Opportunistic salpingectomy for ovarian, fallopian tubal, and peritoneal carcinoma risk reduction
- Dianne M Miller, MD, FRCSC
Dianne M Miller, MD, FRCSC
- Division Head of Gynecologic Oncology
- University of British Columbia and the BC Cancer Agency
- Jessica N McAlpine, MD, FACOG, FRCPSC
Jessica N McAlpine, MD, FACOG, FRCPSC
- Associate Professor
- Department of Gynecology and Obstetrics Division of Gynecologic Oncology
- University of British Columbia
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
Opportunistic salpingectomy is the removal of the fallopian tubes for primary prevention of epithelial carcinoma of the fallopian tube, ovary, or peritoneum in a woman undergoing pelvic surgery for another indication. This is an approach to prevention in women at average risk, rather than high risk, for these cancers.
Traditionally, most malignant epithelial ovarian lesions were considered to be primary ovarian disease, and primary tubal or peritoneal cancers were thought to be rare. However, studies suggest that some apparent ovarian serous carcinomas begin in the fallopian tubes and then spread to the ovary. Similarly, these types of tubal lesions may spread to the peritoneum and result in apparent primary peritoneal carcinoma without an ovarian lesion. Thus, serous ovarian, fallopian tubal, and peritoneal carcinomas are regarded as a single entity. Many studies still refer to this as ovarian cancer. In this topic, these entities will be referred to as either ovarian, fallopian tubal, and peritoneal carcinoma; pelvic carcinoma; or ovarian carcinoma.
Opportunistic salpingectomy for ovarian, tubal, and peritoneal carcinoma risk reduction in average-risk women is reviewed here. Risk-reducing salpingo-oophorectomy for women at high risk of carcinoma of the ovary, fallopian tube, or peritoneum and the pathogenesis of serous carcinoma of the ovary, tube, and peritoneum are discussed separately. (See "Risk-reducing bilateral salpingo-oophorectomy in women at high risk of epithelial ovarian and fallopian tubal cancer" and "Pathogenesis of ovarian, fallopian tubal, and peritoneal serous carcinomas".)
Ovarian cancer is a disease with a poor prognosis and limited options in terms of diagnosis and treatment. Ovarian cancer is the second most common type of gynecologic malignancy and the most common cause of death from gynecologic cancer . It is the fifth most common cause of cancer deaths in women. In the United States and Canada every year, over 25,000 women are newly diagnosed with ovarian cancer, and 16,000 women die from the disease . (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Epidemiology and risk factors", section on 'Epidemiology'.)
Ovarian cancer typically presents at an advanced stage and has a poor prognosis (table 1 and table 2). Unfortunately, there are few current approaches to improve clinical outcomes for ovarian cancer. There are no effective screening tests. For women who present with symptoms suggestive of ovarian cancer or an adnexal mass, evaluation strategies have a low specificity, and many women with a benign mass undergo surgery (in one study, ovarian cancer was found in only 3.5 percent of procedures performed for a suspicious adnexal mass ) [4-7]. (See "Screening for ovarian cancer" and "Approach to the patient with an adnexal mass".)
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- HISTOLOGIC SUBTYPES
- ROLE OF THE FALLOPIAN TUBE
- Primary fallopian tube cancer
- Tubal ligation and ovarian cancer risk
- OPPORTUNISTIC SALPINGECTOMY
- Informed consent
- - Technique at hysterectomy
- - Technique at sterilization procedure
- CLINICAL APPROACH
- SUMMARY AND RECOMMENDATIONS