Why is a gynecologic oncologist important for ovarian cancer surgery?
A gynecologic oncologist is a doctor with specialized training in diagnosing and treating cancers of the female reproductive system, including complex cancer surgery.
When ovarian cancer is suspected or confirmed, it is important to involve a gynecologic oncologist before surgery whenever possible.
Ovarian cancer surgery can be more complex than surgery for a benign ovarian mass. During the procedure, the surgeon may need to examine the entire abdomen and pelvis, remove tumors from several locations, and make decisions about whether other tissues or organs need to be removed.
The Society of Gynecologic Oncology explains the role of a gynecologic oncologist and provides a directory for finding specialists.
You can also use NOCC’s Questions to Ask Your Doctor: The Gynecologic Oncologist’s Role in Your Care to help prepare for your appointment.
What is staging surgery for ovarian cancer?
Staging surgery helps determine where ovarian cancer is located and how far it has spread.
During surgery, the surgeon examines the abdomen and pelvis and may collect tissue or fluid samples for a pathologist to examine.
Depending on your diagnosis and surgical plan, staging may include:
- Examining the ovaries, fallopian tubes, uterus, and other areas of the abdomen and pelvis
- Removing one or both ovaries and fallopian tubes
- Removing the uterus, called a hysterectomy
- Removing the omentum, called an omentectomy
- Collecting fluid or washings from the abdomen and pelvis
- Taking biopsies from areas where cancer may have spread
- Sampling or removing lymph nodes when appropriate
The results help determine the type and stage of ovarian cancer and guide decisions about additional treatment.
Surgery also often provides the tissue needed for a pathologist to confirm an ovarian cancer diagnosis.
What is debulking or cytoreductive surgery?
Debulking surgery, also called cytoreductive surgery, aims to remove as much visible ovarian cancer as safely possible.
This is particularly important when ovarian cancer has spread within the abdomen or pelvis.
The goal is often complete gross resection, which means that no visible cancer remains at the end of surgery when that can be safely achieved.
Depending on where the cancer has spread, debulking surgery may involve removing cancer from the:
- Ovaries and fallopian tubes
- Uterus
- Omentum
- Lining of the abdomen or pelvis
- Bowel or intestines
- Bladder
- Diaphragm
- Spleen
- Surface of the liver
- Other tissues or organs affected by cancer
Not everyone will need extensive surgery or have these organs removed. Your surgeon should explain what they expect may need to be removed and why before the procedure.
🎥 Watch: What types of surgery are used for ovarian cancer?
Nita Lee, MD, MPH, explains laparoscopic and traditional open surgery for ovarian cancer, the different goals of surgery, and why specialized surgical care is important.
Will I have surgery or chemotherapy first?
Some people with ovarian cancer have surgery first. Others may benefit from receiving chemotherapy before surgery.
Surgery first
When the care team believes that most or all visible cancer can be safely removed, primary cytoreductive surgery may be performed first.
Chemotherapy is often given after recovery from surgery depending on the cancer type and stage.
Chemotherapy first
For some people with advanced ovarian cancer, the health care team may recommend neoadjuvant chemotherapy, which means chemotherapy is given before surgery.
This approach may be considered when:
- Imaging suggests that all visible cancer may not be safely removed during an initial operation
- Surgery would be particularly extensive
- Other health conditions increase the risks of a major operation
- The care team believes chemotherapy first may improve the ability to remove cancer later
After several cycles of chemotherapy, imaging and other tests are used to evaluate how the cancer has responded.
Surgery performed after initial chemotherapy is called interval debulking surgery or interval cytoreductive surgery. Additional chemotherapy is generally given after recovery.
Whether surgery or chemotherapy comes first is an individualized decision. Your gynecologic oncologist should explain why one approach is recommended for you.
Learn more about chemotherapy for ovarian cancer.
What procedures may be part of ovarian cancer surgery?
The specific procedures performed depend on your cancer type, stage, fertility goals, and where cancer is found.
Hysterectomy
A hysterectomy is surgery to remove the uterus. The cervix may also be removed.
Removing the uterus means that a person can no longer carry a pregnancy.
Salpingo-oophorectomy
A salpingo-oophorectomy removes an ovary and fallopian tube.
A unilateral salpingo-oophorectomy removes one ovary and fallopian tube. A bilateral salpingo-oophorectomy removes both ovaries and fallopian tubes.
Omentectomy
An omentectomy removes some or all of the omentum, a layer of fatty tissue in the abdomen where ovarian cancer commonly spreads.
Tissue and fluid sampling
The surgeon may collect biopsies from areas of the abdomen and pelvis and fluid or washings to look for cancer cells.
