Surgery for ovarian mass

We will ask you to sign a consent form agreeing to accept the treatment that you are being offered. The basis of the agreement is that you have had a written description of the proposed treatment and that you have been given an opportunity to discuss any concerns.

You are entitled to request a second opinion from another doctor who specialises in treating this cancer. You can ask your own consultant or your GP to refer you. Your consent may be withdrawn at any time before or during this treatment. Should you decide to withdraw your consent then a member of your treating team will discuss the possible consequences with you.

The aim of the operation is to safely remove the mass, tumour or cyst. The pathologist can then make a diagnosis and stage the disease if it is cancer. The stage of the cancer describes its size and the extent of the disease. This will enable the team to know whether further treatment is recommended.

Yes. Chemotherapy is sometimes used alone or before surgery. Treatment options vary from woman to woman, and you should discuss the options available to you with your specialist doctor or nurse.

Your wishes about treatment will be always respected by your medical team. If you choose not to have treatment, your cancer will progress, and your health is likely to deteriorate.

At this time, you may wish for us to transfer your care to the supportive care team, who will discuss with you what will happen next and help you to manage your symptoms and support you either in hospital, at home or in the local hospice.

As with any operation, there are risks but it is important to realise that most women do not have complications. There can be risks associated with having a general anaesthetic and major abdominal surgery.

The risks include:

• Bruising or infection in the wound. Internal bruising and infection may also occur. A blood transfusion is sometimes needed to replace blood lost during the operation. Occasionally, there may be internal bleeding after the operation, making a second operation necessary.
• Infection in the wound or internal infection may occur needing treatment with antibiotics. Occasionally, a second operation may be necessary.
• Blood clots in the leg or pelvis (deep vein thrombosis or DVT). This can lead to a clot in the lungs (pulmonary embolism or PE). Moving around as soon as possible after your operation can help to prevent this. We will give you special surgical stockings (known as ‘TEDS’) to wear whilst you are in hospital and injections to thin the blood. The physiotherapist may visit you and show you some leg exercises to help prevent blood clots.
• Your bladder and bowels may take some time to begin working properly after your operation. Some women have loss of feeling in the bladder that may take some months to get better. During this time, you may need to take special care to empty your bladder regularly.

Occasionally, a hole may develop in the bladder or in the tube bringing urine to the bladder (ureter). If this happens it is generally identified at the time of surgery. If not, it results in leakage of urine into the vagina. The hole may close without surgery, but another operation may be necessary to repair this.

Occasionally, depending on the extent and position of the mass, tumour or cyst, the surgeon may have to operate close to, or including the bowel. If the area of bowel affected by cancer must be removed, the remaining sections of the unaffected bowel are joined together if possible. This is known as an anastamosis.

If this is not possible, the bowel will be diverted to open on the surface of the tummy. This is known as a ‘colostomy’ or ‘stoma’ and allows the stools (faeces) to be collected in a bag attached to your tummy. The bag can be removed and emptied.

If this procedure is likely, it will be explained to you in more detail either by the stoma nurse, the gynaecology CNS or the ward nurses before the operation. It is important to note the risk of having bowel surgery is low in most women. If the doctor thinks there is a significant risk of bowel surgery this will be discussed with you further.

The skin around the wound is usually numb for several months until the small nerves damaged by the incision grow back. Sometimes the numbness may affect the tops of the legs or the inside of the thighs. This nearly always gets better in 6 to 12 months.

At any age, having your womb and ovaries removed can affect the way you feel about yourself. A hysterectomy will prevent you carrying a pregnancy in the future and removing your ovaries will bring on an early menopause.

The loss of fertility can have a huge impact if you have not started or completed your family, and you have an operation that takes that choice away. You may want to make sure that you have explored all your options.

It is important that you can discuss this and how you feel about it with the gynaecology CNS before your operation. They will continue to offer you support when you are recovering from the operation. Advice is also available from the specialist fertility team.

Not all women need HRT after this surgery. This will be discussed with you on an individual basis.

• Both ovaries
• Uterus (womb)
• Cervix (neck of the womb)
• Fallopian tubes
• Omentum
• Occasionally part of the small or large bowel

Yes, although it will fade. The surgeon will make an incision (cut) that runs from your pubic hairline up to the area around your tummy button. The wound will be closed together using either sutures (stitches) or clips.

There will be an internal scar at the top of your vagina where your cervix has been removed. This will heal over time.

Yes. Make sure that all of your questions have been answered to your satisfaction and that you fully understand what is going to happen to you. You are more than welcome to visit the ward and meet the staff before you are admitted to hospital. Just ask the gynaecology CNS to arrange this for you.

