This is a summary of a recent Master Class in Gynecologic Surgery by Farr Nezhat, M.D. from Ob.Gyn.News, April 2016. The topic is endometriosis and ovarian cancer.
Endometriosis affects approximately 1 in 10 women of reproductive age in the United States. An association between endometriosis and ovarian cancer has been suspected for years, but only recently has our knowledge expanded enough to make suggestions for preventing the malignancy.
Fortunately, the life-time risk (about 1 in 75) of developing this malignancy is relatively low when compared to heart disease – 22,000 new cases per year are diagnosed, but the diagnosis is frequently made late in the course of the disease when the survival is dismal. The ideal solution is to primary prevention.
Endometriosis has some characteristics similar to cancer, such as presence of disease both locally and at distant sites, in addition to attachment to and invasion of different organs with damage to these structures. The bladder and intestine are common tissues affected. Recent research on the pathophysiology (cause) of the most common types (epithelial or surface cells) of ovarian cancer divides the disease into two distinct sources – one originates in the distal fallopian tube (end of the tube) and the other traces back to endometriosis.
This knowledge gives the ability to prevent many cases of this potentially deadly type of cancer. First, if there is reason to remove the fallopian tubes (or if there is no reason not to), bilateral salpingectomy can eliminate a risk factor for ovarian cancer. Examples when this may be considered are for permanent sterilization or at the time of hysterectomy when the ovaries are not removed. Rather than performing tubal occlusion (tubal ligation) when no further pregnancy is desired, removal of the tubes will both prevent conception and reduce ovarian cancer risk. If hysterectomy without oophorectomy (removal of ovaries) is planned, there is no good reason not to remove the fallopian tubes.
Secondly, complete surgical excision of all visible endometriosis (even in women with no pain or fertility problems) is the best approach when treating this disease. For instance, if a patient is undergoing a laparoscopic appendectomy for appendicitis and is noted to have endometriosis, it should be removed at the time of the surgery. Unfortunately, many gynecologists (and other surgeons) have not been trained to excise endometriosis but simply burn or cauterize it with electrocautery or laser.
The hope is that in the future we will have genetic or other biomarkers will enable us to prevent ovarian cancer, or at least detect it in the early stages when cure is possible.