Lymph node evaluation
Lymph nodes may be examined, sampled, or removed depending on your cancer stage, imaging results, and what the surgeon finds during the operation.
Bowel or other organ surgery
If ovarian cancer involves the bowel or another nearby organ, part of that organ may need to be removed to remove visible cancer.
If part of the bowel is removed, the surgeon can often reconnect the bowel. In some situations, an ostomy, or opening through the abdominal wall for waste to leave the body, may be needed. An ostomy may be temporary or permanent.
Your surgeon should discuss this possibility with you before surgery if they believe it may be necessary.
Removal of the uterus
(hysterectomy)
Removal of one or both ovaries
(oophorectomy)
Removal of one or both ovaries and one or both fallopian tubes
(salpingo-oophorectomy)
Can ovarian cancer surgery be minimally invasive?
Some ovarian cancer surgeries can be performed using minimally invasive techniques such as laparoscopy or robotic-assisted surgery.
Minimally invasive surgery may be appropriate for selected people, including some with an ovarian mass that appears to be early-stage cancer.
Laparoscopy may also be used before a larger operation to look inside the abdomen and determine whether extensive debulking surgery is likely to remove the visible cancer.
More extensive ovarian cancer surgery is often performed through an abdominal incision, called a laparotomy, because this allows the surgeon to thoroughly examine the abdomen and pelvis and remove cancer from multiple areas.
The best surgical approach depends on your individual diagnosis. Ask your gynecologic oncologist why a particular approach is recommended.
Does ovarian cancer surgery affect fertility?
Yes. Ovarian cancer surgery can affect fertility, but the effect depends on which reproductive organs need to be removed.
For some people with certain early-stage ovarian cancers, fertility-sparing surgery may be possible. This may involve removing the ovary and fallopian tube affected by cancer while leaving the other ovary and the uterus in place.
Fertility-sparing surgery is not appropriate for every ovarian cancer type or stage.
If having biological children in the future is important to you, discuss fertility before treatment begins whenever medically possible. Your care team may recommend meeting with a reproductive endocrinologist or fertility preservation specialist.
Learn more about fertility after ovarian cancer and options for preserving fertility.
🎥 Patient story: Fertility-sparing ovarian cancer surgery
Ariana was diagnosed with ovarian cancer at age 17 and underwent fertility-sparing surgery that preserved her uterus and one ovary. Years later, she shares what she learned and why discussing fertility before treatment can matter.
Can ovarian cancer surgery cause menopause?
Yes. If both ovaries are removed before natural menopause, ovarian cancer surgery causes surgical menopause.
The ovaries produce hormones including estrogen and progesterone. When both are removed, hormone levels fall quickly rather than gradually as they do during natural menopause.
Symptoms may include:
- Hot flashes
- Night sweats
- Vaginal dryness
- Sleep changes
- Mood changes
- Changes in sexual health
Surgical menopause can also affect long-term bone, heart, and sexual health.
Not everyone undergoing ovarian cancer surgery will experience surgical menopause. If one functioning ovary remains, menopause does not automatically occur because of the surgery.
Talk with your health care team about what to expect and which symptom-management options may be appropriate for you.
Learn more about menopause after ovarian cancer and ways to manage menopause symptoms after ovarian cancer treatment.
What should I expect after ovarian cancer surgery?
Recovery is different for everyone. It depends on how extensive the operation was, your overall health, and whether other organs or tissues were involved.
After surgery, your health care team will help you:
- Manage pain
- Begin moving safely
- Resume eating and drinking
- Monitor bowel and bladder function
- Care for your incision
- Reduce the risk of blood clots and infection
- Prepare for additional treatment if needed
A hospital stay may last several days, and recovery at home often takes several weeks. More extensive debulking surgery may require a longer recovery.
Follow the activity, lifting, wound-care, nutrition, and medication instructions provided by your surgical team. Contact your health care provider if you develop symptoms they have told you require immediate attention.
What are possible side effects and complications of ovarian cancer surgery?
Every surgery has potential risks. Your individual risk depends on the type and extent of surgery, your overall health, and other medical factors.
Possible short-term effects can include:
- Pain or tenderness
- Fatigue
- Nausea or changes in appetite
- Constipation or diarrhea
- Bleeding
- Infection
- Blood clots
- Temporary changes in bowel or bladder function
Some people may also experience longer-term effects, including:
- Surgical menopause
- Loss of fertility
- Lymphedema if lymph nodes are removed
- Changes in bowel function
- Sexual health changes
- An ostomy if bowel surgery is required
- Emotional changes related to cancer treatment and recovery
Not everyone experiences these effects.
