Before the Operation: How Ovarian Cancer Gets Planned
Indian Ovary Cancer Institute (IOCI) · Shah’s Gastro, Cancer & Robotic Surgery Centre
Last updated: 20-Oct-2026
Assessment, surgery and follow-up for epithelial ovarian, tubal and peritoneal cancer · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
IN SHORT
Most of this operation is decided before the day of surgery. The scan, the markers and a look inside settle what will be done.
Ovary, fallopian tube and peritoneal cancer are treated as one disease. The plan does not change with the name on the report.
The aim is to leave nothing visible behind. A planned part-removal is not offered here, because it helps no one.
Advanced disease is opened through the midline. Keyhole is used to look, to biopsy, and for a tumour that still sits in the ovary.
The BRCA and HRD test is sent at the first visit. Its result decides the tablet taken after chemotherapy, so it cannot wait.
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Ovary Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Gota, Ahmedabad · 18 years of experience
★★★★★ 4.96 from 24 Google reviews
Indian Ovary Cancer Institute (IOCI). Dr Swati Shah holds MS, DrNB (Surgical Oncology). She studied medicine and trained in general surgery at Maulana Azad Medical College, Delhi. She trained in surgical oncology at Rajiv Gandhi Cancer Institute and Research Centre, Delhi. She has 18 years of experience in cancer surgery for women, and has worked on the robotic console since 2013. Consultation, assessment, surgery, chemotherapy planning and follow-up run as one pathway.
Every new case is discussed at a tumour board before any treatment starts. The board has a cancer surgeon, a medical oncologist, a radiologist and a pathologist. The choice between operating first and giving chemotherapy first is made there. It is not a single surgeon’s call.
What the first visit is for
The first visit answers three questions. What is this mass, how far has it reached, and is the body ready for a long operation.
Women reach this clinic in two ways. Some come with a mass found on a scan. Others come with months of bloating, a full feeling after small meals, and a belly that has grown. Fluid in the belly is common at that point. The visit begins with an examination. Then the records are read in order. Outside scans are reviewed, and some of them can be used as they are. Others have to be repeated before a plan is made.
| At the first visit | Why it is done then |
|---|---|
| Examination of the abdomen and pelvis. | The size of the mass and the amount of fluid are felt, not guessed. |
| Ultrasound of the pelvis, read against a standard scoring system. | It separates a simple cyst from a mass that has solid parts. |
| CT of the chest, abdomen and pelvis. | This is the map. It decides whether the whole disease can be removed. |
| CA-125, CEA and CA 19-9 together. | The pattern of these three says whether the cancer started in the ovary. |
| Weight loss, diet, albumin and daily activity. | A weak body does badly after a long operation. This is fixed first. |
| Age, children, and whether more children are wanted. | A fertility-sparing plan exists only before treatment begins. |
One of those rows matters more than it looks. If the marker pattern does not point to the ovary, a colonoscopy and an endoscopy are done before anything else. A bowel cancer that has spread to the ovary is a different disease with a different operation. Finding that out after the abdomen is opened is too late.
The tests that must be finished before a plan
A scan alone is not a plan. Tissue, markers, a gene test and a fitness check are all needed before anyone is given a date.
- Tissue, taken as a core. A needle core biopsy or a laparoscopic biopsy is needed before any chemotherapy. Fluid cytology on its own is not enough to start treatment.
- The CT read for named places. The omentum, the undersurface of the diaphragm, the porta hepatis, the root of the small-bowel mesentery, the bowel and the nodes. Those places decide the operation.
- BRCA and HRD testing, sent now. Not at relapse. The result chooses the maintenance tablet after chemotherapy, and the report takes several weeks in India.
- Blood counts, kidney and liver tests, albumin and a fitness grade. These decide whether a long operation is safe, and whether to build strength first.
- Fluid from the belly or the chest, where it is present. It is sent for examination, and it also tells us how the disease is behaving.
- A nutrition check. Weight loss, a low body weight, a low albumin or poor eating each trigger a dietitian and a strengthening programme before surgery.
Two tests are often asked for and are not routine here. A PET-CT is not part of first staging. It is kept for a doubtful finding outside the abdomen, or for a suspected return later. An MRI is added only to characterise a mass that the ultrasound and CT cannot settle. How each report changes the plan is set out on our page on what each test result decides.
