Surgery is normally the first treatment for cancer of the ovary, and may sometimes also be needed to make the diagnosis.

If the cancer is in the early stages, surgery may be all the treatment that is needed. It is usually necessary to make a cut in the skin and muscle of the abdomen (a laparotomy). The ovaries, fallopian tubes and the womb are then removed. This is called a total abdominal hysterectomy and salpingo-oophorectomy. The surgeon may remove the fatty membrane lining the abdomen (the omentum) and may take samples from other tissues, such as the lymph glands, to see if the cancer has spread.

Your doctor will discuss with you the most appropriate type of surgery, depending on the type and size of your cancer and whether it has spread. Sometimes this information only becomes available during the operation itself, and so it is important to discuss all the possible options with your doctor before the operation.

Before surgery, if the surgeon feels that the cancer may be difficult to remove, a few courses of chemotherapy may be given first. This is to make the tumour smaller and easier to remove. It is known as neoadjuvant chemotherapy.

Chemotherapy is often given after surgery, if it was not possible to remove all of the tumour or if there is a risk that some cancer cells may have been left behind.

If ovarian cancer has already spread, surgery may be used to take away as much of the tumour as possible. This is known as de-bulking surgery and can make chemotherapy more effective.

If the cancer has spread to the bowel, a small piece of bowel may be removed and the two ends rejoined.

After your operation you will be encouraged to start moving about as soon as possible. If you have to stay in bed, it is important to keep up regular leg movements and deep breathing exercises. You will be shown how to do the exercises by a physiotherapist or specialist nurse.

A drip (intravenous infusion) will be used to maintain your body’s fluids until you are able to eat and drink again, which is usually after a few days.

Sometimes a small tube, called a catheter, is put into the bladder and your urine is drained into a collecting bag. You may also have a drainage tube in your wound to drain excess fluid into a small bottle. This is usually removed within 48 hours.

It is quite normal to have some pain or discomfort for a few days but this can be controlled with effective painkillers. If the pain is not controlled, it is important to let your doctor or nurse know as soon as possible so that your painkillers can be changed.

Most women are able to go home within 8–10 days of their operation, once the stitches or clips have been taken out. If you think you might have problems when you go home (for example, if you live alone or have several flights of stairs to climb) let the nurse or social worker know when you are admitted to the ward so that help can be arranged. Your nurse specialist can offer or arrange support or counselling for you and your family. Social workers are often available to give practical advice. Many are also trained counsellors. If you would like to talk to a social worker you can ask your specialist nurse to arrange it for you.

Before you leave hospital you will be given an appointment to attend an out-patient clinic for your post-operative check up. This is a good time to discuss any problems you may have. If you have any problems or worries before this time, you can phone your ward nurses or hospital doctor.

You will need to avoid strenuous physical activity or heavy lifting for at least three months. Some women also find it uncomfortable to drive for a few weeks after their operation, so it may be a good idea to wait a while before you start driving again. Some insurance companies have guidelines about this, and you can contact your own company or the DVLA (Drivers and Vehicles Licensing Association) for advice.

One of the common questions women ask after a hysterectomy is whether the operation will affect their sex life. To allow the wound to heal properly, most women are advised to wait at least six weeks after their operation before having sexual intercourse. Many women have no problem in having a sexual relationship after this time, while others find that the surgery has shortened their vagina and slightly changed its angle. This can mean that they have different sensations and responses during sex. If this occurs it can be very upsetting. Women who have this effect may take more time to come to terms with their emotions and any physical effects such as pain.

One common fear is that cancer can be passed on to your partner during intercourse. This is not true and it is perfectly safe for you to continue to have a sexual relationship.

In younger women who are still having periods, removing the ovaries will bring on an early menopause. The physical effects of this may be:

• hot flushes
• dry skin
• dryness of the vagina, which can make sexual intercourse uncomfortable
• reduced sexual desire.

Some women may be prescribed hormone replacement therapy (HRT) following treatment for ovarian cancer. This can help to reduce some of the changes caused by the menopause. Lubricants such as Aquaglide, Senselle® or Replens MD® can be bought from most chemists and can ease any discomfort during intercourse.

Taking HRT after treatment for ovarian cancer can help to reduce the chance of the cancer coming back in some women, but not in others. You can discuss with your doctor whether taking HRT would be helpful in your situation.

Younger women in particular, often find it difficult to come to terms with the fact that they can no longer have children after a hysterectomy. They may also be worried that they have lost a part of their female identity. These are very natural, understandable emotions to have at this time. It can be helpful to discuss any fears or worries with a sympathetic friend. Counselling can be arranged either by the hospital or through your GP. There are also support organisations that can help.