The extent of the cancer will determine the type of surgery needed. If the cancer has spread beyond one fallopian tube, as is usually the case, generally the aim of treatment will be to leave you with no visible evidence of disease.

This will usually require a hysterectomy (removal of the uterus), and removal of both fallopian tubes and both ovaries (a bilateral salpingo-oophorectomy). See below for explanations of these procedures. The omentum (a protective apron of fatty tissue over the abdominal organs) is also usually removed, and multiple biopsies will be taken.

If you have advanced disease (i.e. Stage 3), bowel resections may be required. This is an operation for the removal of a length of bowel (either the large bowel or the small bowel).

In cases of very advanced disease, the goal of surgery is primarily to remove as much tumour bulk as safely possible (cytoreduction).

You will generally be in hospital for anywhere from 7 to 14 days, depending on how fast you recover from the surgery and whether or not you receive your first dose of chemotherapy while still in hospital.

If you are premenopausal and feel concerned about how surgery will affect your fertility, see ‘Fertility problems’ for more information.

Hysterectomy

A hysterectomy is the surgical removal of the uterus.

When you wake up from a hysterectomy, you will have several tubes in place. An intravenous drip will administer fluid and medication. There may also be one or two tubes in your abdomen to drain away fluid from the operation site and a small plastic tube (catheter) in your bladder to drain away urine. These tubes will usually be removed about 3–5 days after the operation.

Your doctors, nurses and physiotherapists will advise you on how to move your legs to prevent blood clots forming and help lymph fluid to drain. As soon as you are able, you should get out of bed and walk around. However, it may take several weeks before you feel fully recovered from the surgery.

Bilateral salpingo-oophorectomy

Bilateral salpingo-oophorectomy is surgery to remove both ovaries and both fallopian tubes. ‘Salpingo’ refers to the tube, and ‘oophorectomy’ refers to the ovary; ‘ectomy’ means removal. Bilateral is removing both sides (unilateral is removing one side).

Side effects of surgery

After a hysterectomy and oophorectomy, some women experience the following side effects:

• Pain: As with all major operations, you will have some pain or discomfort. It is best to let your doctor or nurse know when you are feeling uncomfortable – don’t wait until the pain becomes severe. You will be administered pain relief medication through an intravenous drip. You may be able to use a patient-controlled analgesia (PCA) system, which allows you to choose when you receive a dose of medication. Some people receive an epidural to relieve pain. An epidural is a form of regional anaesthesia involving injection of drugs into the spine.
• Tiredness: Women usually feel extremely tired after a hysterectomy.
• Nausea, vomiting, and bladder and bowel problems: Some women may have problems with nausea and vomiting after surgery, and some may have bladder and bowel problems. The doctor may restrict your diet to liquids at first, with a gradual return to solid food.
• Adhesions: Adhesions, or internal scar tissue that glues together tissues in the body, may form. Sometimes this can be painful. Adhesions to the bowel or bladder may need to be treated with further surgery.
• Lymph fluid build-up: If you have had lymph nodes removed (lymphadenectomy), parts of your body may swell because your lymphatic system is not working properly. This is called lymphoedema. Lymphoedema symptoms may not appear for more than 2 years after surgery. Swelling in your limbs may be reduced with gentle massage towards your heart, special compression garments and gentle exercise.
• Not being able to become pregnant: After a hysterectomy, you will not be able to become pregnant.
• Menopause: If you have had a bilateral salpingo-oophorectomy and were not menopausal before the surgery, the removal of your ovaries will cause menopause. Hot flushes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. Hormone replacement therapy (HRT) can help reduce your symptoms. You will need to talk to your gynaecologic oncologist about the benefits and risks of HRT. Because cancer of the uterus can be hormone sensitive, HRT may not be suitable for some women.
• Effects on your sex life: The physical and emotional changes you experience may also affect how you feel about sex and how you respond sexually.

Recovery from surgery

Surgery for cancer of the fallopian tubes is a major operation. It will take time to get back to your normal activities.

• Rest: Recovery time varies from woman to woman. Most women feel better within 6 weeks, but recovery may take longer for women who have had extensive surgery. You should take things easy and only do what is comfortable. When your health-care team advises you to start exercising, you can start by walking. Start with a short walk and try to go a little further each day.
• Lifting: Heavy lifting should be avoided for about 3 months. If you have a partner or children, ask them to help around the house. If you require some home nursing care, ask hospital staff how to get in touch with local services.
• Driving: Avoid driving for about 4 weeks after the operation.
• Sex: Penetrative sexual intercourse should be avoided for about 6 weeks after the operation to give your wound time to heal. Check with your doctor about when you can resume sexual intercourse.

Chemotherapy  will usually be given after surgery for fallopian tube cancer.

In some cases of fallopian tube cancer, radiotherapy to the abdomen and pelvis may be given following chemotherapy.

Some cancers depend on hormones for their growth. Hormonal therapy may be used to block the hormones that help cancer grow.

The role of hormonal treatment for fallopian tube cancer is not clear, although both medroxyprogesterone acetate and megestrol acetate have been used together with chemotherapy with varying degrees of success.