Diagnosis of ovarian cancer often involves surgery to confirm a malignancy and to determine if the tumors have spread. During this exploratory surgery, your surgeon may have removed all or part of the tumor or performed other surgical procedures to limit the damage from the cancer.
Kinds of surgery
Here are some of the procedures that you may undergo either in the diagnosis or the treatment phase of your care. Be sure to ask your surgeon or the staff about concerns or questions you may have about your surgery.
Tumor DebulkingWhen you undergo exploratory surgery and ovarian cancer is found, your surgeon will try to completely remove the tumor. In some situations, he or she will debulk the tumor or tumors by removing as much of them as possible. The goal is to leave small tumors no larger than 1 cm. These small, debulked tumors will be more sensitive to the chemotherapy or radiation therapy.
OophorectomyOophorectomy is the surgical removal of one or both of the ovaries. When the cancer is caught early, the surgeon may remove only one ovary. If the cancer has spread beyond one ovary, however, debulking usually requires removal of both ovaries and their adjoining fallopian tubes (salpingo-oophorectomy),
Before surgery, the doctor may:
- Order blood and urine tests.
- Order an ultrasound or x rays to help with the surgery.
- Have you undergo a colon preparation, if extensive surgery is anticipated.
- Have you meet with the anesthesiologist for evaluation.
- Oophorectomy is done under general or regional anesthesia.A vertical incision is made in the abdomen.
- The abdominal muscles are stretched apart, not cut, so that the surgeon can see the ovaries.
- The surgeon will check surrounding tissue for evidence of disease.
- The ovaries, and often the fallopian tubes, are removed.Oophorectomy can sometimes be done with a laparoscopic procedure. This procedure has the advantage of a shorter recovery time.
- A tube containing a tiny camera and light is inserted through a small incision in the navel.The surgeon can see the abdominal cavity on a video monitor. When the ovaries are detached, they are removed though a small incision.
- The ovaries can also be cut into smaller sections and removed.
You can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.
LymphadenectomyLymphadenectomy, also called lymph node dissection, is a surgical procedure in which lymph glands are removed from the body and examined for the presence of cancerous cells.
The lymphatic system and lymph nodes play an important role in the spread of cancer. Cancer cells can break away from their primary site of growth and travel through the bloodstream or lymphatic system to other sites in body. They may begin to grow at these distant sites or in the lymph nodes themselves. By removing and testing the lymph nodes, doctors can determine if a cancer has begun to spread. Removal of the lymph nodes may prevent further spread of abnormal cells.Although the specific surgical procedure may differ according to which lymph nodes are to be removed, some steps are common among all lymphadenectomies.
- An incision is made into the skin and through the subcutaneous layers.
- The lymph nodes are identified and isolated.
- The nodes are removed from the surrounding tissues.
- The incision is closed with a drain left in place to remove excess fluid from the surgical site.
- After removal, the lymph nodes will be tested for the presence of cancerous cells.
Sentinel node biopsyTo prevent the removal of normal lymph nodes, your surgeon may perform a sentinel node biopsy. When lymph fluid moves out of a region, the sentinel lymph node is the first node it reaches. The theory is that if cancer is not present in the sentinel node, it is unlikely to have spread to other nearby nodes.
LaparotomyA laparotomy is a common surgical method for obtaining a biopsy and if cancer is found, examine the extent of the cancer and to remove or reduce the size of tumors..
A laparotomy requires a hospital stay. What to expect with in-patient surgery will provide you with the information you'll need before and after your surgery.
- Your surgeon cuts through the superficial layers of skin, subcutaneous fat, muscles and abdominal cavity. Retractors hold the incision open.
- Your surgeon then looks for any signs of cancer.
- Biopsies or tissue samples may be taken for testing.
If a tumor is found your surgeon will:
- Remove the entire tumor, if advisable
- A portion of the tumor may be removed to debulk the mass.Debulking makes the tumor more sensitive to chemotherapy.
- A pelvic washing may be performed.A sterile fluid is washed around the abdominal organs and withdrawn. The fluid is analyzed for the presence of abnormal cells, which may indicate that the cancer has begun to spread
- The organs and related structures are returned to their normal anatomical position.
- The incision will be stitched closed. The layers of the abdominal wall are sutured in reverse order, and the skin incision closed with sutures or staples.Discharge from the hospital may occur in as little as one to two days after the procedure depending on the complexity of your surgery.
Once home, you'll be asked to watch for indications of infection such as:
- Redness or swelling around the incision
- Worsening painOmentectomyOmentectomy is the surgical removal of the omentum, the membrane that supports and protects the abdominal cavity. Often, the procedure is performed as part of other surgery if the ovarian cancer has spread to the omentum.