Surgery to lower , ovarian and primary peritoneal cancer risk
This section covers the following topics:
- Types of surgery
- Expert guidelines
- Hysterectomy during risk-reducing removal of ovaries and tubes
- Surgical risks
Note that when we use "women" we are referring to the sex you were assigned at birth.
- Salpingo-oophorectomy is surgery to remove the and ovaries to treat or prevent disease. "Risk-reducing salpingo-oophorectomy" () refers to the removal of the healthy ovaries and to reduce a person's risk of developing cancer. Research on in high risk women has shown that:
- It is an effective way to lower the risk for ovarian and cancer. There is a remaining risk for primary peritoneal cancer even after the ovaries and tubes have been removed.
- it can lower the risk for death in high-risk women.
- It may also lower the risk for breast cancer in certain high-risk women.
- It does not completely eliminate the risk for cancer. After , there is still a risk for primary peritoneal cancer. The risk for primary peritoneal cancer is very small and varies by gene mutation.
- involves removal of the only. Research suggests that the may be the source of many ovarian cancers. This has led researchers to study if it is safe to remove the only before menopause and delay removal of the ovaries until after menopause. Studies looking at to lower risk are currently enrolling people. Until these studies are completed, experts cannot say for certain that lowers the ovarian cancer risk in high-risk people.
- Open surgery (also known as a laparotomy) involves one incision in the lower abdomen to remove the ovaries, , and (for those undergoing hysterectomy) uterus.
- Laparoscopic surgery involves a small incision made in the abdomen to insert a flexible scope with a camera, which is used to see the ovaries and tubes. Addition small incisions are made to insert surgical instruments needed to perform the salpingo-oophorectomy. In general, people who have surgery by laparoscopy may heal quicker and spend a shorter time in the hospital than people who have open surgery. Most can be performed by laparascopic surgery.
Surgery can have risks and side effects. It's important for people to speak with experts in order to learn as much as possible about their ovarian cancer risk and to make an informed decision about the best option for lowering their risk.
The National Comprehensive Cancer Network (NCCN), is an organization of cancer experts that creates guidelines on cancer care and updates them yearly. NCCN's guidelines recommend for people with a mutation in or after they are done having children. (Each gene has a slightly different recommendation, see the link for the full risk-management recommendation).
NCCN suggests that people with a mutation in one of the genes below "consider " after they are done having children. This includes having a conversation about the benefits, risks and best timing for surgery.
For people with mutations in other genes or a strong family history of ovarian cancer with no known mutation, the decision of may be based on personal and family history of cancer.
Hysterectomy can be performed at the same time as . Mutations in the following genes increase the risk for both ovarian and endometrial cancer.
People who have increased risk for ovarian cancer and average risk for endometrial cancer may still choose to remove their uterus at the same time that they undergo risk-reducing removal of their ovaries and . Factors that may affect the decision to remove or spare the uterus at the time of risk-reducing salpingo-oophorectomy include:
- Uterine cancer risk:
Although the overall risk is not increased, some studies have shown that women with an inherited mutation may be at an increased risk of a very rare type of uterine cancer called “uterine serous papillary carcinoma.” Women who have taken tamoxifen have increased risk for uterine cancer.
- Previous uterine or cervical abnormality:
Hysterectomy is often considered if a woman has had any previous abnormal pap smears or any abnormality of the uterus.
- Considerations about hormone replacement
Women who plan to take hormone replacement after may consider hysterectomy in order to simplify hormone replacement. There is an increased risk for uterine cancer in women who take alone compared to with progesterone. Women who have hysterectomy can take without progesterone. alone may have fewer side effects than with progesterone. See our section on Surgical Menopause for more information.
- Intra-operative risk of hysterectomy:
Removing the uterus involves more surgery than alone. Therefore, there is a slight increase in operative complications and in the risk that a laparoscopic procedure will have to turn into an abdominal surgery with a full incision.
- Insurance coverage:
Because of the surgery, recovery and hospitalization are lengthier; some insurance companies won’t pay for hysterectomy unless there is medical necessity.
- Possible long term effects of hysterectomy:
Hysterectomy may increase the risk for some of the long term health issues which may be associated .
Every surgery has risks; some are more serious than others. Some risks can affect recovery or long term health
- Delayed healing
- Blood loss
- Blood clots
- Pain (post-operative and long term pain syndromes)
- Surgical menopause and related health issues (see our section on Side Effects of Menopause for more information)
- Injury to internal organs
- Bladder incontinence
- Sexual side effects
It is important for people to discuss possible surgical risks with a surgeon to understand the seriousness and likelihood of these risks before making the decision to have risk-reducing surgery.
Average recovery time after is about 1-2 weeks.
FORCE offers many peer support programs for people with inherited mutations.
- Our Message Boards allow people to connect with others who share their situation. Once registered, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Our moderated, private Facebook group allows you to connect with other community members 24/7.
- Check out our virtual and in-person support meeting calendar.
- Join one of our Zoom community group meetings.
The following are studies looking at ovarian cancer screening or prevention.
- NCT04251052: A Study to Compare Two Surgical Procedures in Women with Mutations to Assess Reduced Risk of Ovarian Cancer (SOROCk). This study is looking at whether women with mutations who remove just the can reduce the risk of ovarian cancer nearly as much as women who remove their ovaries and .
- NCT05287451: Risk Reducing With Delayed as an Alternative to Risk- Reducing Salpingo-oophorectomy in High Risk-Women to Assess the Safety of Prevention. This study will look at outcomes in women with , , , and who remove their , followed by removal of their ovaries compared to women who undergo standard-of-care removal of their ovaries and at the same time.
- Validating a Blood Test for Early Ovarian Cancer Detection in High-risk Women and Families: MicroRNA Detection Study (MiDE). The goal of MiDe is to develop a test to detect early-onset ovarian cancer. Currently, no reliable screening or early detection tests are available. Participants can be expected to provide up to 4 tubes of blood every 6 months for up to 5 years. These samples can be collected by mobile phlebotomy all around the US.
- NCT04794322: Developing a Test for the Detection of Ovarian Cancer. This study aims to develop an ovarian cancer early detection test that looks at found in a uterine (womb) washing and proteins found in the blood. Participants will not receive the results of their tests.
Additional clinical trials for ovarian cancer screening and prevention may be found here.