Mutations and sick relatives: in which case a woman should remove the fallopian tubes
Russian oncologists argued with American doctors about ovarian cancer
Scientists from the US Ovarian Cancer Research Alliance have recommended that women have their fallopian tubes removed to avoid ovarian cancer. This is offered to those who no longer intend to have children and are planning some other gynecological operation – during it, you can also get rid of the tubes. Relevant recommendations are published on the Alliance website.
As observations of more than 200 thousand women since 2001 have shown, screening with ultrasound and tests for tumor markers does not have a noticeable effect on the timing of the detection of the disease and mortality. In addition, screening results are often false positive, which leads to unnecessary examinations and surgical interventions in healthy women, which affects their psychological state and finances.
In this regard, scientists have formulated a number of recommendations, including informing and educating the public about the risk factors for developing ovarian cancer and its symptoms, more active genetic testing, especially among women whose families had cases of such cancer,
and encouragement of operations to remove the fallopian (fallopian) tubes in cases where a woman is about to have any pelvic surgery and the patient no longer plans to have children.
Such an operation is called an opportunistic salpingectomy – as the researchers expect, it will reduce the number of cases of ovarian cancer, since tumor growth most often begins in the tubes.
“Every year more than 225,000 new cases of ovarian cancer are registered in the world, of which about 140,000 are fatal. In a quarter of cases, cancer is diagnosed in the early stages. 95% of patients with stage I live more than 5 years. Unfortunately, despite the progress made in the diagnosis of ovarian cancer, in 75% of cases this type of cancer is detected in the later stages. The five-year survival rate at stage III is about 24%, at stage IV – 4.6%, ”the chief oncologist of the SM-Clinic, doctor of medical sciences, professor Alexander Seryakov told Gazeta.Ru .
The average age for developing ovarian cancer is about 50 years. Symptoms in the early stages are nonspecific and can occur with a variety of other diseases. A woman may experience an increase in the volume of the abdomen due to a growing tumor and accumulation of fluid in the abdominal cavity, unusual bleeding from the vagina, pain in the back and abdomen. However, often ovarian cancer is asymptomatic and it becomes known only when it is no longer possible to completely defeat the disease.
“Today, there are no specific symptoms that speak of ovarian cancer, and existing diagnostic and screening methods are not as effective,
– Suna Isakova, an oncologist at the SberHealth medical online service, confirmed in an interview with Gazeta.Ru. – A high risk of developing this disease in women with mutations in the BRCA1 and 2 genes. Typically, people with mutations in these genes have tumors in various organs at a younger age than is typical for cancer. Most often it is breast and ovarian cancer in women, prostate cancer in men.
The chances of detecting ovarian cancer at an early stage increase if a woman visits a gynecologist every six months. If a malignant process in the ovaries is suspected, the gynecologist prescribes additional clinical and instrumental examinations, including CT, MRI, biopsy and consultation with an oncologist. When ovarian cancer is confirmed, the scope of the operation is planned. The earlier the diagnosis is made, the higher the chances of completely getting rid of the disease.
“For a woman, regularly visiting a gynecologist as part of a medical examination or professional examinations is just as necessary as brushing her teeth daily,” Seryakov emphasized.
To remove the fallopian tubes or ovaries for prevention is for those women for whom the risk of cancer is increased, primarily at the genetic level.
“If a woman has a family history, that is, she has several close relatives with these diagnoses, or one of the relatives has a similar mutation, such a woman is at risk. And if the presence of a mutation is confirmed in her, then the most optimal recommendation in this case is the removal of the ovaries or fallopian tubes, ”Isakova noted.
In this, Russian oncologists disagreed with the opinion of specialists from the US Ovarian Cancer Research Alliance. They advise removal not to everyone or those who are scheduled for gynecological surgery, but only to those who have a genetic predisposition to such cancer.
The rest of the women need to monitor their health more closely, since the appearance of most malignant ovarian tumors cannot be explained by known risk factors, Seryakov believes. In addition to women with a genetic predisposition, they also occur in postmenopausal, infertile, breast cancer survivors who are on hormone replacement therapy.
And yet, tubal removal surgery is too much of an intervention, so even women in these groups do not have to resort to it.
Although the Alliance recommends the removal of the fallopian tubes for women who are no longer planning children, if the ovaries are preserved, there is still a chance to get offspring.
“If the fallopian tubes are removed, the ovaries will be preserved. This implies that pregnancy will not occur naturally, but if desired, a woman can freeze the eggs and then use them for IVF or surrogate motherhood, ”explained Isakova.
If cancer is diagnosed, both ovaries, uterus, fallopian tubes and the greater omentum are removed at once. In the postoperative period, chemotherapy is prescribed.
“It is clear that if both ovaries and uterus are removed, pregnancy becomes impossible.
Cryopreservation of eggs in patients with ovarian cancer is practically not performed, since this technique involves hormonal stimulation of the patient’s ovarian function for the maturation of several follicles in the body, which takes at least 2 weeks, their collection and quick freezing, and placement in cryostorage. In the case of a woman diagnosed with ovarian cancer, the start of treatment is very important, and the strategic goal is to save the life of the patient herself,” said Seryakov.