You may take part in the Enhanced Recovery Programme (ERP). The aim of this programme is to improve the quality of your care and get you back to full health as quickly as possible after your surgery.

If you are a smoker, it would benefit you greatly to stop smoking or cut down before you have your operation. This will reduce the risk of chest problems as smoking makes your lungs sensitive to the anaesthetic. If you need further information about stopping smoking, please contact your GP or the Smokefree NHS 0300 123 1044. A specialist adviser is available Monday to Friday from 9am to 8pm and on Saturday and Sunday from 11am to 4pm.

You should also eat a healthy diet and if you feel well enough, take some gentle exercise before the operation, as this will also help your recovery afterwards. Your GP, the practice nurse at their surgery or the doctors and nurses at the hospital will be able to give you further advice about this.

Before you come into hospital for your operation, try to organise things ready for when you come home. If you have a freezer, stock it with easy-to-prepare food. Arrange for relatives and friends to do your heavy work (such as changing your bedding, vacuuming and gardening) and to look after your children if necessary. You may wish to discuss this further with the gynaecology CNS.

If you have any concerns about your finances whilst you are recovering from your operation, you may wish to discuss this with the gynaecology CNS.

Tests will be done to ensure that you are physically fit for surgery and help your doctor to choose the most appropriate treatment for the type and extent of your disease. Recordings of your heart (ECG) may be taken, as well as a chest X-ray. An MRI or CT scan of your pelvis and abdomen will be needed.

A blood sample will also be taken to check that you are not anaemic and to identify your blood group in case you need a blood transfusion.

We may take swabs from your nose, throat and perineum to find out whether or not you carry the bacterium known as MRSA. This is so we can identify whether you will need any treatment for this infection during your stay in hospital. Do not worry, if you are carrying the bacterium this will not cause your operation to be cancelled.

You will also get to ask the doctor and the specialist nurse any questions that you may have. It may help to write them down before you come.

Before your admission to hospital, you will be asked to attend the pre-operative clinic to make sure that you are fit for the operation. During this visit, the staff will discuss your operation with you and what to expect afterwards. You will have the opportunity to ask any questions.

Your temperature, pulse, blood pressure, respiration rate, height, weight and urine are measured to give the nurses and doctors a base line (normal reading) from which to work.

You will be admitted to the ward the day of your operation or the day before. You will meet the nurses and doctors involved in your care. The anaesthetist may visit you to discuss the anaesthetic and to decide whether you will have a ‘pre-med’ (tablet or injection to relax you) before you go to the operating theatre. Any further questions you have can also be discussed at this time.

Before your operation, you may be given some medication or an enema to help you have your bowels open.

You will not be allowed to have anything to eat or drink (including chewing gum or sweets) for several hours before your operation. Each hospital has slightly different fasting times and the ward staff will tell you more about this.

Before coming to hospital, you will be asked to take a bath or shower. You will be asked to change into a theatre gown before going down to the operating theatre. All make-up, nail varnish, jewellery (except your wedding ring), dentures and contact lenses must be removed.

After your operation you will wake up in the recovery room before returning to the ward. You may still be very sleepy and be given oxygen through a clear face mask to help you breathe comfortably immediately after your operation.

An intravenous infusion also called a ‘drip’ will be attached to your hand or arm to give you fluids and prevent dehydration for the next 24 to 48 hours. You may also have a drain (tube) in your wound which is inserted during your operation. This is so that any blood or fluid that collects in the area can drain away safely and will help to prevent swelling. The drain will be removed when it is no longer draining any fluid, which could take several days.

During your operation, a catheter (tube to drain urine away) will be put into the bladder. The catheter will need to stay in until you are walking around. The doctor will see you after your operation to explain the details of your surgery.

You may have trouble opening your bowels or have some discomfort due to wind for the first few days after the operation. This is temporary and we can give you laxatives and painkillers if you need them.

You can expect to be extremely sleepy or sedated for the first few hours. This will allow you to rest and recover.

Please tell us if you are in pain or feel sick. We have tablets/injections that we can give you as and when needed, so that you remain comfortable and pain free. You may have a device that you use to control your pain yourself. This is known as a PCA (Patient Controlled Analgesia) and the staff will show you how to use it. Alternatively, an epidural may be inserted in your back for pain relief. The anaesthetist will discuss these choices (PCA or an epidural) with you before surgery.

You may have some vaginal bleeding or a bloodstained discharge, but this does not usually last for more than a few days. The wound will have a dressing on it to keep it clean and dry. Depending on the type of incision used, the sutures or clips will be removed 5 to 10 days later. We will encourage you to do gentle leg and breathing exercises to help your circulation and prevent a chest infection.

