Ovarian cancer treatment

Ovarian cancer is the fifth most common type of cancer in women. It occurs when the cells in your ovaries start to grow and divide in an uncontrolled, abnormal way. Over time, they form a growth (tumour) in your ovary. This is a solid mass of tissue that can, if left untreated, spread into other areas of your body. Your tumour may be benign (non-cancerous and not capable of spreading), malignant (cancerous and capable of spreading), or borderline (where there is a small possibility of it being malignant).

If there is a tumour developing in your ovaries, some of your symptoms may include:

• Bloating and/or swelling in your stomach
• Quickly feeling full when you're eating
• Losing weight
• Tiredness or fatigue
• Back pain
• Changes in your bowel movements (constipation or diarrhoea)
• Needing to pee more often
• Gas or indigestion
• Nausea
• Bleeding from your vagina
• Shortness of breath caused by build-up of fluid around your lungs

It is not clear what causes ovarian cancer, although there are certain factors that can increase the likelihood of the condition developing, such as old age, being overweight, and genetics or a family history of ovarian cancer.

Types of ovarian cancer

There are three main types of ovarian cancer that you might have. These include:

Epithelial ovarian cancer

This is the most common form of ovarian cancer, and means that it started in the layer of tissue that covers your ovary. Although there are many different types of epithelial ovarian cancer that may affect different cells in your body, treatment is generally the same regardless of what specific form of epithelial ovarian cancer you have.

Germ cell tumours

Germ cell tumours are rare, usually affecting girls and young women up to their early thirties. They develop from the cells in your ovary that make eggs, and is generally quite treatable. Surgery can be done to remove the tumour; chemotherapy is used when your germ cell tumour has become cancerous.

Stromal tumours

These tumours develop in the tissue cells that are responsible for your body’s production of oestrogen and progesterone (hormones that are crucial for your sexual and reproductive development). They are extremely rare, representing around 1% of all ovarian cancer cases, and are typically diagnosed at an earlier stage compared with other types of ovarian cancer.

To start with, your consultant will ask about your general health, what symptoms you've been experiencing, and whether anyone in your family has had breast and/or ovarian cancer. This will then be followed by a series of tests, which may include:

Pelvic exam

You'll be asked to undress from the waist down, with a sheet placed over you. Your consultant will gently place a speculum (a smooth tube-shaped tool) into your vagina, which enables them to see inside more clearly. They will then insert gloved fingers into your vagina, along with pressing a hand on your belly, to feel your pelvic organs and check for any lumps and/or tender areas. This will be accompanied by them taking a visual examination of your vagina and cervix.

You shouldn't feel any pain during this examination; you're always welcome to ask for a female consultant and have a friend, partner, and/or family member with you to help you feel more comfortable.

Imaging tests

Your consultant may run some tests to check for any abnormal growth in your ovaries. This is usually done with a TVUS (or transvaginal ultrasound), which uses sound waves to look at your uterus, fallopian tubes, and ovaries. It enables them to see if there is a tumour present, although it won't be able to determine if it's benign or malignant. CT scans might also be used to look at the size, shape, and structure of your ovaries. If they are larger than they should be, or shaped differently, it can indicate that you have a tumour.

Blood tests

A blood test may also be needed to measure the levels of a substance in your blood called CA-125, which is elevated in women who have ovarian cancer. These tests can't tell your consultant if you have ovarian cancer, given that noncancerous conditions can cause CA-125 levels to be elevated as well, but they may be helpful when making a diagnosis.

Your consultant may recommend non-surgical treatments for ovarian cancer as one part of your treatment, as a complete treatment plan, or when you are unsuitable for surgery due to the size of your tumour and/or your general health. These non-surgical ovarian cancer treatments include:

Chemotherapy

You will typically have chemotherapy after your ovarian cancer surgery, in order to lower the risk of cancer cells developing in your ovaries again and to kill any cancerous cells that are still there.

Chemotherapy may also be used before surgery if the size of your tumour is too large to safely recommend surgery - in which case you'll typically have it for three weeks, after which your consultant will take another CT scan to check how well the treatment has worked.

Chemotherapy uses anti-cancer drugs that interfere with the ability of your cancer cells to grow. Different groups of medications work in different ways to fight cancer cells, so your consultant will recommend a treatment plan that is tailored closely to your condition.