Talk with your health care team before surgery about which complications are most relevant to the operation being planned and what symptoms you should report during recovery.
💡 Prepare for ovarian cancer treatment
Knowing what to expect can make it easier to take an active role in treatment decisions.
NOCC’s Questions to Ask Your Doctor: How Can I Prepare for Treatment? guide includes questions about treatment options, additional testing, second opinions, clinical trials, side effects, nutrition, emotional health, and practical preparation.
Download the How Can I Prepare for Treatment Questions Guide PDF
What should I ask my doctor before ovarian cancer surgery?
Before surgery, consider asking:
- What is the goal of my surgery?
- Will the surgery be used for staging, debulking, or both?
- Will a gynecologic oncologist perform my surgery?
- Which organs or tissues do you expect to remove?
- How likely is it that all visible cancer can be removed?
- Could I need bowel surgery or an ostomy?
- Will the surgery affect my fertility?
- Could the surgery cause menopause?
- Why are you recommending surgery before or after chemotherapy?
- Will my surgery be open or minimally invasive?
- What are the most important risks or possible complications?
- How long might I be in the hospital?
- What should I expect during recovery?
- How will my pain be managed?
- When will the final pathology results be available?
- Will I need additional treatment after surgery?
- When can I return to work, exercise, driving, and other normal activities?
Writing down your questions before your appointment and bringing someone with you to take notes may also help.
Can surgery be used if ovarian cancer comes back?
Sometimes.
For selected people with recurrent ovarian cancer, another operation, called secondary cytoreductive surgery, may be considered.
Whether surgery is appropriate depends on factors such as:
- Where the cancer has returned
- How much cancer is present
- How long it has been since previous treatment
- Whether all visible recurrent cancer is likely to be removed
- Previous surgeries and treatments
- Overall health
Research has shown that secondary surgery can benefit some carefully selected patients, but it is not appropriate for everyone with recurrent ovarian cancer.
Discuss the potential benefits, risks, and alternatives with a gynecologic oncologist experienced in recurrent ovarian cancer.
Understanding your ovarian cancer treatment plan
Surgery is one part of an individualized ovarian cancer treatment plan.
Ask your health care team to explain the goal of your surgery, what they expect to remove, how surgery fits with other treatments, and what recovery may look like for you.
Explore additional NOCC information and resources:
Frequently asked questions about ovarian cancer surgery
Surgery is part of treatment for most ovarian cancers, but not everyone has surgery at the same point in treatment.
Some people have surgery first, while others receive chemotherapy before surgery. In certain situations, a person may not be able to undergo major surgery because of their health, the extent of the cancer, or other factors.
Treatment should be individualized by the cancer care team.
The goal of debulking, or cytoreductive surgery, is to remove as much visible cancer as safely possible.
When possible, surgeons aim for complete gross resection, meaning no visible cancer remains after surgery.
Not always.
The organs removed depend on the cancer type, stage, location, and fertility considerations.
For many epithelial ovarian cancers, surgery may include removal of the uterus, both ovaries, and both fallopian tubes. However, fertility-sparing surgery may be appropriate for selected people with certain early-stage cancers.
Many people with epithelial ovarian cancer receive chemotherapy after surgery, but not everyone does.
Whether chemotherapy is recommended depends on the cancer type, stage, grade, pathology findings, and other factors.
Learn more about chemotherapy for ovarian cancer.
Recovery often takes several weeks, but there is no single recovery timeline.
Someone undergoing a smaller procedure may recover more quickly than someone who has extensive cytoreductive surgery involving the bowel, bladder, spleen, diaphragm, or other organs.
Your surgical team can give you a more individualized estimate based on the procedure planned.
Most people undergoing ovarian cancer surgery do not automatically need an ostomy.
An ostomy may be necessary if cancer involves the bowel and the surgeon cannot safely reconnect the bowel during the same operation. When an ostomy is required, it may be temporary or permanent.
If bowel surgery is possible, ask your surgeon about this before the operation.
Yes. Surgery often provides the tissue needed to confirm ovarian cancer.
A pathologist examines the tissue removed during surgery to determine whether cancer is present and identify the cancer type and subtype.
The final pathology report may provide more detailed information than is available during the operation.
Learn more about how ovarian cancer is diagnosed.
After recovery, your health care team will review your final pathology, cancer stage, surgical findings, and any genetic or biomarker testing.
This information helps determine whether additional treatment is recommended.
Your next steps may include:
More information about ovarian cancer surgery
