Our Summary

This research paper looks into the findings from preventative surgery performed on Korean patients who were identified to have certain genetic mutations (BRCA1/2) that increase the risk of developing ovarian cancer, but who showed no symptoms of the disease. These patients had a procedure called risk-reducing salpingo-oophorectomy, which is the removal of the fallopian tubes and ovaries to prevent cancer.

The study found that about half of the patients had a BRCA1 mutation, half had a BRCA2 mutation, and a very small number had both. During the surgery, a few patients with BRCA1 mutation were found to have early stages of cancer (STIC or STIL) or hidden cancer, which could not be detected before the operation. In the BRCA2 group, only one case of early-stage cancer was found and no hidden cancers.

These patients were followed up for a certain period of time and none of them developed a specific type of cancer (primary peritoneal carcinomatosis) that starts in the peritoneum (a thin layer of tissue that covers the abdomen). This suggested that additional treatment might not be necessary for patients diagnosed with early stages of cancer during this preventative surgery.

FAQs

  1. What is risk-reducing salpingo-oophorectomy?
  2. What were the findings in patients with BRCA1/2 mutations who underwent risk-reducing salpingo-oophorectomy?
  3. Is additional treatment necessary for patients diagnosed with early stages of cancer during the preventative salpingo-oophorectomy?

Doctor’s Tip

A doctor might tell a patient undergoing salpingo-oophorectomy for preventative reasons to follow up closely with their healthcare provider to monitor for any potential signs of early-stage cancer that may be detected during the surgery. Additionally, they may recommend genetic counseling for family members to assess their own risk and potential need for preventative measures. It is important for patients to understand the reasons for the surgery and to discuss any concerns or questions with their healthcare team.

Suitable For

Overall, patients who are typically recommended salpingo-oophorectomy include those with a high risk of developing ovarian cancer, such as those with BRCA1 or BRCA2 genetic mutations. This may include individuals with a family history of ovarian or breast cancer, those with a personal history of breast cancer, or those who have undergone genetic testing and been found to have these mutations. Additionally, women with certain conditions such as Lynch syndrome or hereditary nonpolyposis colorectal cancer (HNPCC) may also be recommended for this procedure.

Timeline

Before the salpingo-oophorectomy:

  1. Patients undergo genetic testing to identify mutations (BRCA1/2) that increase the risk of ovarian cancer.
  2. Patients with identified mutations who show no symptoms of the disease are recommended for risk-reducing salpingo-oophorectomy.
  3. Pre-operative counseling and discussions take place to educate patients about the procedure and potential risks and benefits.

After the salpingo-oophorectomy:

  1. During the surgery, the fallopian tubes and ovaries are removed to prevent cancer.
  2. Some patients may be found to have early stages of cancer (STIC or STIL) or hidden cancer during the operation.
  3. Patients are followed up for a certain period of time to monitor for any signs of cancer recurrence.
  4. None of the patients in the study developed primary peritoneal carcinomatosis, suggesting that additional treatment may not be necessary for those diagnosed with early-stage cancer during the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about salpingo-oophorectomy include:

  1. What are the reasons for recommending a risk-reducing salpingo-oophorectomy for me?
  2. What are the potential risks and complications associated with this surgery?
  3. How will this surgery affect my hormone levels and menopausal symptoms?
  4. Will I need hormone replacement therapy after the removal of my ovaries?
  5. How will this surgery impact my fertility and options for preserving fertility?
  6. What are the chances of finding early-stage cancer or hidden cancer during the surgery?
  7. Will I need any additional treatment if cancer is found during the surgery?
  8. How often will I need to undergo follow-up screenings or tests after the surgery?
  9. Are there any long-term effects or consequences of having my fallopian tubes and ovaries removed?
  10. Are there any alternative options for reducing my risk of ovarian cancer that I should consider?

Reference

Authors: Kang OJ, Lee SW, Kim JH, Park JY, Suh DS, Kim DY, Kim JH, Kim YM, Kim YT. Journal: Int J Gynecol Cancer. 2023 Nov 6;33(11):1743-1749. doi: 10.1136/ijgc-2023-004618. PMID: 37541685