Immunotherapy

This form of treatment uses medications that boost your immune system's natural ability to kill cancer cells in your ovaries. When you have ovarian cancer, your cancer cells produce proteins that help them hide from your immune system cells. Immunotherapy can interfere with this process and target the cancerous cells, although this treatment hasn't been as effective for ovarian cancer in particular.

Radiotherapy and targeted therapy

By using high-energy X-rays, radiotherapy can destroy your cancer cells and shrink the size of your tumour. This is often done when you have symptoms that cannot be treated via surgery, such as vaginal bleeding. Another option is targeted therapy, which uses different drug treatments to target specific weaknesses in your cancer cells, causing them to die and therefore reducing the size of your tumour.

Hormone therapy

Hormone therapy uses drugs that stop the effects of oestrogen on your ovarian cancer cells. In some instances, your ovarian cancer relies on oestrogen to develop, so blocking your oestrogen may help to control your cancer and prevent the cells from growing any further. This is often used as an option when you have a slow-growing type of ovarian cancer.

Surgery is the most common treatment for ovarian cancer, as it helps us know more about your exact condition and gives us the best chance of removing cancerous cells. Ahead of your surgery, there are some things you may need to do to prepare, such as:

Tests

Your consultant may run a series of tests to check if you are suitable for general anaesthetic, such as blood tests, ECG (to confirm your heart is healthy), breathing tests, and/or a chest X-ray to see if your lungs are in a healthy condition.

Plan for a hospital stay

You will need to stay in hospital for two to four days after your ovarian cancer surgery (the exact time will depend on what surgery you had and your general health). So, before you get to hospital, think about bringing along anything that might make your stay with us more comfortable. This might be a laptop and/or tablet to keep you entertained, or some loose-fitting clothing.

Stock up on supplies

After getting home from ovarian cancer surgery, you'll need to rest for around a month and avoid any activities that are physically strenuous. This means that you won't be able to make quick trips to the shop, especially in the first week, so take care to round up all the supplies you might need beforehand. If possible, have a family member, partner, or friend nearby during this time to pick up additional supplies whenever they're needed.

You should also think about making your home recovery friendly. If you sleep on the second or third floor, for instance, move your recovery space to the ground floor to avoid trips up the stairs as you recover. Please also consider any potential tripping hazards in your home (loose flooring, furniture, general mess, etc).

Stop smoking

If you are a smoker, there is an increased risk of breathing and/or heart problems as a result of surgery. Your overall recovery may be negatively affected as well. Your consultant may therefore ask you to stop smoking two weeks prior to coming to hospital for ovarian cancer surgery.

Discuss medications with your consultant

Your consultant will ask about any medications that you are taking before arranging your procedure. If you are on aspirin, warfarin, anti-inflammatories, or some other blood-thinning medication, your consultant may ask that you stop taking these two weeks before surgery to prevent any unwanted bleeding both during and after the procedure.

Food and drink

Eat a healthy balanced diet before your procedure, and drink plenty of water as well. If you are obese, the chances of complications during surgery are higher, and your consultant may as a result give you some safe ways to lose weight.

Avoid alcohol for 48 hours prior to your treatment. And, as always, don't drink or eat anything after midnight on the day of your procedure.

Surgery for ovarian cancer is done under general anaesthesia. This means you'll be asleep for the entire procedure and won't feel anything.

The exact type of ovarian cancer surgery you have will depend on your specific type of ovarian cancer and whether it's spread. If the cancer cells have not spread outside of your ovaries, your consultant may recommend surgery to remove both ovaries and your fallopian tubes. The most common forms of ovarian cancer surgery are:

Staging surgery

Your surgeon will examine you closely to see if your cancer has spread outside your ovaries - also known as 'staging' - and decide if you need further treatment after surgery. They will do this by taking samples of tissue from several areas within your stomach and pelvis, along with removing a layer of fatty tissue near your ovaries.

The procedure could also involve taking some abdominal (stomach) fluid and sending it to a laboratory for tests. After doing these tests, your consultant should know what stage your ovarian cancer is in and what sort of treatment you need.

