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Ovarian Cancer

Surgery for ovarian cancer

Surgery may be the first treatment for ovarian cancer, and is sometimes needed to make the diagnosis, or may follow a course of chemotherapy (aimed at shrinking the cancer). Surgery is done through a cut in the abdomen (tummy) - what is removed and how this is done depends upon the size and spread of the tumour (cancer). Sometimes this is not known before the operation, and sometimes the surgeon does not know whether the tumour is malignant (cancerous) or benign until it has been removed and examined in detail. Laparoscopic surgery can be used for staging of early ovarian cancer. This ensures a quicker recovery and avoids a large scar.

If the cancer is in the early stages, removal of one or both ovaries may be enough treatment. Younger women who have only one ovary removed may still be able to have children. More commonly the the womb (uterus) and cervix are removed as well as both ovaries and fallopian tubes (total abdominal hysterectomy TAH and bilateral salpingo-oophorectomy BSO). The surgeon may also remove the fatty tissue lining the abdomen (the omentum) and may take other samples to check if the cancer has spread.

 

Describes how she only had a cyst and one ovary removed.

Describes how she only had a cyst and one ovary removed.

Age at interview: 47
Sex: Female
Age at diagnosis: 35
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The cyst was removed and the ovary that it was attached to, which I always forget which one it was, whether it was the right or the left, but it was one. That's all I had removed. The other ovary, uterus, because they didn't see any sign of it having spread, not that they were thinking it was malignant. I mean they just saw a cyst there that had squashed an ovary. So they took out the ovary because it was a bit of a mess I think they described it as. It looked a bit messy and they took out the cyst but there were no signs of anything else there. And as the surgeon said 'we had a good look around'. Imagine (laughing) these people cutting you open and oh yes, having a good old look round. And then I was in hospital for about a week recovering.

Women said that before surgery they had been worried about pain, the side effects of anaesthetic and what the scar would be like, but most had been impressed with the pain control and the speed of healing.

If the cancer has spread to the bowel, a piece of bowel may be removed and the two ends rejoined. More rarely, the bowel may be rerouted through an opening (stoma) onto the front of the abdomen and the stools collected in a bag worn over the stoma. This is called a colostomy, and is often only temporary. Several women had a piece of bowel removed and some were asked to consent to a colostomy in case this was found necessary during the operation. Many women worried about the possibility of a 'stoma', which was sometimes the first thing they felt for when they came round after surgery. (For more on living with colostomies see our bowel cancer site).

 

Her surgeon warned her that he might have to do a colostomy as well as a hysterectomy.

Her surgeon warned her that he might have to do a colostomy as well as a hysterectomy.

Age at interview: 62
Sex: Female
Age at diagnosis: 61
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Anyway the, the next appointment came round the following week and I didn't think the news could get much worse but it did, I was immediately handed over to the gynae-oncologist who said 'your CA125 is off the scale at 5000 plus, this is a particularly aggressive cancer and we propose a hysterectomy and de-bulking, followed by chemotherapy', and he explained precisely what would be done during surgery, and I said 'okay, fine'.

And he did mention, he just threw in casually the word 'stoma' and I, this frightened me and I said 'I do not want a stoma' and he said 'well it could just be temporary'.

During the day I'd had the stoma nurse come round and visit me and she had marked two possible stoma exits on my abdomen but I was willing to have a temporary stoma if it meant, if it gave my system a chance to recover from the cancer.

Sometimes the cancer had spread too much to enable all the affected tissues to be removed. If chemotherapy failed to destroy all the remaining cancer a second operation was sometimes done. One woman had a second operation to remove the omentum where her oncologist feared the cancer might spread. Another had a second operation cancelled because her cancer turned out to be of 'borderline' malignancy and only needed to be watched. 

 

Some of her cancer was left in as it was too difficult to remove.

Some of her cancer was left in as it was too difficult to remove.

Age at interview: 44
Sex: Female
Age at diagnosis: 41
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But anyhow, I had the operation, and in the recovery room the surgeon said to me that I had two large tumours, they were both malignant, but because of the placement of the tumours, he couldn't remove my womb and therefore he only removed my ovaries and all the bits and pieces attached to them, and unfortunately he had to leave some of the tumour behind as well.

