Updates in Gynaecology

Edited by Dr Roman

PREVENTING OVARIAN CANCER

by Jose Roman

Women at a high-risk of developing serous ovarian cancer due to their inheritance of a mutation in a cancer predisposition gene, such as BRCA1, BRCA2, are strongly advised to have prophylactic surgery to remove their ovaries and fallopian tubes (risk-reducing bilateral salpingo-oophorectomy) once childbearing is complete. 

This approach is NOT advisable for women at a low-risk ( premature menopause, cardiovascular disease, dementia, osteoporosis ).

Fallopian tubes of high-risk women were carefully examined and preinvasive cancerous lesions were found leading to other reports with similar findings and the unifying hypothesis suggesting that the fallopian tubes were the site of origin of many serous ovarian cancers . These precursor lesions – tubal intraepithelial carcinomas (TICs) – had no correlating precursor lesions within the ovary. When specimens from women with serous ovarian cancers, untested for BRCA mutations, were examined these lesions were also found in at least 40–60% of cases and the fimbrial end of the fallopian tube obliterated in another 20%.

Tubal hypothesis for the origin of ovarian cancer: PREVENTING OVARIAN CANCER BY BILATERAL SALPINGECTOMY

So women at high risk of ovarian cancer may be offered BILATERAL SALPINGECTOMY WHEN PREMENOPAUSAL UNTIL LATER ON WHEN THEY BECOME MENOPAUSAL THEY MAY BE OFFERED BILATERAL OOPHORECTOMY

1. Removing the fallopian tubes at the time of hysterectomy

2. Performing bilateral salpingectomies at the time of sterilisation ( instead of tubal occlusion )

ACOG Feb 2016- Committee opinion- Salpingectomy for ovarian cancer prevention

 

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