Ovarian Cancer Surgery

Introduction

The ovaries are the components of the female reproductive system. The almond shaped ovaries are located on each side of uterus. The contain eggs and produce hormones that regulate menstrual cycle. The ovaries produce an egg at each menstrual cycle throughout the reproductive period of a woman’s life. The egg travels via a tube called the fallopian tube to reach the uterus. Cancerous conditions may invade both the ovaries. Nature of surgery will be based on the age of the patient.

Procedure and considerations

Oophorectomy is the surgical procedure where one or both the ovaries are removed. If the both the ovaries are removed the surgery is called bilateral Oophorectomy.

Oophorectomy is conducted in following conditions:

• Ovarian cancer

• Tubo-ovarian abscess – Infection of the tubes and the ovary leading to accumulation of pus

• Endometriosis – Inflammation over the uterus, tubes and ovaries.

• Ovarian torsion – The band of tissues that contain the blood vessels coming in and out of the ovary are attached to the back of the abdomen and are called the pedicle. This is a vital band of tissues from which the ovaries hand. If there is twisting of this pedicle the blood supply to the ovary may die resulting in severe pain and damage to the ovary. This is an emergency and in case of severe damage to the ovary, oophorectomy may be opted.

Oophorectomy can be combined with other surgical procedures like excision of uterus (hysterectomy) or fallopian tube (salpingotomy). Oophorectomy is comparatively a safe procedure. It is conducted under general anaesthesia. Before surgery the bowl needs to be cleared using laxatives. Patient has to fast overnight with not even water intake. Oophorectomy can be conducted as a laparoscopic procedure or as open procedure. Once the patient is under anesthesia her lower abdomen is cleaned with an antiseptic solution and draped with sterile surgical drapes. For an open surgery an incision is made in the lower abdomen (usually at the panty-line). In laparoscopic surgery the incisions are smaller and flexible tubes with camera and operative instruments are inserted through them. The ovary is dissected out. The cut blood vessels are sutured or cauterized using electricity to prevent bleeding. If needed tubes and the uterus may also be removed. For ovarian cancer the nearest lymph nodes are examined and removed. These are sent to the pathologist for examination under the microscope. The incision is closed using sutures or staples after placing a drainage tube to drain excess fluids and blood. If the uterus of patient is kept intact, help of associated reproductive technology can adopted.

Chances of minor complications like infection, bleeding and complications related to anesthesia exist. Immediately after surgery the patient will be taken to the recovery room. The patient will spend time till anaesthesia is worn off. Following surgery few days of hospitalisation is required. Duration of hospital stay depends on the majority of surgery. For ovarian cancer surgery may need to be followed up with chemotherapy using anticancer drugs and radiation therapy. These kill any residual cancer cells that may be present. If the cancer has spread to other major organs like liver, lungs or brain, chances of recovery after therapy is poor. Regular follow up visit to the doctor is essential for quick recovery and early restoration of normal activities. Patients need to follow instructions of the doctor carefully for a healthy life.

Removal of ovaries will lead to early onset of menopause. Signs and symptoms associated with menopause like hot flashes, loss of menstruation, mood swings and increased risk of heart disease and fractures might manifest. Proper measures should be undertaken to tackle the signs and symptoms associated with menopause. This commonly includes institution of hormonal therapy. The female hormones when administered act as replacement for the hormones that is produced by the female body before surgery. If the patient wants to have children advice of the doctor should be sought accordingly. If the uterus of patient is kept intact, help of associated reproductive technology can adopted.