This was because - as I remember it - that the tumour was stuck to the bowel and the stomach, and he felt that if he removed that small bit that was left it could cause some damage and maybe I would have had to have a colostomy or something, and he knew that I wouldn't have wanted that.

 

Had a hysterectomy and then a second operation to remove the omentum in case of spread.

Had a hysterectomy and then a second operation to remove the omentum in case of spread.

Age at interview: 54
Sex: Female
Age at diagnosis: 53
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So I had, the cyst was removed, both ovaries, both fallopian tubes, the uterus and cervix were removed. It all went according to plan, it was all straightforward and when the surgeon came to see me afterwards he initially was quite reassuring. He said 'yes, it had been large, the cyst, about the size of an orange but that it had looked and felt like a dermoid cyst'. There were no adhesions and no fluid in the abdomen and the surrounding organs, from what he could see, looked healthy. But he said 'obviously, we'll have to wait for the biopsy results'.  

And when I went for my fourth chemotherapy session the oncologist said that she'd like one of the surgeons to have a word with me. 

He explained to me that when the original hysterectomy had been performed something called the omentum hadn't been removed. Now I mean, I'd got no idea what the omentum was but that was explained to me. And he said 'really' he said 'at this hospital we would really like to remove it'. He said 'I can understand your original surgeon not removing it because he felt reasonably confident that there was nothing to worry about'. He said 'but the omentum and the surrounding lymph nodes are often the first site of any spread of the cancer'. So he said 'we would like you to come in and have that removed'. He said 'I know it means another big operation' he said 'but just to be on the safe side'. So 2 weeks later I went in and I had the omentum removed and everything went well.  

 

Had a second operation cancelled because her doctors decided to monitor her 'borderline' cancer...

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Had a second operation cancelled because her doctors decided to monitor her 'borderline' cancer...

Age at interview: 38
Sex: Female
Age at diagnosis: 33
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The operation was on a Wednesday and I had to check in on Tuesday afternoon. And we got there, I think it was two o'clock check in time on the Tuesday, it must have been about the 26th or something of July, and, just as we were coming in to the ward, the consultant was doing her rounds. And she saw me and she pulled me off into a side room. And at this stage I'm thinking in terms of, I'm checking in for hysterectomy, other ovary out, massive course of chemotherapy. 

She pulled me into a room and said, 'Look, you know, you're not having the operation tomorrow. We have sought a second opinion on the histology from another hospital, and it has come back saying that it's borderline'. And she explained that that meant, as we thought, no treatment, you know, we just monitor it. She said, 'But, you know, I'm keen to get a third opinion, with your permission, I'd like it to go to the international expert, a professor, for the third opinion and, you know, we want to wait to see what he has to say. And that will take a couple of months'. 

And then I went back to work, you know, and sat there and just waited for the third opinion to come through. It finally did in the September '98 and, basically it was in line with the second opinion that this was borderline and it needs to just be monitored. And the advice from the gynaecologist was, 'Well look, you know, it was your original ambition to have children. We really think that you're ultimately going to have to have everything taken out, but want you to basically try and get on with having your children as soon as possible, and, you know, we'd like you to have IVF, try IVF to speed up the process'.

Some women had their first operation done as an emergency to treat a blocked bowel. If the surgeon did not know that ovarian cancer was the cause, a second operation was needed to remove other affected tissues. When surgeons knew the cancer would be difficult to remove, chemotherapy was given before surgery to shrink it and make it easier to remove. 

 

Had two operations: first an emergency operation to unblock her bowel, then a hysterectomy.

Had two operations: first an emergency operation to unblock her bowel, then a hysterectomy.

Age at interview: 61
Sex: Female
Age at diagnosis: 54
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So I had the operation for a blocked bowel and he didn't actually, the surgeon who did that operation didn't, in the course of the operation, find anything that particularly worried him as far as I could gather. And then after the operation he, for some reason, decided that he would send a small piece of tissue for a biopsy and, so I'd kind of come out of the operation, which had been successful, never having heard of a blocked bowel actually before, but suddenly being told that this is quite serious, you know, and can be quite a dire thing to happen, and sort of felt 'oh that's alright then we've got that', when he then came back, very kindly, on the Monday and said that this tissue had actually shown up ovarian cancer cells and he hadn't wanted to tell me on the phone because he didn't want to spoil my weekend.  

