Fallopian tube removal may reduce risk of ovarian cancer
In November 2013, I received the devastating and potentially life-changing news that I had ovarian cancer. It was particularly overwhelming in that treatment would entail major surgery, months of chemotherapy and difficult side effects from treatment. Suddenly, I was looking at the possibility that I could die from this condition.
Yet, I am here today because of my early diagnosis that I attribute to my primary care physician who paid attention to my benign symptoms of fatigue, bloating, constipation and abdominal discomfort. She decided it was worth investigating with an abdominal ultrasound followed by an abdominal CT scan. The tests showed a tumor on each ovary.
Ovarian cancer accounts for 1 percent of all new cancer cases in the United States, according to the Ovarian Cancer Research Alliance. It is the 11th most common cancer among women in the United States, is the fifth leading cause of cancer-related death among women and the deadliest of gynecologic cancers.
Other than my diagnosis, the other surprising news was that the cancer had started in my left fallopian tube. In the past few years, studies have shown that’s where ovarian cancer often starts.
A small-sample-sized 2017 study published by the National Cancer Institute provided evidence that the most common type of ovarian cancer (high-grade serous ovarian cancers, HGSOC) may originate in the fallopian tubes. The study also showed that most genetic alterations (changes in DNA) in the ovarian tumors were present in lesions that had formed years earlier in the fallopian tubes before the cancer started in the ovaries.
The findings could potentially enable earlier detection of the disease, the researchers said. Approximately 70 percent of women with high-grade serous ovarian carcinomas are diagnosed in the advanced stages of their disease.
Reducing Your Risk
While there are no screening tests for ovarian cancer, and women are often diagnosed in the later stages because the symptoms are so subtle, like mine were, there is a glimmer of hope that prevention may help reduce the risk of ovarian cancer for some women.
“In 2019, The American College of Obstetricians and Gynecologists (ACOG) published recommendations that opportunistic salpingectomy (removal of fallopian tubes) in patients undergoing pelvic surgery for a benign disease, including hysterectomy for heavy menstrual periods, fibroids or sterilization, is an opportunity to decrease the risk of ovarian cancer,” said Holly Zheng, MD, an obstetrician/gynecologist with Cape Obstetrics & Gynecology in Falmouth, Sandwich and Bourne. “An opportunistic salpingectomy means that we offer women who have a general population risk of getting ovarian cancer, which is approximately 1.1 percent, or 1 in 91, the option of having their fallopian tubes removed during their hysterectomy or other pelvic surgery as a preventative step.”
She cited a 2017 Swedish study reported in the International Journal of Clinical Studies and Medical Case Reports that showed a 65 percent reduction in the risk of ovarian cancer with bilateral salpingectomy and a 28 percent reduction with tubal ligation. The women in the study were followed for 30 years.
“This is why you are seeing an increase in the bilateral salpingectomy, as opposed to tying the tubes,” she said.
For those who may be undecided about having their fallopian tubes removed, especially if you are still within child-bearing age, it can be a difficult decision.
Dr. Zheng recommends having the discussion with your gynecologist and keeping in mind that removing the fallopian tubes is permanent sterilization.
“You have to be 100 percent certain this is what you want and that you don’t want any more children,” Dr. Zheng said. “If you are going to have a hysterectomy, the majority of OB/GYNs are going to encourage you to remove your fallopian tubes at the same time, as it has been shown to also reduce the risk of ovarian cancer.”
