What is ovarian cancer debulking?

Debulking is a type of surgery with the goal of removing as much cancerous tissue as possible. In terms of ovarian cancer treatment, this surgery will aim to remove some or all of the cancer, and may involve removing affected reproductive organs such as the ovaries, uterus, womb, cervix, lymph nodes or fallopian tubes.

This treatment is very important for women whose ovarian cancer has spread to other parts of the body, as it can dramatically improve survival rates by making other treatment strategies - such as chemotherapy or radiotherapy - more effective.

What happens during surgery?

The operation can be quite a big procedure. It is sometimes carried out using a traditional vertical incision of the abdomen, allowing the surgeon to explore the pelvic region and remove as many tumours as possible. This type of surgery is known as open surgery, and the patient is asleep the entire time. Recovery time is usually around 4-6 weeks.

Alternatively, some surgeons decide to use a minimally invasive procedure known as laparoscopy, involving small incisions, special instruments, and a camera to assist in the removal of tumours. The recovery time of this is greatly reduced and women can typically return to normal daily activities within a week. It’s important to note that some women cannot be optimally debulked (successfully removing a sufficient amount of cancer) using this minimally invasive procedure, so a larger incision and more extensive exploration may be needed after.

In some cases, the surgeon will need to remove more than just the reproductive organs. For example, cancer may have spread to the colon or small intestine, in which case parts of them will need to be removed. There is also a chance that the cancer has spread to other organs such as the bladder, spleen, gallbladder, stomach, liver, or pancreas. The surgeon will have to decide what is best for your individual case.

Are there any risks?

As with any type of surgery, ovarian cancer debulking does carry some risk of complications:

• infection
• blood clots
• excessive bleeding
• pain
• adverse reactions to the anaesthetic
• slow recovery

The chances of complications occurring are, however, very rare.

Before surgery

Before undergoing this debulking operation, your doctor will assess whether you are fit to undergo surgery using blood tests, breathing tests, an x-ray, and other tests to check the health of your heart.

You may also visit a pre-assessment clinic to prepare you for the operation and your recovery, and you will have a chance to meet members of your treatment team to discuss any doubts you might have. A specialist may also discuss any recovery plans the hospital has to offer.

After surgery

Following surgery, you will need time to recover. If you have undergone open surgery, you will need to spend a few days in the hospital before being allowed to go home. When your doctor thinks you are ready, you will likely undergo either chemotherapy or radiotherapy to destroy any cancer that your surgeon couldn’t remove. The less cancer left, the easier it is for these therapies to kill the remaining cancer cells.

Some women may have to undergo chemotherapy before and after surgery, which is known as interval debulking surgery (IDS).

Prognosis

Patients who have been optimally debulked have a better outlook than those left with large tumours, known as sub-optimally debulked.

Having children in the future

For stage 1 cancers that haven’t spread very far, the surgeon may be able to leave behind an unaffected ovary and your womb - meaning you may still be able to become pregnant later.

For advanced-stage cancer, meaning your cancer has spread away from the ovary, your surgeon might have to remove them completely. This ultimately means you won’t be able to become pregnant after.

Which specialist performs this surgery?

Ovarian cancer debulking surgery is typically performed by a gynaecological oncologist.