Our Summary

This research study looked at women who had surgery (known as Risk-reducing salpingo-oophorectomy or RRSO) to remove their ovaries and fallopian tubes in order to lower their chances of getting breast and ovarian cancer. They specifically focused on women who might be more likely to get these cancers due to family history or because they had certain gene mutations.

Out of 80 women who took part in the study, two had a type of cancer that had spread but the original source was unknown, and four had a family history of cancer but chose not to have genetic testing. The remaining 74 women had harmful gene mutations. The most common mutations were in the BRCA1 and BRCA2 genes, which are known to increase the risk of breast and ovarian cancer. Other mutated genes were also found, each present in one patient.

Among the women with gene mutations, three were found to have cancer, one was found to have a certain type of pre-cancerous lesion in the fallopian tubes, and five were diagnosed with another type of pre-cancerous lesion in the tubes. Another signature of cancer risk was found in 24 patients. There were also instances of unusual findings in the fallopian tubes of patients with certain gene mutations.

The results of this study provide additional information about the findings that can be seen in women at higher risk of breast and ovarian cancer who undergo surgery to remove their ovaries and fallopian tubes. It also shows that a particular approach to examining the fallopian tubes during this surgery can be useful in clinical practice.

FAQs

  1. What is the purpose of a risk-reducing salpingo-oophorectomy (RRSO)?
  2. What were the main findings of the study on women receiving RRSO?
  3. What is the SEE-FIM protocol and how does it apply to patients at an increased risk of breast and ovarian cancer?

Doctor’s Tip

A helpful tip a doctor might tell a patient about salpingo-oophorectomy is to discuss the possibility of genetic testing before the surgery to determine if they carry mutations in genes such as BRCA1 and BRCA2. This information can help guide post-operative surveillance and treatment decisions. It is also important to follow up with regular screenings and appointments with your healthcare provider to monitor for any potential signs of cancer recurrence or new developments.

Suitable For

Patients who are typically recommended salpingo-oophorectomy include those with inherited susceptibility gene mutations such as BRCA1 and BRCA2, as well as those with a family history suggesting an increased risk of ovarian cancer. Additionally, patients with isolated metastatic high-grade serous cancer of unknown origin may also be recommended for RRSO. Other mutated genes, such as ATM, BRIP1, PALB2, MLH1, and TP53, may also indicate a need for RRSO. Overall, women at increased risk of breast and ovarian cancer, as well as those with specific genetic mutations, may benefit from undergoing salpingo-oophorectomy.

Timeline

Before salpingo-oophorectomy:

  1. Patient is identified as being at increased risk of breast and ovarian cancer, either through genetic testing or family history.
  2. Patient undergoes counseling and consultation to discuss the risks and benefits of RRSO.
  3. Patient may undergo additional testing, such as imaging or blood tests, to assess their current health status.
  4. Patient makes the decision to proceed with RRSO.

After salpingo-oophorectomy:

  1. Surgery is performed using the SEE-FIM protocol, with thorough examination of the fimbriae.
  2. Pathological analysis of the surgical specimens is conducted to identify any abnormalities or precursor lesions.
  3. Results may show the presence of mutations in genes such as BRCA1, BRCA2, ATM, BRIP1, PALB2, MLH1, or TP53.
  4. Precursor lesions such as STIC or STILs may be identified in some patients.
  5. Follow-up care and monitoring is recommended for patients with identified abnormalities or mutations.
  6. Evidence of precursor escape may be recognized in some patients, indicating the need for continued surveillance and risk management.

What to Ask Your Doctor

  1. What is the purpose of a salpingo-oophorectomy and why is it recommended for women at increased risk of breast and ovarian cancer?
  2. What is the SEE-FIM protocol and how does it differ from a standard salpingo-oophorectomy?
  3. What are the potential risks and complications associated with a salpingo-oophorectomy?
  4. How will my recovery process look like after the surgery?
  5. Will I need hormone replacement therapy after the procedure?
  6. How often will I need follow-up appointments and screenings after the surgery?
  7. How will the surgery impact my fertility and menopausal symptoms?
  8. Are there any alternative risk-reducing options to consider?
  9. Will genetic testing be recommended before the surgery, and if so, what genes will be tested for?
  10. How will the results of genetic testing impact my treatment plan and future cancer risk management?

Reference

Authors: Feng Z, Zuo K, Ju X, Chen X, Yang W, Wen H, Yu L, Wu X. Journal: J Ovarian Res. 2023 Jun 29;16(1):125. doi: 10.1186/s13048-023-01222-1. PMID: 37386498