Surgery for low-grade cancer

If you have very early-stage ovarian cancer, and still wish to have children, it may be possible for your surgeon to do a procedure that means you can still get pregnant. This procedure would involve your surgeon removing your affected ovary and connecting fallopian tube, leaving intact your other ovary, fallopian tube, and womb. Your surgeon may recommend removing these as well if you have had your menopause or don't want to have any more children.

Surgery for advanced ovarian cancer

When your ovarian cancer cells have spread beyond your ovaries, into your pelvis and/or stomach area, your surgeon will perform debulking surgery. This is a treatment that involves surgically removing all disease by performing a total hysterectomy, which means removing your womb, ovaries, fallopian tubes, and your omentum (a sheet of tissue that connects your stomach with other abdominal organs), along with all growths sitting in your stomach. It could be that a part of your bowel also needs to be removed.

Ovarian cancer surgery is a big treatment, so you'll need to take it easy for a few weeks after your surgery and have some help nearby during this time - both for practical and emotional support. You might feel vulnerable or quite down after the procedure, so be sure to have some good friends or family nearby.

Please remember that everyone recovers at a different rate. The extent and speed of your recovery will depend on a range of factors, such as:

• What type of ovarian cancer surgery you had
• The severity of your ovarian cancer
• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• Your age

Recovering in hospital

When you wake up from surgery, you will probably feel quite tired and groggy, and this is completely normal as your general anaesthetic wears off. You-ll be given some time to rest in a private room after your procedure.

There may be some tubes in place when you wake up. This might be a bit scary, but they-re only temporary, and are there help you with things like eating, drinking, peeing, and draining away fluid to help your wound heal. If you are in any pain, your nurse will make sure you receive all the pain relief medication that you need. After a couple of days, your nurse will remove your surgical dressing and clean your wound.

You will be encouraged to move around as soon as you feel ready to do so - this may even be on the same day as your operation - and given some breathing and leg exercises that help you recover and reduce the likelihood of chest infections and/or blood clots.

Four days to four weeks after ovarian cancer surgery

When you get home from hospital after ovarian cancer surgery, you'll need to rest for around four to six weeks. For the first fortnight, at least, keep your feet up, only standing for a few minutes at a time. You'll need to avoid any activities that put strain on your stomach muscles and skin. This includes heavy housework (vacuuming, cleaning high surfaces, etc), carrying heavy bags of shopping or washing, or driving. If your job involves being sat down all day, you may be able to return to work after four weeks - or perhaps a little bit earlier.

One to three months after ovarian cancer surgery

Four weeks on from your ovarian cancer surgery, you should be able to gradually build up your level of activity. You can have sex again once the stitches at the top of your vagina have healed, which usually takes four weeks. A return to driving will also be possible at this stage of your recovery.

Please note that you will probably still get quite tired very easily. How you recover in the long-term depends strongly on the severity of your ovarian cancer. If you need chemotherapy treatment, for example, your rate of recovery may be slower. Your consultant will arrange regular appointments with you to check on your progress and make any changes to your treatment plan wherever necessary.

There are some complications that can occur with ovarian cancer surgery, but these are rare. Your consultant will answer any questions you might have before the procedure and explain all the risks to you well in advance.

General complications of any operation:

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of ovarian cancer surgery

• High temperature
• Feeling hot and/or cold
• Coughing
• Vaginal bleeding and/or discharge
• Internal bleeding (this is rare)
• Bladder or bowel problems
• Swelling in your legs
• Early menopause

When you choose to go private with Circle Health Group, you can expect:   

• Flexible appointment times and locations to fit your routine  
• The freedom to choose which hospital and Consultant suit your needs  
• Personalised, Consultant-led treatment plans tailored to your individual needs  
• Comfortable and safe private facilities maintained by expert multidisciplinary teams  
• Private ensuite rooms as standards and delicious healthy meals
  
• Affordable, fixed-price packages with aftercare included  
• Flexible payment options to spread the cost of your care

If you would like to learn more about this procedure, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Ovarian cancer, NHS
2. Ovarian cancer, Mayo Clinic
3. Epithelial ovarian cancer, Cancer Research UK
4. Ovarian stromal tumours, Moffitt
5. Ovarian cancer, John Hopkins Medicine
6. Ovarian cancer surgery, MacMillan
7. After having ovarian cancer surgery, Cancer Research UK