Surgery Overview

A hysterectomy is the removal of your uterus. The goal of the initial surgery is to remove all visible ovarian cancer. Surgery confirms the diagnosis and how far the cancer has spread. It is also the initial treatment for the cancer. Having an experienced gynecologic oncologist will help you get the best possible treatment and live longer than having a doctor who doesn't have as much experience treating ovarian cancer.^{footnote 1}

Surgery for ovarian cancer usually includes:

• A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
• Taking a sample of peritoneal fluid (peritoneal washings) from the abdominal (belly) cavity, to look for cancer cells.
• Removing and checking the pelvic and aortic lymph nodes, to see if the cancer has spread.
• Checking the abdominal organs and tissues for cancer cells. Biopsies may be done.
• Removing and checking the fatty tissue (omentum) attached to some of the abdominal organs, to see if the cancer has spread.
• An appendectomy, which removes your appendix.

Your long-term outcome (prognosis) depends on the type and stage of your cancer, your age, your overall health, and the amount of cancer that remains after surgery.

What To Expect

Feeling better after surgery takes time. Most women are in the hospital 1 or 2 days after the surgery. Some women stay in the hospital up to 4 days.

When you get home, make sure you move around, but also be sure you don't do too much. You can walk around the house and up and down stairs, but take it slow. During the first 2 weeks, it's important to get plenty of rest. Even after you start to feel stronger, you should not lift heavy things (anything over 10 kilograms). Also, you should not have sex until your doctor says it's okay. It usually takes 4 to 6 weeks to get back to a normal routine.

Chemotherapy, which uses medicines to kill cancer cells, is recommended after surgery for most stages of ovarian cancer. Chemotherapy is usually started 1 to 4 weeks after surgery.

After a hysterectomy, call your doctor if:

• You have bright red vaginal bleeding that soaks one or more pads in an hour, or you have large clots.
• You have foul-smelling discharge from your vagina.
• You are sick to your stomach or cannot keep fluids down.
• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the incision.
  • Pus draining from the incision.
  • Swollen lymph nodes in your neck, armpits, or groin.
  • A fever.
• You have pain that does not get better after you take pain medicine.
• You have loose stitches, or your incision comes open.
• You have signs of a blood clot, such as:
  • Pain in your calf, back of knee, thigh, or groin.
  • Redness and swelling in your leg or groin.
• You have trouble passing urine or stool, especially if you have pain or swelling in your lower belly.
• You have hot flashes, sweating, flushing, or a fast or pounding heartbeat.

Your doctor will give you specific instructions after your hysterectomy. Be sure to follow them. Usually, getting some rest and following those instructions will help problems after surgery diminish over time.

Why It Is Done

Ovarian cancer develops in one ovary but can spread to the other ovary, the uterus, and the other abdominal organs too. The goal of the first surgery is to remove all visible cancer. The surgery confirms the diagnosis and how far the cancer has spread.

How Well It Works

Surgery may be the only treatment needed for women with early-stage ovarian cancer and low risk of the cancer progressing. This includes women whose surgery showed no tumour cells in the abdomen or in the capsule surrounding the ovary.

Risks

Most women do not have complications after a hysterectomy. But complications that may occur include:

• Fever. A slight fever is common after any surgery.
• Difficulty urinating or not being able to control your urine (urinary incontinence).
• Continued heavy vaginal bleeding. Some vaginal bleeding for 4 to 6 weeks following a hysterectomy is expected. But call your doctor if bleeding continues to be heavy.
• The formation of scar tissue (adhesions).

Other complications may include:

• Infection.
• Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolus).
• Injury to other organs, such as the bladder or bowel.
• A collection of blood at the surgical site (hematoma).

You may develop other physical problems after a hysterectomy. In some women, the pelvic muscles and ligaments that support the vagina, bladder, and rectum may become weak. The weakness may cause bladder or bowel problems, such as cystocele, urinary incontinence, or rectocele. Kegel exercises may help strengthen the pelvic muscles. And some women need other treatments, including additional surgery.

Vaginal dryness may develop from the removal of your ovaries and the loss of the hormones (estrogen and progesterone) that the ovaries make. If sexual intercourse is painful because of vaginal dryness:

• Use a vaginal lubricant, such as K-Y Jelly or Astroglide, or a polyunsaturated vegetable oil that does not contain preservatives. If you are using condoms, use a water-based lubricant, rather than an oil-based lubricant. Oil can weaken the condom so that it breaks. Avoid petroleum jelly (for example, Vaseline) as a lubricant, because it increases the risk of vaginal irritation and infection.
• Use a low-dose vaginal estrogen cream, ring, or tablet, which will reverse vaginal dryness and irritation by affecting only the vaginal area. If you are having other menopausal symptoms, talk to your doctor about systemic estrogen therapy (ET) and other treatment options. To learn more about treatment, see the topic Menopause and Perimenopause.