Operate first, or give chemotherapy first
This is the real decision in this cancer. It turns on one question: can every visible deposit be removed safely, right now.
| Finding | What usually follows |
|---|---|
| Disease that can all be removed, in a woman who is fit. | Surgery first, then chemotherapy. This gives the strongest long-term result. |
| Disease at the root of the small-bowel mesentery. | Chemotherapy first. The bowel cannot be cleared there without losing too much of it. |
| Disease around the entrance to the liver, or large-volume upper abdominal disease. | Chemotherapy first, then an operation once it has shrunk. |
| A woman who is weak, poorly nourished, or carrying other illness. | Chemotherapy first, with strength built up at the same time. |
| Very limited spread outside the abdomen. | Chemotherapy first, then an operation if the disease answers well. |
| Widespread disease in a woman who cannot walk unaided. | Medicines and comfort care, discussed honestly and early. |
The judgement is not made on the CT alone. A keyhole look is done, and the spread is scored at that look. Sometimes the abdomen is opened and assessed directly. Either way, the call is made with eyes on the disease. The sequence that follows, and how long each part takes, is explained on our page on which treatment comes when.
One rule governs all of it. A deliberately partial removal is not done. If everything cannot come out, the surgeon takes a biopsy, closes, and starts chemotherapy. Three or four cycles later the abdomen is reassessed. The operation then has a real chance of clearing it. Our page on surgery first or chemotherapy first works through the same choice in detail.
The route: why advanced disease is opened
Advanced disease is operated through a midline cut. Every surface has to be seen and felt, and keyhole cannot do that.
| Situation | Route used | Why |
|---|---|---|
| Disease spread across the lining of the abdomen. | Open, through the midline. | The diaphragm, the gutters and the bowel are all examined by hand. |
| Judging whether everything can be removed. | Keyhole. | A short look answers the question without a large wound. |
| Taking tissue when a needle biopsy has failed. | Keyhole. | A proper piece of tissue is taken under vision. |
| A tumour that still appears confined to one ovary. | Keyhole or robotic, in selected women. | The mass can be lifted out whole, and the staging steps are done at the same sitting. |
| A borderline tumour in a young woman. | Keyhole or robotic, in selected women. | The ovary on the other side and the womb can be kept. |
| A mass that is large, fixed, or likely to burst. | Open. | Spilling the contents turns a contained tumour into a spread one. |
So the route is not a preference. It follows the disease. A woman who asks for keyhole surgery deserves a plain answer, and the plain answer for widespread disease is that the belly must be opened. The steps of the operation itself are described on our page on how the operation is done.
What complete removal actually means
Complete removal means no deposit is left that the eye can see. Surgeons write it as R0. It is the one thing surgery controls.
- Washings first. Fluid is taken from the abdomen before anything is moved, and sent for examination.
- The womb, both tubes and both ovaries. This is where the disease begins, and it comes out together.
- The fatty apron. The omentum is removed, and in advanced disease the part above the colon is taken as well.
- The diseased lining. The peritoneum is stripped from the pelvis, the gutters and the undersurface of the diaphragm where deposits sit.
- Bowel, only where it earns its place. A length of bowel is removed when that is what turns a near-complete clearance into a complete one.
- Spleen, gallbladder or the tail of the pancreas. Removed when deposits sit on them, and not otherwise.
- The appendix in mucinous disease, and biopsies in apparent early disease. Both are part of staging, not extras.
- Lymph glands, chosen and not swept. Enlarged glands are removed. In advanced disease with normal-looking glands, a full clearance adds harm without adding benefit.
That last line is a change many families have not heard. For years every gland was taken out. A large trial settled it. Where the glands look normal and everything visible has gone, taking them all out does not help. So they are left, and the operating time goes into clearing disease instead.
Where HIPEC belongs, and where it does not
HIPEC is heated chemotherapy washed through the abdomen during surgery. It belongs in one setting, and it is not added to every operation.
The evidence supports it at the interval operation. That is the operation done after three or four cycles of chemotherapy, in disease that had spread across the lining of the abdomen. The drug is warmed and circulated for about an hour and a half once everything visible has been removed.
Two limits are said plainly. At a first operation, before any chemotherapy, HIPEC is still under study, and it is offered on that footing or not at all. And if disease has been left behind, HIPEC is not added. Washing heated drug over a tumour that is still there does not treat it. The machine and the team are in house at Apollo Hospital, Bhat, through Innovative Cancer Solutions. That means the choice rests on the disease, not on what happens to be available. Who it suits is set out on our page on who is a candidate for cytoreduction and HIPEC.
