Fallopian Tube Removal: “stic-Ing” it to Ovarian Cancer: What Is the Utility of Prophylactic Tubal Removal?

Abstract

The exact percentage of ovarian tumours arising from the tube is unknown. Some estimates set the association at up to half of these tumours, but recent reports have estimated a much higher proportion. Przybycin et al. determined the frequency of stic in 114 non-uterine gynecologic cancers and determined that stic was confirmed in 59% of the high-grade serous tumours, with 92% of the lesions found in the fimbriated portion of the tube and the remaining 8% in the ampullary region 6 . Furthermore, these investigators reported that when high-grade serous carcinomas conventionally classified as ovarian, peritoneal, and tubal in origin were re-classified using a supplemental stic criterion to define a case as tubal in origin, the original distribution of 70%, 17%, and 13% was modified to 28%, 8%, and 64% respectively 6 .Gao and colleagues looked at 116 consecutive cases of stic and found that 92% were associated with high-grade serous tumours 7 . Tang et al. found a lower incidence of 19% stic in 32 high-grade serous tumours 8 . Many other reports have shown intermediate incidences of stic precursors associated with high-grade serous tumours. MODELLING A BENEFIT OF TUBAL REMOVALThe importance of identifying the true incidence of the putative precursor tumours is important in trying to formulate effective screening and prevention programs. As can be seen from the foregoing studies, the range of stic precursors varies widely: from nearly 20% to 90% is reported and likely depends on patient selection and the protocol used for the pathologic interrogation of the tubes. If 60%-70% of epithelial tumours are assumed to be of high-grade serous histology, and if the true incidence of stic precursors is as high as 50%-60%, then more than 9000 cases of ovarian cancer would be prevented with bilateral tubal removal. Even if the most conservative numbers were to be applied, then more than 3000 cases would be projected to be prevented. This magnitude BACKGROUND

Does the Presence of Endometriosis Affect Prognosis of Ovarian Cancer?

“…Ovarian cancers that originate from malignant transformation of endometriosis appear to be part of type I ovarian cancers, which are typically of endometrioid or clear cell histology, with defects in ARID1A. These tumors are slower growing and more indolent compared to type II ovarian cancers (17–21). This genetic difference may explain the tendency for early stage and confinement to the pelvis in cancers associated with endometriosis in the current study.…”

Preventing Ovarian Cancer by Salpingectomy

“…In 2008, about 47,000 hysterectomies were performed in Canada. So, if the hypothesis is correct and if the numbers are accurate, then large numbers of women who do not otherwise "need" a hysterectomy will have to undergo bilateral salpingectomy to achieve a 40% This issue of Current Oncology contains four articles [1][2][3][4] on the subject of the role of bilateral salpingectomy in preventing high-grade serous ovarian carcinoma. To the uninitiated, that idea may seem counterintuitive.…”

Spectrum of Morphological Changes and Prevalence of “P53 Signatures” In Tubal Fimbrial Epithelium in General Population and In Patients with Pelvic Serous Carcinomas

“…Herzog and Dinkelspiel have suggested that bilateral salphingectomy with ovarian retention (BSOR) as a new standard for ovarian cancer risk reduction and examination of the tubes should be extended to the general population also. Herzog and Dinkelspiel [2] They suggest that when the true incidence of these precursor lesions are known, effective screening and preventive strategies can be developed.…”

“…It is important to know the true incidence of the precursor lesions so that optimal screening and preventive methods can be employed. Herzog and Dinkelspiel [2]. As on date there are no effective screening test to detect early precursor lesions in the tubal epithelium.…”