Surgery is often the first treatment for cancer of the ovary, and may sometimes also be needed to make the diagnosis. Your doctor will discuss with you the most appropriate type of surgery, depending on the type and size of your cancer and whether it has spread. Sometimes this information only becomes available during the operation itself, and so it’s important to discuss all the possible options with your doctor before the operation.

If the cancer is in the early stages, surgery may be all the treatment that‘s needed. It‘s usually necessary to make a cut in the skin and muscle of the abdomen (a laparotomy). The ovaries, fallopian tubes and the womb are then removed. This is called a total abdominal hysterectomy and salpingo-oophorectomy.

In young women with borderline tumours, or low-grade, stage 1a cancer (see staging and grading) it may be possible to remove only the affected ovary and fallopian tube, and leave the womb and unaffected ovary. This will mean that you will be able to have children in the future. Women with stage 1b and 1c cancer, or those who have had their menopause, or don’t want any more children, will usually be advised to have both ovaries and the womb removed.

The surgeon may remove a layer of fatty tissue called the omentum, which is close to the ovaries (an omentectomy). They will also take samples from other tissues, such as the lymph glands, to see if the cancer has spread. The surgeon will also put fluid into your abdomen and send some of it to be tested for cancer cells. This is known as an abdominal washing.

If it is unclear before surgery what stage the cancer is, the surgeon may remove just the affected ovary and fallopian tube and take a number of biopsies and abdominal washings. Depending on the results of the biopsies and washings, further surgery to remove the womb and remaining ovary and fallopian tube - sometimes called completion surgery - may be needed.

Chemotherapy is usually given after surgery if it wasn’t possible to remove all the tumour, or if there is a risk that some cancer cells may have been left behind.

If ovarian cancer has already spread, an operation to remove both ovaries, the fallopian tubes and the womb (total abdominal hysterectomy and salpingo-oophorectomy), and as much of the tumour as possible will be done. This is known as de-bulking surgery. The surgeon will also take biopsies or remove some of the lymph nodes in the abdomen and pelvis. They may also have to remove the omentum, the appendix and part of the lining of the abdomen (the peritoneum). This operation can be complicated and should ideally be done by a specialist gynaecological oncologist.

If the cancer has spread to the bowel, a small piece of bowel may be removed and the two ends joined together. Rarely the two ends can’t be rejoined and the upper end of the bowel will be brought out onto the skin of the abdomen. This is known as a colostomy and the opening of the bowel is known as a stoma. A bag is worn over the stoma to collect the stool (bowel motions). Your doctor or specialist nurse will discuss this with you.

Chemotherapy is usually given after the operation to try and kill any cancer cells that couldn’t be removed.

Sometimes a second operation will be done after three or four cycles of chemotherapy, as it may now be possible to remove the remaining cancer. This is known as interval de-bulking surgery.

It may be possible to have an operation to remove some of the cancer. However, sometimes surgery isn’t possible if the cancer is very advanced, or if a woman isn’t well enough for a major operation. Chemotherapy, and occasionally radiotherapy are the main treatments used for women in this situation.

After your operation you will be encouraged to start moving about as soon as possible and you will usually be helped to get out of bed the next day. While you are in bed, it’s important to move your legs regularly and do deep breathing exercises to help prevent chest infections and blood clots. You will be shown how to do the exercises by a physiotherapist or specialist nurse. You will also be given some stockings to wear that help to prevent blood clots in your legs.

A drip (intravenous infusion) will be used to give you fluids until you are able to eat and drink again, which is usually the next day. Many women are able to eat light meals after about 48 hours.

You may have a small tube called a catheter, which is put into the bladder and drains your urine into a collecting bag. This will be removed after a day or two.

You are also likely to have a drainage tube in your wound to drain excess fluid into a small bottle. This is usually removed after a few days.

It is quite normal to have some pain or discomfort for a few days but this can be controlled with effective painkillers. The anaesthetist will often discuss pain control with you before your operation. If the pain is not controlled, it is important to let your doctor or nurse know as soon as possible so that your painkillers can be changed.

Most women are able to go home 5–10 days after their operation, once the stitches or clips have been taken out. If you think you might have problems when you go home (for example, if you live alone or have several flights of stairs to climb), let the nurse or social worker know when you are admitted to the ward so that help can be arranged. Your nurse specialist can offer or arrange support or counselling for you and your family. Social workers are often available to give practical advice. Many are also trained counsellors. If you would like to talk to a social worker you can ask your specialist nurse to arrange it for you.

Before you leave hospital you will be given an appointment to attend an outpatient clinic for your post-operative check up. This is a good time to discuss any problems you may have. If you have any problems or worries before this time, you can phone your ward nurses or hospital doctor.

You will need to avoid strenuous physical activity or heavy lifting for at least three months. You will also be advised not to drive for about six weeks after your operation and may find it uncomfortable to wear a seatbelt for some time. It’s best not to start driving until you are comfortable wearing a seatbelt as a passenger first. Some insurance companies have guidelines about this, and you can contact your own company or the DVLA (Drivers and Vehicles Licensing Association) for advice.

One of the common questions women ask after a hysterectomy is whether the operation will affect their sex life. To allow the wound to heal properly, most women are advised to wait at least six weeks after their operation before having sexual intercourse. Many women have no problem in having a sexual relationship after this time. However, others find that the surgery has shortened their vagina and slightly changed its angle. This can mean that they have different sensations and responses during sex. If this occurs it can be upsetting. Women who have this effect may take time to come to terms with their feelings and any physical effects such as pain. Your specialist nurse can help you if you are having problems after your surgery.

One common fear is that cancer can be passed on to your partner during intercourse. This is not true and it is perfectly safe for you to continue to have a sexual relationship.

In younger women who are still having periods, removing the ovaries will bring on an early menopause.

The physical effects of this may include:

• hot flushes
• dry skin
• dryness of the vagina, which can make sexual intercourse uncomfortable
• reduced sexual desire.

Lubricants such as Aquaglide, Senselle®, Sylk® or Replens MD® can be bought from most chemists and can ease any discomfort during intercourse.

Some women may be prescribed hormone replacement therapy (HRT) following treatment for ovarian cancer. This can help to reduce some of the problems caused by the menopause. You can discuss with your doctor whether taking HRT would be helpful.

Younger women in particular, often find it difficult to come to terms with the fact that they can no longer have children after a hysterectomy. They may also be worried that they have lost a part of their female identity. These are very natural, understandable emotions to have at this time. It can help to discuss any fears or worries with a sympathetic friend or with the specialist nurse. Counselling can be arranged either by the hospital or through your GP. There are also support organisations that can help.

We have information on cancer and fertility which you may find useful.