So I sort of got over one and then discovered that this was another possibility. So as far as he was concerned he didn't really make it seem as if this was a very serious thing but he wasn't an oncologist. So he gathered round him a gynaecologist, and very fortunately in my area we have an ovarian cancer specialist oncologist, and he recruited him as well so there were three of them on the case.

And the way the oncologist worked was that he preferred to have a full scale hysterectomy first before any chemo was tried. So within three weeks of the operation for the blocked bowel where I had a portion of the bowel taken away, I then went to have a hysterectomy.  

As with any surgery women were not allowed to eat or drink for several hours before the anaesthetic and had to use a strong laxative to purge the bowel the night before the operation.

Many women praised the care they received in hospital but some who were in surgical rather than oncology wards voiced criticisms. Some found it difficult being the only cancer patient on the ward. One who experienced difficulties getting pain relief was moved to an oncology ward. 

 

Criticised the ward environment.

Criticised the ward environment.

Age at interview: 41
Sex: Female
Age at diagnosis: 38
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And what was sad whereas with the local hospital I'd been put in the gynae ward, which was quite sympathetic and, you know, a lot of women were in the same boat in that they were having hysterectomies, we were put on, well I'm not really sure what the ward was but it was to do with bladder and bowels, and it was the most unsympathetic ward I'd ever been on. Not that the nurses or the doctors weren't, it just seemed an inappropriate place to be. You know, it's a mixed ward as well and I just remember things like the smell was hideous, you know, it was quite insurmountable at times. But, you know, you get through that. And again, you know, people jollied each other along.  

 

Being the only cancer patient on the ward was difficult.

Being the only cancer patient on the ward was difficult.

Age at interview: 54
Sex: Female
Age at diagnosis: 53
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I would say the nature of the surgical ward in the hospital where I had the second operation, gynae surgical, very, very busy, lots and lots of different sorts of operations taking place. And I had decided to not wear my wig in hospital because I thought it's too hot, it's going to be too uncomfortable, I'm just going to wear a headscarf. 

And I thought, actually, I was going to be fine about it, you know. People would soon realise she's lost her hair, she's in because she's got cancer, you know, and I thought it wouldn't be a problem.

But actually it was a problem because I was, I mean women get together 'oh what are you in for?'  I was quite open about, you know, why I was there, so it wasn't a problem for me to actually say to other ladies that I'd got cancer, but I felt very self-conscious about the fact that I was wearing a headscarf and that I'd obviously got no hair. And I also felt that once I'd said 'cancer' they felt sorry for me and didn't want to talk about it. And I felt that, I felt that was quite hard actually, because I didn't want them to feel sorry for me but I felt that they did. I mean, I might just have been me over-reacting, I suppose. And I actually found it quite sort of hard to be in a very busy, normal surgical ward, I suppose. But luckily I wasn't in there too long so, you're home before it sort of starts to really get to you.

 

Did not get prompt pain relief after her operation and was moved to a different ward.

Did not get prompt pain relief after her operation and was moved to a different ward.

Age at interview: 49
Sex: Female
Age at diagnosis: 48
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And I had, when I was admitted I went onto the oncology ward and it's a very, very nice ward. They're very caring, very quick with the pain relief if you're not well. But after the operation, because it was a bowel surgeon, I went onto a general medical ward where he had his patients, and there is a significant difference in pain relief in that ward from the oncology ward. Where they have routine times where they bring drugs, you don't get the pain relief when you need it and you ask for pain relief and it doesn't come. This is a very common experience amongst other people that I've talked to.  

There's a lot of things, difficult things about being in hospital. One is the toilets. They don't keep them very clean. It's just very unpleasant. And the drugs, they don't bring them, they often do things like bring you something but leave it out of your reach and you can't get it and so you, you know, you do need back up if you can get it. You also need to be quite articulate to defend yourself and to cope with everything that's happening.  

