Hysterectomy—Ovarian Cancer & the Fallopian Tubes

“There has been a major breakthrough in our understanding of the origin of ovarian cancer with the identification of the fallopian tubes as the major source of ovarian cancer.” (Dr. Daly, 4/15/15)

If you or someone you know is planning to have a hysterectomy for a benign condition such as fibroids, recent research that implicates the fallopian tubes in the development of ovarian cancer may be important to discuss with the doctor. 

Breakthroughs in Ovarian Cancer

Ovarian cancer is relatively rare in the United States yet it represents the leading cause of gynecological cancers. The cure rates are high when the diagnosis is made in early-stage disease, but most women are diagnosed with late-stage disease. The screening options are limited.

Causes

Many of the theories about the causes of ovarian cancer came about from looking at things that reduce the incidence of this disease. For example, a history of taking oral contraceptives, pregnancy, tubal ligation, and hysterectomy in which the ovary is retained all have been associated with a reduced risk of ovarian cancer. A small portion of ovarian cancers occurs in women with inherited gene mutations linked to an increased risk of ovarian cancer. Genetic testing can detect gene mutations associated with inherited syndromes (including BRCA 1 & 2), but it is not useful for screening the general population.

Mary Daly, MD, head of the Genetics Risk Assessment Division of Fox Chase Cancer Center in Philadelphia commented for an article on MedScape, Ap 15, 2015, “There has been a major breakthrough in our understanding of the origin of ovarian cancer with the identification of the fallopian tubes as the major source of ovarian cancer.” High-grade serous cancer of the ovary is the most lethal form of ovarian cancer and appears to arise from the fallopian tube rather than the ovaries. 

Implications for the Future

These breakthrough findings raises the question of risk-reducing surgeries that might be undertaken prior to menopause for those women identified to have the inherited genetic mutations that increase risk. It turns out that high grade serous cancer of the ovary is the most common form of ovarian cancer among women with high genetic risk. 

Many women undergo hysterectomy for more benign conditions such as fibroids. A strong case can now be made for bilateral salpingectomy (removal of both fallopian tubes) with ovarian retention since this may reduce the risk of ovarian cancer among women undergoing a hysterectomy. Approximately 15% who have had a hysterectomy for benign conditions go on to develop ovarian cancer and performing removing the tubes while leaving the ovaries can be expected to reduce their risk. Undoubtedly, more research will be done to better understand the impact of removing the fallopian tubes on ovarian function and the risks involved in the surgical procedure itself.  Before this approach of bilateral salpingectomy with ovarian retention becomes the standard of care, the safety and effectiveness of this approach needs to be established. 

Talk to Your Doctor

Women who are anticipating having a hysterectomy may want to discuss these recent findings with their gynecologist prior to surgery.