There are several types of risk-reducing prophylactic surgery:
- Removal of both ovaries and fallopian tubes – this is the best researched option and reduces the risk of ovarian cancer to less than 5%. Women will become menopausal straight away and may require Hormone-Replacement Therapy. This option is the best option for women who had breast cancer previously, who are menopausal or who wish to maximally reduce the ovarian cancer risk.
- When the ovaries and fallopian tubes are removed, the uterus is not usually removed but for other medical reasons some women might decide to have a hysterectomy.
Prophylactic surgery should be performed by an experienced laparoscopic surgeon or someone with a special interest in hereditary gynaecological cancer. Both ovaries and fallopian tubes need to be removed in their entirety and specimens need to be properly labelled.
Pelvic washings and biopsies of any suspicious areas are also required. There is a special way that the tissues need to be examined by the pathologist so that “occult cancers” are not missed. In 5% of women having this surgery there is already a cancer in the fallopian tube.
Prophylactic surgery will induce instant menopause if performed on a premenopausal woman. Patients need to be medically fit to tolerate surgery, need to be aware of the most common risks and possible complications of surgery and require some investigations (blood tests, medical imaging) prior to surgery Hospital stay is 1 to 2 days.
Prophylactic surgery does not protect 100%. There is also a very small possibility of developing cancer of the inner lining of the abdomen and pelvis (peritoneum) subsequent to prophylactic surgery. However, risk-reducing surgery is by far the most effective way to reduce the risk of ovarian cancer.