Surgery is usually the first step in treating ovarian cancer and it should be performed by a surgeon with experience in gynecology and oncology. Most surgery is performed using a procedure called a laparotomy during which the surgeon makes a long cut in the wall of the abdomen. Occasionally, early stage ovarian cancer can be managed by laparoscopic surgery whereby a small (1/2” to 3/4” incision is made in the belly button or lower abdomen. Laparoscopic surgery sometimes can also be performed on women with advanced ovarian cancer.

If ovarian cancer is found, the gynecologic oncologist performs the following procedures:

For staging, the omentum (or e loon), a fatty pad of tissue that covers the intestines, is removed along with nearby lymph nodes, and multiple tiny samples of tissues from the pelvis and abdomen.

If the cancer has spread, the gynecologic oncologist removes as much cancer as possible. This is called “debulking” surgery. Often this will involve extensive surgery, including removal of portions of the small or large intestine, and removal of tumor from the liver, diaphragm and pelvis. Removal of as much tumor as possible is one of the most important factors affecting cure rates.

If you have early Stage I cancer, and still hope to get pregnant, it may be possible to only remove one ovary and fallopian tube. Your future pregnancy wishes should be discussed with your gynecologic oncologist before surgery.

Side Effects of Surgery
Some discomfort is common after surgery. It often can be controlled with medicine. Tell your treatment team if you are experiencing pain. Other possible side effects are:

Talk with your doctor if you are experiencing any of the side effects listed above.

Surgical Staging
When ovarian cancer is diagnosed, it is vital to determine if the cancer has spread beyond the ovaries. Your treatment team may do more tests to determine if the cancer has spread. In addition, during surgery, certain additional steps should be performed to determine the extent of the disease. This process is called staging. Staging helps to determine the exact extent of your cancer and what treatment plan is best for you.

Following surgery, your cancer will be categorized into one of the following stages:
Stage I: The cancer is found in one or both ovaries. Cancer cells also may be found on the surface of the ovaries or in fluid collected from the abdomen.
Stage II: The cancer has spread from one or both ovaries to other tissues in the pelvis, such as the fallopian tubes or uterus. Cancer cells may also be found in fluid collected from the abdomen.
Stage III: The cancer has spread outside the pelvis or nearby lymph nodes.
Most commonly the cancer spreads to the omentum (an apron of fatty tissue that hangs down from the colon and stomach), diaphragm, intestine and the outside (surface) of the liver.
Stage IV: The cancer has spread to tissues outside the abdomen and pelvis. Most commonly the cancer has spread to the space around the lungs. If the cancer spreads inside the liver or spleen, it is considered stage IV.