Risk reducing bilateral salpingectomy (aka removing the fallopian tubes). Guest Blogger Dr Richard Robbins discusses the benefits in reducing ovarian cancer by removing the fallopian tubes.
Removing Fallopian tubes to prevent ovarian cancer? Why? And who should have it done?
Here’s the general premise. Ovarian cancer as you know is generally a terrible disease, often found as stage 3-4 at first diagnosis. And so many studies have looked for ways to find earlier stage ovarian cancer (using blood testing for tumor markers or using frequent ultrasounds). These studies have universally failed. Experts then questioned whether ovarian cancer skipped from microscopic disease straight to stage 3-4. How could this happen?
Doctors know there are many different pathologic sub-types of ovarian cancer. And we know that one of the sub-types is the worst – the so-called serous cystadenocarcinoma. Doctors have also known for decades that at the microscopic level this type of ovarian cancer looks exactly like Fallopian tube cancer. Recently, experts in the field have proposed the idea that serous cystadenocarcinoma of the ovary MIGHT ACTUALLY BE Fallopian tube cancer that spread out the tube onto the adjacent ovary and simultaneously spread throughout the abdomen and pelvis. And since there are no screening tests for Fallopian tube cancer, we’d have no chance of finding the stage 1 disease. What to do???
US and International experts have recently proposed that Gyn doctors strongly consider removing Fallopian tubes in the following circumstances:
1. when patients want their tubes “tied”
2. when patients are having their uterus removed
Let’s think about both of these scenarios.
When patients want their tubes tied (tubal sterilization) we know they want no more pregnancies and that their significant other has likely declined vasectomy. We also know that they may have considered all the other methods of contraception, including long-acting methods such as IUD’s. When they decide tubal sterilization is right for them, then it’s time to choose the method (laparoscopic, hysteroscopic (Essure), or they might be getting it done during an operation such as a Cesarean Section). It’s at this time they should discuss bilateral salpingectomy.
When a hysterectomy is in the planning stages AND when there is no plan to remove both tubes and ovaries, the patient should discuss having their doctor remove the uterus plus perform bilateral salpingectomy.
Why not remove both tubes? First, it’s often technically more difficult to remove the tubes than do a tubal ligation using other methods. In fact in some instances it’s not possible to remove a tube without removing the adjacent ovary. So a Gyn might not want to do salpingectomies due to the extra work. Second, there’s more risk of bleeding complications with bilateral salpingectomy, So your doctor might be hesitant to have you subjected to this additional risk. And third, in most instances, it takes more time to perform the salpingectomies than standard tubal ligation and certainly adds time to the hysterectomy.
But….
If the experts are correct, a risk-reducing bilateral salpingectomy might save a person’s life. A recent review in Canada showed that up to 50% of Gyns have incorporated this into their practice and at Roswell ObGyn this is roughly true at this time.
If you are planning tubal sterilization or hysterectomy, consider discussing the issue of bilateral salpingectomy with your own Gyn.
