Surgery for ovarian cancer

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1 This information is an extract from the booklet Understanding cancer of the ovary. You may find the full booklet helpful. We can send you a free copy see page 8. Contents About surgery About surgery Type of surgery Before your operation After your operation Going home Surgery is one of the main treatments for cancer of the ovary, and may sometimes also be needed to make the diagnosis. A specialist gynaecological oncologist will do your operation. Your doctor and specialist nurse will talk to you about the most appropriate type of surgery for your situation. This often depends on the stage of the cancer its size and whether it has begun to spread Sometimes information about the stage of the cancer only becomes available during the operation itself, or afterwards when the pathologist (a specialist who advise on the type and extent of the cancer) examines the tissue that was removed. Your surgeon and specialist nurse will talk to you about the possible options before the operation. It may help to look at the diagrams on pages 2 when reading this information. Questions about cancer? Ask Macmillan Page 1 of 8

2 Organs close to the ovaries Kidney Ureter Lymph node Fallopian tube Omentum Lymphatic vessel Rectum Ovary Bladder Urethra Womb Vagina Side view of the body Liver Peritoneum Stomach Omentum Bowel Spine Peritoneal space Womb Ovary Bladder Rectum (back passage) Page 2 of 8 Questions about cancer? Ask Macmillan

3 Types of surgery Surgery to remove the ovaries and womb The aim of this operation is to remove all of the cancer. It involves removing: the ovaries and fallopian tubes (called a bilateral salpingo oophorectomy or BSO) the womb and cervix (called a total abdominal hysterectomy or TAH) the omentum, which is the fatty layer that covers the bowel (called an omentectomy). During the operation, the surgeon takes biopsies from other tissues and may remove some of the lymph nodes in the abdomen and pelvis. This is to check whether the cancer has spread. The surgeon will also put fluid into the abdomen, remove it and then test it for cancer cells. Doctors call this abdominal or peritoneal washing. Fertility-conserving surgery Women with a borderline tumour or stage 1a ovarian (a borderline tumour or very early stage (stage 1a), slow growing (low grade) ovarian cancer) cancer may be able to have surgery that allows them to remain fertile (able to get pregnant). It may be possible for the surgeon to remove only the affected ovary and fallopian tube. This means you may be able to become pregnant and have children in future. During the operation, the surgeon checks the other ovary and may take a sample from it. They also remove lymph nodes and take washings and samples (biopsies) from the pelvis and abdomen. If the washings and biopsies show the cancer has spread, unfortunately it means you need a second operation. The most effective treatment is to remove the womb, omentum and remaining ovary and fallopian tube. Removing as much of the cancer as possible When cancer has spread to other areas in the pelvis or abdomen, the aim of surgery is to try to remove as much of the cancer as possible. Doctors may call this debulking surgery. Questions about cancer? Ask Macmillan Page 3 of 8

4 If scan results show the cancer has spread, your surgeon will discuss this type of operation beforehand. If, when removing the ovaries and womb, the surgeon finds the cancer has spread they usually try to remove as much of the cancer as possible. Removing part of the bowel Some women have some of their bowel removed. If you are likely to need bowel surgery, your surgeon or specialist nurse will talk to you about this before the operation. You may need some bowel removed if the cancer has started to grow on the outside of the bowel. If possible, the surgeon removes the affected piece of bowel and rejoins the two remaining pieces together. Rarely, the surgeon cannot rejoin the two ends of bowel. In this situation, the upper end of the bowel is brought out onto the skin of the abdomen to form a stoma. You wear a bag over the stoma to collect stools (bowel motions). If this happens, you will be given a lot of support from your hospital team and a specialist stoma nurse to help you to cope. Before your operation Before your operation, you will have some tests to prepare you for surgery. These tests are usually done a few days or weeks beforehand at a pre-assessment clinic. A member of the surgical team and a specialist nurse will discuss the operation with you. You ll also be visited by the doctor who will give you your anaesthetic (the anaesthetist). You ll usually be admitted to hospital on the morning of your operation. You ll be given special elastic stockings (TED stockings) to wear during and after the operation to prevent blood clots forming in your legs. Make sure that you talk to your nurse or doctor about any questions or concerns that you have about the operation. If you smoke, try to give up or cut down before your operation. This will help reduce your risk of chest problems, such as a chest infection, and will help your wound to heal after the operation. Your GP can give you advice and you may find it helpful to read our booklet Giving up smoking. Page 4 of 8 Questions about cancer? Ask Macmillan

