumor
- Cancers that are more optimally debulked have a better prognosis
Doctors have a variety of treatments for ovarian cancer which can be used in some combination or sequence including surgery, chemotherapy, and more recently, PARP inhibitors. Because ovarian cancer symptoms can be subtle, the disease has often spread significantly by the time you see your doctor. As a result surgery can be a common initial treatment. "The type of surgery really depends on how much the cancer has spread," says Dr. Amer Karam, gynecologic oncologist at Stanford University.
Read MoreStaging Surgery
Your doctor will assign your cancer a stage from one to four. The higher the number, the further the cancer has spread. Knowing the stage can help guide your treatment. "We frequently will use imaging like CT scans, MRIs, and PET scans to get an idea of how far the cancer has spread, but obviously, we'll need to have confirmation of that with surgery or biopsies," Dr. Karam says.Surgery to stage the cancer starts with an exploratory procedure. The surgeon looks inside your abdomen and pelvis for signs of cancer, and removes biopsies–samples of tissue and fluid–to test for cancer.
The procedure can be performed through one large vertical incision in your abdomen (exploratory laparotomy), or a minimally invasive approach, through a few small incisions in the abdomen (exploratory laparoscopy). During a laparoscopy, the surgeon inserts a flexible tube with a camera on one end (laparoscope) through one of the small incisions to view the area.
While you're still in the operating room, the fluid and tissue samples go to a pathologist in a laboratory. "The grading is performed by the pathologist and it's determined by the pathologist, looking at the cancer under the microscope to see how aggressive it looks," Dr. Karam adds.
For early-stage ovarian cancers, where there is one mass and the cancer hasn't spread, staging surgery is usually the best approach. "For that surgery, usually the ovary that’s involved is removed or both ovaries are removed, along with probably the uterus," Dr. Karam says.
Some lymph nodes in the pelvis and abdomen may also be removed and biopsied, to see whether the cancer has spread outside of the ovary into the abdomen or other areas. In addition, the omentum a layer of fatty tissue that covers the abdominal organs may be removed if the cancer has spread there as well.
Debulking Surgery
If the surgeon discovers that your cancer is more aggressive or it has spread outside your ovaries into your abdomen or to other organs, you'll continue with a more extensive surgery to remove as much of the cancer as possible. This is called debulking surgery and it often requires an open approach with a larger incision.
During the procedure, the surgeon will examine your entire abdominal and pelvic area for signs of cancer. "The goal is to remove all of the cancer that you could see or feel, wherever it has spread to," Dr. Karam says. "And this may involve removing parts of the diaphragm, removing parts of the intestines, sometimes parts of the liver. Sometimes the spleen is removed."
When you no longer have any signs of cancer in your abdomen, or no remaining tumor is larger than 1 centimeter (less than half an inch), your cancer is considered "optimally debulked." People whose tumors have been optimally debulked typically have a better prognosis than those with larger tumors left behind.
For the most part, doctors say, surgery for ovarian cancer is a safe surgery, especially when it's done with skilled hands and in institutions that know how to care for cancer patients.
Recovery from Ovarian Cancer Surgery
Understandably, many women are concerned about how much pain they will be in after their operation. Though there's no such thing as painless surgery there are many ways to decrease discomfort. Doctors will often use a variety of methods to manage incisional pain.
After surgery, doctors say that generally speaking, they prefer that pain be managed with non-narcotic medications which can make patients feel fuzzy and sleepy, and mean they may not be up and walking around as much as doctors would like.
Recovery time can often be six to eight weeks though patients are encouraged to get up and move around as soon as possible after surgery. While it may be difficult at first, it's been shown that the sooner patients are moving the better they'll usually feel, and the faster they tend to recover.
Learn more about SurvivorNet's rigorous medical review process.