Gynecologic oncologist explains how removing fallopian tubes can prevent ovarian cancer

A cancer advocacy group recently recommended that, as a way to prevent ovarian cancer, women consider having their fallopian tubes removed when they’re having other pelvic surgeries. That may seem drastic to those who haven’t heard the idea before, but it’s a procedure that has gained traction in the last five or so years, said Brian Orr, M.D., a gynecologic oncologist at MUSC Hollings Cancer Center.

“Unfortunately, there's no effective screen for ovarian cancer. Breast cancer, cervical cancer, colon cancer – they all have very good screens. And the goal of the screen is to catch lesions that are precancer or early cancer, and then the curative potential is extremely high,” Orr explained. “The challenge with ovarian cancer is that it's a silent cancer. It usually presents at advanced stages that are a lot more challenging to treat.”

With ovarian cancer, most patients can achieve remission with surgery and chemotherapy at first, he said.

“Unfortunately, a lot of patients do recur. Once it recurs, it's a lot more challenging to treat and it's usually not curable in that situation,” Orr said.

However, researchers have come to believe that many ovarian cancers actually start in the fallopian tubes, the tubes that connect the ovaries to the uterus. Thus, removing the fallopian tubes – after a woman has finished having children or has decided to not have children – reduces the risk of most ovarian cancers.

Orr said researchers uncovered this after women with the BRCA gene mutation, which increases the chances of several cancers, including ovarian cancer, had their fallopian tubes and ovaries removed and studies showed that about 8% to 10% of the women already had early cancers on the fallopian tubes. Put that together with the observation that women who have their tubes tied have a lower risk of ovarian cancer, and researchers are able to start to piece together how ovarian cancer grows.

The timeline for ovarian cancer is still unknown, Orr said. With cervical cancer, for example, all of the millions of Pap tests, biopsies and cancer diagnoses that have happened form a large body of knowledge about how cervical cancer grows and how long it takes to develop. But that early screening and detection information simply doesn’t exist for ovarian cancer, meaning researchers don’t have much information about how the cancer grows or how quickly.

“I think it's important that this recommendation becomes more discussed and publicly known so that for patients who do fall in that ovarian low risk category and are otherwise undergoing an abdominal surgery, this would be discussed in counseling."

Brian Orr, M.D.

Another complicating factor is that the cancer typically develops on the outside layer of the tube, which may contribute to how quickly it spreads to other areas.

“The way that it spreads throughout the abdomen is it exfoliates, or sheds, cancer cells into the abdomen. An analogy I'll use sometimes is that the cancer cells are like snow in a snow globe,” Orr said. “They just sort of coat the whole surface of the abdomen.”

Because it could be another 10 to 20 years before an effective screening or early detection test is developed, the Ovarian Cancer Research Alliance said, it decided to focus on the steps that can be taken now to reduce the risk of ovarian cancer – including removing the fallopian tubes when a woman is undergoing a pelvic surgery for benign conditions like cysts or endometriosis or after a C-section.

Orr said he hopes the alliance’s statement brings more public attention to this option. He’d also like to see the option for fallopian tube removal presented to women who are undergoing other abdominal surgeries, like appendectomies or gall bladder surgeries.

Orr emphasized that this option is for women at average risk of ovarian cancer, which for most women is between 1% and 2%. Women at high risk for ovarian cancer, because of gene mutations, would follow a different set of recommendations that includes removal of both the ovaries and the fallopian tubes.

He wouldn’t recommend that someone at average risk have surgery for the sole purpose of removing the fallopian tubes – at that point, the risks from surgery are about equal to the risk of ovarian cancer, he said. But if another surgery is already scheduled, adding the fallopian tube removal is a good option.

“I think it's important that this recommendation becomes more discussed and publicly known so that for patients who do fall in that ovarian average risk category and are otherwise undergoing an abdominal surgery, this would be discussed in counseling,” Orr said.

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