For a few days after surgery most women are connected to a drip to maintain their body fluids until they can eat and drink again. They may also have a tube put in their bladder to drain their urine, and a drain from their wound to stop excess fluid collecting. It is normal to have some pain for a few days after surgery and some women described feeling ill. One woman felt the nurses made her sit up too soon after her operation, but others were pleased to achieve milestones such as sitting, getting out of bed and taking a shower.

 

Describes her experiences of catheters, drains and drips after her operations.

Describes her experiences of catheters, drains and drips after her operations.

Age at interview: 52
Sex: Female
Age at diagnosis: 50
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How long were the drain and the drip in?

About three days, yeah. And a catheter, which was a new experience for me, because I'd not had one before. During the hysterectomy, again, I had to get up, you know, to go to the toilet and so on, so, again, you was a lot more mobile a lot more quickly. But, I mean this time, I didn't question it, because I didn't, well, feel up to questioning it, you just, you know, if they say, 'You've got a drain in', you say, 'Fair enough. There's obviously a reason for it', which I hadn't needed before, when I was' perhaps it's an age thing, perhaps it's just difference, you know, in your bodily make up as you get older and' whatever reason, you know, I had a drip in.  

So between the' with just the drip, it's fine, you can walk to and from the toilet, you can walk to the shop, you can go anywhere with your little portable friend, but it's more difficult if you've got a catheter and you've got that bag, and you've got the bottle with the drain and so on, so'

 

Felt unwell and had post-operative pain due to the size of the incision.

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Felt unwell and had post-operative pain due to the size of the incision.

Age at interview: 59
Sex: Female
Age at diagnosis: 50
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I think I came out after 5 days. I was quite unwell for a couple of days, the first couple of days after, when they moved me to the gynae unit, I was quite unwell then. But I had a really high temperature, couldn't keep any food down and I was in a lot of pain. And then they used some Voltaral suppositories, which were absolutely wonderful and I was practically pain-free then.  Because I have got rather a large scar, it's sort of about 12 inches long I think, the scar.

Really?

Because they cut me to supposedly take the appendix out. So then had to go from the appendix right across and put the appendix, they moved the appendix I think, and but that's still intact. That stayed there. So I was in quite a lot of pain at first. But I mean once I came home I was pottering about and I wasn't too bad at all.  
 

Women can usually go home 3 - 4 days after their surgery depending on the type of operation and the woman's speed of recovery. Women often wanted to go home to see their families, or because they found it hard to eat or sleep in hospital. One woman pointed out that, even though she had lost weight, her abdomen was swollen and tender after the surgery and she needed to borrow a pair of loose jogging trousers to wear at first. Some women feel very protective about the scar - one described feeling as though her 'insides were going to fall out' the first time she stood up, and later discovered that this was a common sensation.

Most women recovered well. They were warned to avoid strenuous physical activity, heavy lifting and told not to drive for 6 weeks. A few found their recovery boring or frustrating because they were limited in what they could do. Women who were lucky enough to be able to go away said it helped them recover - one said she was playing table tennis on a cruise three weeks after leaving hospital.

 

Recovered quickly from surgery and avoided strenuous activity by getting her mother to help with...

Recovered quickly from surgery and avoided strenuous activity by getting her mother to help with...

Age at interview: 41
Sex: Female
Age at diagnosis: 35
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So was the surgery fairly straight forward? How long did it take you to recover?  

I didn't take long at all to recover from the surgery, in fact I was sitting cross legged on my bed after two days, which I think is pretty good. I don't think many people are as lucky as that. I had no real problems at all. I'm making it sound like I sailed through everything, I really didn't I must have, I must be very quick to heal but no problems. 

But you were in hospital for over two weeks?

I was in the main hospital for two weeks and then I was discharged to the local country hospital for convalescence. So probably about a month, and of course once you get back you're not supposed to lift or do anything. But I was very fortunate I had my mother here to help, so she was doing all the household chores and lifting the baby and stuff. I think that was the hardest bit, 'cause I couldn't really play with my child as much as I wanted to, I had to always watch.

Follow-up care sometimes had gaps: two women found that the hospital had not contacted their GPs and another did not receive an expected visit from a nurse. People were not always told what to expect after surgery - one woman had a bleed which she did not know could happen.


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Last reviewed June 2016.

Last updated June 2016.

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