Yes, it is a very common reaction to your diagnosis and the operation. Also sometimes being away from your family and friends can make you feel weepy. If these feelings persist or develop when you leave hospital, the advice and support of your friends, family, GP or gynaecology CNS may help. There are also several local and national support groups.

You will usually be in hospital between 5 and 14 days depending on the type of operation you have had, your recovery, how you feel physically and emotionally and the support available at home. This will be discussed with you before you have your operation and again whilst you are recovering.

It is usual to continue to feel tired when you go home. It can take up to 3 months to fully recover from this operation, sometimes longer, especially if you need further treatment following surgery. However, your energy levels and what you feel able to do will usually increase with time.

This is individual, so you should listen to your body’s reaction and rest when you need to. This way, you will not cause yourself any harm or damage.

We suggest you shower and do not have a bath for the first 3 weeks after the procedure to minimise the risk of vaginal infection. Avoid lifting or carrying anything heavy (including children and shopping). Vacuuming and spring-cleaning should also be avoided for at least 6 weeks after your operation.

Rest as much as possible, gradually increasing your level of activity. Continue with gentle activities such as making cups of tea, light dusting and washing up.

Generally, within 3 months you should be able to return to your normal activities, but you can discuss this further on your return to the follow-up clinic.

We advise you not to drive for at least 6 weeks after your operation. However, this will depend on the extent of your surgery and your individual recovery. You will be able to discuss it further with your doctor at your follow-up appointment. We advise you to contact your car insurers for advice on driving following major abdominal surgery.

This will depend upon the type of work you do, how well you are recovering and how you feel physically and emotionally. It also depends on whether you need any further treatment, such as chemotherapy, after your operation.

Most women need approximately 2 to 3 months to recover but remember that the return to normal life takes time. It is a gradual process and involves a period of readjustment and will be individual to you. You can discuss this further with your doctor, gynaecology cancer specialist nurse or GP.

It is important to continue doing the exercises shown to you for at least 6 weeks after your operation. Ideally, you should carry on doing them for the rest of your life, particularly the pelvic floor exercises.

Avoid all aerobic exercise, jogging and swimming until advised, to allow the muscles cut during 16 your operation to heal. The physiotherapist or gynaecology CNS will be happy to give advice on your individual needs.

Following the diagnosis of and treatment for ovarian cancer, you may not feel physically or emotionally ready to start having sex again for a while. We normally advise women not to have sexual intercourse for 6 weeks following surgery.

During this time, it may feel important for you and your partner to maintain intimacy, despite refraining from sexual intercourse. However, some couples are both physically and emotionally ready to resume having sex much sooner and this can feel like a positive step. If you have any worries or concerns, please discuss them with the gynaecology CNS.

It can be a worrying time for your partner. They should be encouraged to be involved in discussions about the operation and how it is likely to affect your relationship afterwards.

If you do not have a partner at the moment, you may have concerns either now or in the future about starting a relationship after having this surgery. Please do not hesitate to contact the gynaecology CNS if you have any queries or concerns about your sexuality, change in body image or your sexual relationship either before or after surgery.

Yes. It is very important that you attend any further appointments arranged. If the histology (tissue analysis) results from your surgery are not available before you are discharged home, an early appointment for the outpatient clinic will be made to discuss the results and any further treatment options if necessary. This will be within a few weeks following discharge from hospital.

You will need to attend for regular follow-up appointments once your treatment is complete. These follow up appointments will be arranged for every 3 to 6 months for the first 2 years, then every 6 months up to 5 years, and then every year up to 10 years after your operation. At these appointments, you will be seen by a member of the cancer team. This may be a doctor or gynaecology CNS who works closely with your consultant.

After your first follow up appointment, your subsequent appointments will be at your local hospital if no further treatment is necessary.

Yes, if the histology (tissue analysis) shows that you need further treatment. An appointment will be made with the medical oncology team to discuss chemotherapy.

No, cervical smear tests are generally not necessary after this operation, as your cervix is usually removed during your operation.

By having frequent appointments over several years, any problems can be detected early. A blood test known as a CA125 will be taken to monitor your cancer. Occasionally you may need to have a scan.

These appointments are not only to look for medical problems. A diagnosis of cancer can affect any aspect of your life, you can discuss any of these issues with your gynaecology CNS.

If you have any of the following symptoms, please contact your gynaecology CNS, GP, or hospital for an earlier appointment:

• swelling of the abdomen (tummy)
• a new change in your bowel habit
• becoming short of breath

After you have had treatment for cancer, it can be a worrying time. Please remember that you will have the same aches and pains that you have always had. If you develop a new health problem, this may not be related to your cancer and its treatment.