The team around one operation
This operation is not a single-handed job. Several people decide part of the plan, and each of them is named before the date.
| Role | What that person decides |
|---|---|
| Cancer surgeon. | Whether an operation helps now, which organs come out, and the route. |
| Medical oncologist. | The chemotherapy, the order it is given in, and the maintenance tablet afterwards. |
| Radiologist. | How far the disease reaches on the CT, and whether it can be cleared. |
| Pathologist. | The type of cancer, and whether the origin is the ovary at all. |
| Anaesthetist and intensive care. | Fitness, blood arrangements, warmth, fluids and the first night after surgery. |
| Stoma nurse. | Where a bag would sit, marked while the woman sits and stands, before the operation. |
| Dietitian and physiotherapist. | Protein, walking and breathing exercises before surgery, and feeding afterwards. |
| Genetic counsellor. | The BRCA result, what it means for the woman, and testing for her relatives. |
The stoma conversation is the one most often left out. If the CT suggests the bowel may be involved, a bag is possible. So it is discussed before the operation, the spot is marked, and consent is taken for it. No woman here wakes up to a bag she had not been told about.
BRCA, HRD and the talk with the family
A gene test is part of treatment, not an extra. It is sent at the first visit, because the result chooses what happens after chemotherapy.
- Sent at diagnosis, not at relapse. Indian laboratories take several weeks. A test sent late holds up the tablet that follows chemotherapy.
- Both kinds of test. The inherited change is looked for in blood, and the change inside the tumour is looked for in the tissue.
- What the result changes. A BRCA change usually leads to one tablet for two years. Other results lead to a different tablet, or to one given with another drug.
- What is said honestly. Where the result shows no change, the gain from maintenance is smaller. That is said at the time, not implied.
- The family. A BRCA change means sisters, daughters and other close relatives can be tested. That offer is tracked until it is taken up or declined.
- Cost. Some of these medicines are expensive and some are hard to obtain in India. Cost is raised at the first visit, not at the prescription counter.
What is settled before the date of surgery
By the time a date is given, the operation, the possible bag, the blood, the drinks and the first follow-up are already agreed.
- The board decision. Surgery first or chemotherapy first, written down with the reason.
- The planned extent. Which organs may need to come out, including bowel, spleen or diaphragm lining.
- The stoma. Marked and consented wherever bowel resection is possible.
- Blood and nutrition. Haemoglobin brought up, iron corrected, protein started from the clinic visit.
- Prehabilitation. A daily walk, a breathing device, and a plan the family can follow at home.
- Fasting and drinks. A carbohydrate drink the evening before and a smaller one on the morning, with clear fluids allowed up to two hours before.
- No routine bowel washout. It is used only when a bowel join is planned, and then with antibiotics by mouth.
- Clot prevention. Risk is scored, and injections are planned for four weeks after discharge. This cancer carries the highest clot risk of the women’s cancers.
- The next appointment. The medical oncology visit is booked before discharge, not after it.
What to ask any centre about this operation
These questions tell you more about a centre than any claim on a website. Ask them wherever you are being treated.
- Will my case go to a tumour board before treatment starts? Ask who sits on it.
- How will you decide whether to operate now or give chemotherapy first? Ask whether a keyhole look is part of that.
- Is the aim to leave nothing visible? Ask what happens if that turns out to be impossible on the day.
- Who will be in theatre if the bowel, spleen or diaphragm is involved? Ask whether that is routine there.
- Has the BRCA and HRD test been sent already? Ask for the date it went, not a promise to send it.
- Is a bag possible, and has it been marked? Ask to meet the stoma nurse before the operation.
- Is HIPEC being suggested, and at which operation? Ask what the evidence is for that setting.
- What will be done to prevent clots after I go home? Ask for how long.
- Who sees me afterwards, and how often? Ask what each visit checks.
Training, published work and case summaries
Training, teaching and published work are facts you can check. Counts of operations and success rates are not published on this site.
Dr Swati Shah studied medicine and trained in general surgery at Maulana Azad Medical College, Delhi. She trained in surgical oncology at Rajiv Gandhi Cancer Institute and Research Centre, Delhi, and holds MS, DrNB (Surgical Oncology). She has 18 years of experience in cancer surgery for women. She has worked on the robotic console since 2013. She teaches surgeons and trainees in advanced ovarian cancer surgery, and runs the national academic platforms PROM, Pelvic POINT, POFCON and POEM.
The operations she performs for this disease are named through this page. They are staging surgery for apparent early disease, cytoreductive surgery with removal of the womb, tubes, ovaries and omentum, peritoneal stripping including the diaphragm, bowel resection where it is needed, spleen and upper abdominal work where deposits sit there, interval surgery after chemotherapy, HIPEC in the setting described above, fertility-sparing surgery in a small and carefully chosen group, and surgery for disease that has come back. She is a member of the Association of Surgeons of India, the Indian Association of Surgical Oncology, the Association of Gynecologic Oncologists of India, the European Society of Gynaecological Oncology, the Society of Endoscopic and Laparoscopic Surgeons of India, the Indian Medical Association and the European Association of Urology.