5 Some hospitals follow an enhanced recovery programme. This aims to reduce the time in hospital and to speed up your recovery. It also involves you more in your own care. For example, you ll be given information about diet and exercise before surgery and any arrangements needed for you to go home will be put in place for you. Your doctor will tell you if an enhanced recovery programme is suitable for you and if it s available not all hospitals follow this. After your operation You ll be encouraged to start moving about as soon as possible. The nurses will help you to get out of bed the day after your operation. While you re in bed, it s important to move your legs regularly and do deep breathing exercises to help prevent chest infections and blood clots. A physiotherapist or nurse will explain how to do these. Back on the ward To begin with you ll be given fluids into a vein in your hand or arm, called a drip or an intravenous infusion. Once you re eating and drinking normally again, the drip is taken out. You usually have a tube (catheter) put in during the operation. This drains urine from your bladder. It may be taken out shortly after your operation but may sometimes need to stay in for longer. Pain You ll have some pain and discomfort after your operation, but your doctor will prescribe painkillers to control this. If you re in pain or feel sick, let the nurses know. They can give you medicines to relieve sickness and adjust the dose or type of painkiller to suit you. You may have painkillers through a pump attached to a fine tube (cannula) placed in a vein in your hand or arm. This is called patient-controlled analgesia (PCA). It allows you to release painkillers when you need it by pressing a button. The machine is set so you always get a safe dose and can t have too much. Questions about cancer? Ask Macmillan Page 5 of 8

6 Or, you may have an epidural. This is a fine tube that is put in your back to give a continuous dose of painkillers. This stops you feeling pain in your tummy and pelvic area without making you drowsy. Always let your doctor or nurse know if the pain is not controlled, so that your painkillers can be changed. Wind and constipation Some women have difficulty opening their bowels or have uncomfortable wind for a few days after the operation. Tell the nurses if you have this. They can give you medicines to relieve discomfort and constipation. Constipation and wind usually get better once you re up and moving around more. Drinking plenty of fluids and eating high-fibre foods can also help ease constipation. Your wound You usually have staples or stitches removed after about seven days. A district nurse or practice nurse can do this after you go home. Sometimes dissolving stitches are used. Going home Most women are able to go home 3 7 days after their operation. This will depend on the operation you had and how quickly you recover. Before you go home you ll be given an appointment for the out patient clinic to see the surgeon and specialist nurse. They check your wound is healing properly and you are recovering well. They will also tell you more about the results of your operation and any further treatment you might need. This is a good opportunity to ask questions and to discuss any problems. If you have any difficulties or worries before your appointment, phone your ward nurses or hospital doctor. Page 6 of 8 Questions about cancer? Ask Macmillan

7 Physical activity You ll still be recovering for some time after you go home and will need to take things easy for several weeks. It can take three months or more to fully recover, and longer if you re having chemotherapy as well. Avoid strenuous exercise or heavy lifting for at least 12 weeks. Your physiotherapist or specialist nurse will give you advice about this. Build up your energy levels gradually. Taking regular walks is a good way of doing this. You can increase the amount you do as you feel able. Driving How soon you can drive will depend on the extent of the surgery you ve had and how quickly you recover. You ll need to feel comfortable wearing a seatbelt and be able to carry out an emergency stop if necessary. Some insurance policies give specific time limits, so it s a good idea to contact your insurance company to check you re covered before driving again. Sex life You may not feel physically or emotionally ready to start having sex again for a while. Most women are advised to wait at least six weeks after the operation. It may take longer than this for your energy levels and sex drive to return. If you have any worries or concerns, you can discuss them with your specialist nurse. You may also find it helpful to contact support organisations such as Ovacome (visit ovacome.org.uk or call ). You could also call the Macmillan Support Line on Some women worry that cancer could be passed on to their partner during intercourse. This is not true and it s perfectly safe to continue having sex. Questions about cancer? Ask Macmillan Page 7 of 8

8 Early menopause If you were still having periods before your operation, having your ovaries removed will bring on an early menopause. This may cause physical changes such as hot flushes, vaginal dryness, lowered sex drive (libido) and mood changes. The Daisy Network (visit daisynetwork.org.uk) supports women who have had an early menopause. Fertility Fertility is a very important part of many people s lives, and not being able to have children can seem especially hard when you already have cancer to cope with. It can help to discuss your feelings with a partner, relative or close friend, or with your specialist nurse. Your specialist nurse or GP can usually arrange counselling for you. We can send you more information about cancer and fertility. More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding cancer of the ovary, or any other cancer information, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN MAY 2015 Planned review in 2017 Page 8 of 8 Questions about cancer? Ask Macmillan

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