Dr. Sarah Finlayson (biography and disclosures)
What I did before
When I was in training as a gynecologic surgeon, I was taught how to do a “proper” hysterectomy and “proper” tubal ligation. I practiced until I had mastered it. By surgical convention, when we did a hysterectomy and planned to leave the ovaries in situ (in pre-menopausal women); we left the fallopian tubes inside the patient too. At the time of tubal ligation, we clipped or burned the tube and left it inside the patient.
What changed my practice
High grade serous cancer of the ovary represents about 2/3rds of the cases of ovarian cancer that we see. These cancers are often diagnosed at an advanced stage. While this cancer usually responds to initial treatment, it frequently recurs and is not curable in the majority of patients. A growing body of knowledge reveals that the majority of cases of high grade serous “ovarian” cancer actually are fallopian tube cancers. The precursor lesions begin in the fimbriated end of the fallopian tube and the cancer spreads from there. This knowledge about the true origin of this devastating cancer completely changed my surgical practice.
What I do now
I now advise patients to consent for removal of the fallopian tube at every single hysterectomy. Family Physicians can advocate for their patients to ensure the fallopian tube is removed at hysterectomy and tubal ligation. My hope is that by removing the fallopian tube we will prevent many cases of this terrible disease. As a gynecologic oncologist, the majority of my patients already have cancer. The potential for a major impact in ovarian cancer prevention rests with general gynecologists—who perform the vast majority of hysterectomies and tubal ligations. Hysterectomy and tubal ligation are among the most common surgeries that a woman will undergo in her lifetime. This September 2010, the Ovarian Cancer Research Program of BC, launched a province-wide educational initiative aimed at every gynecologist in BC. We are asking gynecologists to remove the fallopian tube at hysterectomy. We are also requesting removal of the fallopian tube at tubal ligation, when a patient requests permanent contraception. I believe these simple changes in surgical convention hold the promise of preventing future cases of “ovarian cancer”.
For more information: www.ovcare.ca
References: (Note: Article requests require a login ID with the BC College of Physicians website or with UBC)
1. Przybycin CG, Kurman RJ, Ronnett BM, Shih IM, Vang R. Are All Pelvic (Nonuterine) Serous Carcinomas of Tubal Origin? Am J Surg Pathol. 2010 2010 October; 34(10): 1407-16. (View article with CPSBC or UBC)
2. Salvador S, Gilks B, Köbel M , Huntsman D, Rosen B, Miller D. The fallopian tube: primary site of most pelvic high-grade serous carcinomas. Int J Gynecol Ca 2009;19:58-64 (View article with CPSBC or UBC)
3. Crum CP, Drapkin R, Miron A, Ince TA, Muto M, Kindelberger DW, et al. The distal fallopian tube: a new model for pelvic serous carcinogenesis. Curr Opin Obstet Gynecol 2007;19(1):3-9. (View article with CPSBC or UBC)
4. Kindelberger DW, Lee Y, Miron A, Hirsch MS, Feltmate C, Medeiros F, et al. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. Am J Surg Pathol 2007;31(2):161-9. (View article with CPSBC or UBC)
5. Lee Y, Miron A, Drapkin R, Nucci MR, Medeiros F, Saleemuddin A, et al. A candidate precursor to serous carcinoma that originates in the distal fallopian tube. J Pathol 2007;211(1):26-35. (View article with CPSBC or UBC)
6. Crum CP, Drapkin R, Kindelberger D, Medeiros F, Miron A, Lee Y. Lessons from BRCA: the tubal fimbria emerges as an origin for pelvic serous cancer. Clin Med Res 2007;5(1):35-44. (View article with CPSBC or UBC)