Surgery for ovarian cancer

The most efficient treatment for ovarian cancer is a combination of chemotherapy and surgery. Both ovaries will be surgically removed, usually together with the uterus and omentum (fatty tissue).

If you want to have children and your illness hasn’t progressed too far, we may be able to preserve the uterus and one ovary. Your surgeon won’t know whether this is an option for you until the operation.

Surgery for ovarian cancer - what to expect?

Before your surgery, you will be invited to come in for a preoperative screening. Right before the operation, you will receive an epidural which will numb your lower body, or general anesthetics, so you will be unconscious during the procedure.

Ovarian surgery is an open surgery that is performed through an incision in the abdomen. This incision will run between your pubic bone up to the sternum. This is necessary to allow your surgeon to inspect the lower abdomen. Your surgeon will remove the uterus, both ovaries, and the omentum.

Your surgeon will remove as much tumor tissue as possible. This means that parts of your intestines, liver, or bladder might need to be removed if your tumor has spread to these organs.

For some patients, additional surgery would not be safe. If this is the case for you, you will receive chemotherapy before your surgery in order to shrink the tumor as much as possible. Afterwards we will see if your tumor can be surgically removed after all.

Effectiveness

The tumor may be removed in its entirety after the surgery. Sometimes, however, tumor tissue remains in the body, and will need to be treated with chemotherapy.

In some cases, the tumor tissue is so expansive that your surgeon cannot remove a sufficient amount. If this is the case for you, chemotherapy will be your primary treatment. You will start chemotherapy, or – if you have already received chemotherapy – continue receiving adjusted chemotherapy. Once the tumor has decreased in size, another surgery will be scheduled to see if the tumor can be removed after all.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General and local anesthesia

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side-effects

Removal of the uterus and ovaries will affect your fertility. Removal of ovaries will precipitate menopause. You may experience hot flashes, excessive perspiration, and temperature fluctuations.

Depending on your age, you may need hormone replacement therapy, or we can give you suggestions for lifestyle adjustments that can help you maintain bone density.

oor het verwijderen van de baarmoeder en de eierstokken wordt u onvruchtbaar en u komt u vervroegd in de overgang. Hierdoor kunt u last krijgen van ‘opvliegers’, overmatige transpiratie en u kunt het afwisselend warm en koud hebben. Afhankelijk van uw leeftijd kan hormoon vervanging nodig zijn of krijgt u leefregels om uw botdichtheid zo goed mogelijk te houden.

After the procedure

You will need care over the first few days following your surgery. We will check your pulse, blood pressure, and blood loss.

It may take some time before you can continue your day-to-day activities. Please make sure to get plenty of rest during your recovery. You will be invited for follow-up screenings for 5 years after your surgery.

Fertility preservation before the start of treatment

Treatment for ovarian cancer may negatively affect your fertility levels, which is why the Netherlands Cancer Institute, in collaboration with the Amsterdam UMC, location AMC and the LUMC, offers fertility preservation. Treatment can induce early menopause. Your practicing physician will discuss your options in preventing or treating menopausal symptoms with you.

Surgery for ovarian cancer

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