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.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 After Surgery
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 20 pounds). Also, you should not have sex until your doctor says it's okay. It usually takes 4 to 8 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
tumor 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 replacement therapy (ERT) and other treatment options. For more treatment information, see the topic Menopause and Perimenopause.
Hysterectomy and Oophorectomy: Should I Use Estrogen Replacement Therapy (ERT)?
What To Think About
Following hysterectomy, you will not be able to become pregnant. If you have plans for a future pregnancy, talk with your doctor about what other treatments might be possible.
Your doctor will tell you how long you should wait after surgery
before having sexual intercourse. If you have pain during intercourse, changing
positions may help make intercourse less painful. If you continue to have
trouble during intercourse after a hysterectomy, talk with your doctor.
Sexual response is different for every woman. Some women may notice a change in their sexual response after a hysterectomy. Talk with your doctor about any concerns you may have. For more information, see the topic Sexual Problems in Women.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- National Comprehensive Cancer Network (2011). Ovarian cancer, including fallopian tube cancer and primary peritoneal cancer. NCCN Clinical Practice Guidelines in Oncology, version 2. Available online: http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf.
Credits
| By | Healthwise Staff |
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| Primary Medical Reviewer | Adam Husney, MD, MD - Family Medicine |
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| Specialist Medical Reviewer | Ross Berkowitz, MD - Obstetrics and Gynecology |
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| Last Revised | July 6, 2011 |
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