Tubo-ovarian carcinoma and OS

Tubo-ovarian carcinoma

Each year, over 320.000 women worldwide are diagnosed with ovarian cancer. Despite intensive treatment involving surgery and chemotherapy, the prognosis for ovarian cancer remains poor. Furthermore, there are currently no effective screening methods for early detection, and the disease is usually diagnosed at an advanced stage. (1) As a result, the five-year survival rate is only 39%. (2) The focus is therefore on primary prevention of ovarian carcinoma.

Research shows that the most common type of ovarian cancer, high-grade serous carcinoma (referred to as tubo-ovarian carcinoma), originates from the tubal epithelium rather than the ovarian epithelium. (3,4) Removal of the fallopian tubes could therefore reduce the incidence of tubo-ovarian carcinoma. The fallopian tubes lose their function once women have completed childbearing.

Opportunistic salpingectomy

The lifetime risk of developing ovarian carcinoma in the general population (without a pathogenic variant) is 1.3%. This risk alone does not justify elective preventive surgery, as the risks associated with general anesthesia and surgery outweigh the risk of developing tubo-ovarian carcinoma.

Opportunistic salpingectomy (OS) is a primary prevention strategy that involves the removal of the fallopian tubes, while preserving the hormone-producing ovaries, during already planned abdominal surgeries, with the aim of preventing tubo-ovarian carcinoma.

Risk reduction of OS

Large cohort studies have shown a 50–80% reduction in the risk of developing tubo-ovarian carcinoma later in life through bilateral salpingectomy. (5-9)

 

References:

  1. Menon U, Gentry-Maharaj A, Burnell M, Singh N, Ryan A, Karpinskyj C, et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. 2021;397(10290):2182-93.

  2. prof. dr. R. Kruitwagen pdKvdV, dr. G. Sonke, dr. M. van der Aa. Ovariumcarcinoom in Nederland. IKNL: Integraal Kanker Instituut Nederland; 2019.

  3. Piek JM, van Diest PJ, Zweemer RP, Jansen JW, Poort-Keesom RJ, Menko FH, et al. Dysplastic changes in prophylactically removed Fallopian tubes of women predisposed to developing ovarian cancer. J Pathol. 2001;195(4):451-6.

  4. Mingels MJ, Roelofsen T, van der Laak JA, de Hullu JA, van Ham MA, Massuger LF, et al. Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls. Gynecologic oncology. 2012;127(1):88-93.

  5. Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst. 2015;107(2).

  6. Lessard-Anderson CR, Handlogten KS, Molitor RJ, Dowdy SC, Cliby WA, Weaver AL, et al. Effect of tubal sterilization technique on risk of serous epithelial ovarian and primary peritoneal carcinoma. Gynecol Oncol. 2014;135(3):423-7.

  7. Madsen C, Baandrup L, Dehlendorff C, Kjaer SK. Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: a nationwide case-control study. Acta Obstet Gynecol Scand. 2015;94(1):86-94.

  8. Kahn RM, Gordhandas S, Godwin K, Stone RL, Worley MJ, Jr., Lu KH, et al. Salpingectomy for the Primary Prevention of Ovarian Cancer: A Systematic Review. JAMA Surg. 2023;158(11):1204-11.

  9. van Lieshout LAM, Piek JMJ, Verwijmeren K, Houterman S, Siebers AG, de Hullu JA, et al. Ovarian cancer risk after salpingectomy for ectopic pregnancy or hydrosalpinx: results of the OCASE nationwide population-based database study. Hum Reprod. 2021;36(1):211-8.