Numbers of operations, success rates and survival figures are deliberately absent from this page. They are kept in the surgical registry, where they are used for consent discussions, audit and papers. Your own outlook is given to you in person, for your disease and your fitness, before you sign a consent form.
A short film on what cytoreductive surgery means in advanced ovarian cancer. Every woman’s plan is made for her own disease and her own fitness.
The first week after surgery
Recovery is planned day by day from the evening of surgery. Sitting up, sipping and walking start far earlier than families expect.
| Day | What is aimed for |
|---|---|
| Day of surgery. | Sitting out of bed for about two hours, small sips, pain control without heavy opioids. |
| Day one. | Liquid diet, walking three times, the urine tube out unless the pelvic dissection was extensive. |
| Days two and three. | Soft diet, drips stopped, tablets for pain, a close watch for a lazy bowel. |
| Days four to seven. | Full soft diet, drains out as they dry up, bag training finished, discharge checked. |
Discharge is not a date on a calendar. Every one of these has to be true. No fever for a day. Soft diet tolerated. Wind or motion passed. Walking without help. Pain controlled on tablets. The family able to give the clot injection at home, and able to manage a bag if there is one. The histology appointment and the chemotherapy appointment are both booked before the woman leaves. What the ward days feel like is described on our page on the hospital stay and recovery.
Risks and certainties, named in words
Risks are named here in words. Your own figures are given in person before consent, for your disease and your fitness.
| Risk or certainty | What it means |
|---|---|
| Bleeding needing a transfusion, or a wound infection. | The general risks of a long abdominal operation. |
| A clot in the leg or the lung. | Higher in this cancer than in the other women’s cancers. Four weeks of injections after discharge lower it. |
| Bowel removal, and sometimes a bag. | Discussed and consented before the operation whenever the scan suggests it. |
| A leak where bowel has been joined. | Shows as fever and a fast pulse after a few days. It is acted on the same day, never watched overnight. |
| Fluid or air beside the lung after diaphragm surgery. | Found on a chest X-ray and drained if it causes breathlessness. |
| A leak from the pancreas after spleen or pancreas surgery. | The drain is kept and measured. It is not removed early. |
| A lazy bowel after eating restarts. | Rest, a tube if needed, and a scan if it does not settle. |
| Kidney strain after HIPEC. | Watched with blood tests, treated with fluids, and kidney specialists are involved early. |
| A time in intensive care, and a longer stay. | More likely after upper abdominal work, bowel resection or HIPEC. |
| Menopause begins at once. Certain if both ovaries are removed. | Symptoms and bone health are treated, and hormone replacement is discussed in most types. |
| Fertility ends. Certain, unless a fertility-sparing operation was planned in advance. | It cannot be arranged after treatment has started. |
| Chemotherapy follows the operation. Certain. | Surgery alone is not the treatment for this cancer. |
- Fever with abdominal pain, or a fast pulse that will not settle. This needs the team the same day.
- A newly swollen painful leg, chest pain, or sudden breathlessness. A clot is assumed until a scan says otherwise.
- Vomiting with a swollen belly after food has restarted. Stop eating and call.
- Watery discharge from the vagina weeks later. It is never dismissed as normal healing.
Follow-up runs three-monthly for two years, then four to six-monthly to five years. Each visit is an examination, with CA-125.
Scans are not done on a routine timetable while a woman is well and the marker is normal. A CT is done when the marker rises or symptoms appear. And a rising marker on its own, in a woman who feels well, is not by itself a reason to restart chemotherapy. That is a judgement made with her, not driven by a number on a form. The schedule is set out on our page on how often the checks are needed.
Reviews below are shown as Google holds them. They describe one family’s experience, and no two women have the same disease or the same plan.
What patients and families have said
★★★★★
“My relative was treated for ovarian cancer at Indian Ovarian Cancer Institute (IOCI), and we are thankful for the outstanding care throughout the treatment journey. From diagnosis to surgery and follow-up, every stage was managed with professionalism, compassion, and attention to detail. The institute’s expertise in robotic ovarian cancer surgery, Cytoreductive Surgery (CRS), and CRS HIPEC gave us complete confidence. We would highly recommend IOCI to anyone seeking comprehensive ovarian cancer treatment in Ahmedabad, Gujarat, or India.”
