Risk-Reducing Ovarian Cancer Surgery
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/ Updated October 14th, 2020

Risk-Reducing Ovarian Cancer Surgery

Medical Source: Dr. Gillian Hsieh
Sutter Bay Medical Foundation
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Risk-Reducing Surgery Explained

  • Doctors may recommend preventive surgery for women with BRCA1 or BRCA2 genetic mutations
  • Laparoscopic surgery is intended to remove the fallopian tubes and ovaries prophylactically
  • Doctors do “pelvic washings” to check for hidden cancer cells
It’s no secret that some cancers are genetically linked, meaning inherited mutations from your parents increase your risk of developing the disease. Studies show that between 10 and 15 percent of high-grade epithelial ovarian cancers have an inherited component. That’s one reason the Society of Gynecologic Oncology recommends that ovarian cancer patients and, in some cases, their immediate family members undergo medical genetic testing.

“Genetics is a really hot issue in ovarian cancer right now, because there are a lot of treatment options for patients with certain genetic mutations,” says Dr. Gillian Hsieh, gynecologic oncologist at Sutter Bay Medical Foundation in the San Francisco Bay Area. For example, women who test positive for the BRCA1 or BRCA2 mutations may choose to undergo surgery, even before receiving a cancer diagnosis.

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Candidates for Risk Reducing Surgery

Women who test positive for one of the BRCA mutations have a significantly increased risk of developing ovarian cancer by age 70. Those with BRCA1 mutations have a 40 percent increased risk of developing ovarian cancer while those with BRCA2 mutations have a 20 to 25 percent increased risk.

“In addition to BRCA1 and BRCA2, there are a number of genes that may be implicated in issues with cellular and DNA repair that can predispose you to ovarian cancer,” Dr. Hsieh says. “For these patients, screening is important not only because their risk is so high, but also because ovarian cancer is difficult to detect in the early stages.”

For some of these women, just knowing they have an increased risk of potentially developing cancer can cause undue stress and anxiety that interferes with their quality of life. These women are good candidates for a procedure called risk-reducing salpingo oophorectomy. During this procedure, doctors remove the fallopian tubes and ovaries prophylactically, usually between the ages of 35 and 40 for BRCA1 carriers and between 40 and 45 for the lower risk BRCA2 carriers.

Risk Reducing Surgery Explained

Compared to ovarian cancer surgery, risk reducing surgery is an almost seamless procedure. But it is different from a standard oophorectomy and includes a few extra steps for your surgeon.

“For risk-reducing surgery, we need to remove a longer segment of the blood supply to the ovary, which comes through the pelvic ligament,” Dr. Hsieh says. “So a portion of that ligament has to be removed along with the ovaries and fallopian tubes.”

The idea, of course, is to cut off the blood supply to an area where a future cancer could emerge. For that reason, doctors also do a procedure at the time of surgery called pelvic washings. With this procedure, doctors insert saline into the patient’s belly and then suction out the fluid to be examined for hidden cancer cells.

Deciding Whether to Move Forward

Your risk of developing ovarian cancer depends on a host of factors, including your family history and possible genetic mutations, age, and lifestyle. The decision about whether or not to move forward with risk-reducing surgery is complex. Not only do women have to weigh their odds of developing ovarian cancer, but they also have to consider how the procedure will impact their life.

With prophylactic oophorectomy, women lose their ovaries. That can have important implications for women who are pre-menopausal, particularly those who are planning for a family. Even if you don’t plan on having children, removing your ovaries will push you into premature menopause, which can impact your lifestyle and relationships.

Deciding if risk-reducing, prophylactic surgery is right for you isn’t easy. There is no right or wrong answer, and you’re the only person who can make the choice. Talking through your options with a genetic counselor, doctor or social worker will not only provide you with a clearer picture of your risk of developing ovarian cancer, but it can also help you identify the best path forward.

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Dr. Gillian Hsieh is a gynecologic oncologist at Sutter Bay Medical Foundation Read More

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