— Dr Dushyant Baraiya, Google review
★★★★★
“My relative required surgery for a large ovarian mass, and we chose Indian Ovarian Cancer Institute (IOCI) because of its exclusive focus on ovarian diseases. Every report was explained patiently, and we never felt rushed while making treatment decisions. The surgery was successful, recovery was excellent, and the follow-up has been very reassuring. We highly recommend IOCI for ovarian mass, ovarian tumour, and robotic ovarian surgery.”
— Jignesh Patel, Google review
★★★★★
“We are extremely grateful to Dr. Swati Shah for treating my mother for ovarian cancer and performing her surgery. She is a very experienced, compassionate, and dedicated doctor. She explained the treatment and surgery very patiently and gave us confidence throughout the entire journey. The surgery went well, and my mother is doing much better now. Thank you, Dr. Swati Shah, for your excellent care and support. Highly recommended for ovarian cancer treatment.”
— Jay Udasi, Google review
These are Google reviews, shown exactly as written, from families treated for ovarian cancer at the IOCI clinic and at Apollo Hospital, Bhat.
Your path, from first visit to follow-up
- Book your consultation. At the Gota OPD, Gota, Ahmedabad, with every scan, report and slide you hold.
- Assessment and the missing tests. The CT is read or repeated, markers and the gene test are sent, and tissue is obtained.
- The tumour board. Surgery first or chemotherapy first is chosen, and the reason is explained to you in plain words.
- The operation. At Apollo Hospital, Bhat, Gandhinagar, with intensive care and blood support on hand.
- Chemotherapy, maintenance and follow-up. Booked before discharge, then visits every three months for two years.
Cost, insurance and admission
The cost depends on the extent of the operation and the length of stay. You are given a written estimate before any admission.
Apollo Hospital, Bhat works with the major insurers and with cashless cover, and its office handles the pre-authorisation. Four things move the estimate. How much has to be removed. Whether HIPEC is part of the plan. How many days are spent in intensive care. And how long the stay runs. The maintenance tablet after chemotherapy is a separate cost, and often the largest one, so it is discussed at the first visit rather than at the end. Please bring every scan on a disc or a link, the biopsy slides and blocks if you hold them, your medicine list, your insurance card and an identity document.
Frequently asked questions
How is it decided whether I have surgery first or chemotherapy first?
It turns on whether every visible deposit can be removed safely now. The CT gives the first answer, and a keyhole look or an open assessment confirms it. The tumour board records the decision before treatment starts.
Can this operation be done by keyhole or by robot?
For disease spread across the lining of the abdomen, no. Every surface has to be seen and felt, so the belly is opened. Keyhole is used to assess and to biopsy, and for a tumour that still appears confined to one ovary.
Will I need a bag after the operation?
Most women do not. A bag becomes possible when a length of bowel has to be removed low in the pelvis. Where the scan suggests that, it is discussed, marked and consented before the operation, never decided on the day.
Should HIPEC be part of my operation?
It depends on which operation. The evidence supports it at the interval operation after chemotherapy, in disease spread across the lining of the abdomen. At a first operation it is still under study, and it is never added when disease has been left behind.
Why is the BRCA test sent before treatment has even started?
Because the result chooses the maintenance tablet taken after chemotherapy, and Indian laboratories take several weeks. A test sent at relapse arrives too late to be useful, which is the commonest avoidable delay in this pathway.
Can I still have a child after treatment for ovarian cancer?
Only in a small and carefully chosen group, and only when it is planned before treatment begins. It needs disease confined to one ovary, a favourable report and detailed counselling. Once chemotherapy or a full operation has gone ahead, the option has gone.
Why does this page carry no numbers of operations or success rates?
Volume and outcome figures are not published on this site. They are kept in the surgical registry, which is used for consent, audit and papers. Your own outlook is explained to you in person before you sign consent.
Where Dr Swati Shah sees and operates
Indian Ovary Cancer Institute (IOCI), Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Ovary Cancer Surgeon
Consultation: Gota OPD, Gota, Ahmedabad. Surgery: Apollo Hospital, Bhat, Gandhinagar.
Gota OPD, Gota, Ahmedabad — SF-203, 2nd Floor, Olive Greens, S G Highway, Ahmedabad, Gujarat 382481. Directions
Apollo Hospital, Bhat, Gandhinagar — Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat 382428. Directions
Call: +91-63590-11009 · WhatsApp: +91-63590-11009
Women travel to Ahmedabad for ovarian cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
Told that an ovarian mass may be cancer? Your CT images, CA-125 and any biopsy or laparoscopy report can be sent ahead, so the consultation starts with them already read. The plan is decided at the consultation, after examination, and at the tumour board. Call +91-63590-11009 · Send the reports ahead on WhatsApp
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