Prophylactic Surgery

Some women require gynaecologic surgery in order to reduce their risk of being affected by cancer. These women usually have an hereditary condition. Prophylactic, or preventative surgery, is recommended once you have completed your family and are over the age of 35. For women who do not fall into this category or are uncertain about having surgery there is an option for surveillance.

Hereditary Breast and Ovarian Cancer

The breast cancer (BRCA) gene is responsible for breast and ovarian cancers. Less than 10% of breast cancers and less than 15% of ovarian cancers are associated with an inherited mutation of this gene.

The risk of ovarian cancer is 45-50% for the BRCA 1 gene and 10-25% for the BRCA 2 gene. This is considerably elevated compared to the background population risk (1.4%).

In order to reduce this risk it is recommended that the fallopian tubes and ovaries are removed. This will also reduce the risk of breast cancer recurrence in women who have already developed a breast cancer. Ideally this procedure is performed laparoscopically, but your full medical history would be obtained and a physical examination would need to be performed in order to ascertain if this approach is suitable for you. Removing the uterus at the time of surgery can also be considered, particularly if you are required to take Tamoxifen for treatment of your breast cancer.

There is some evidence that BRCA mutation carriers may confer an increased risk of cancer of other organs such as the uterus, pancreas, cervix, prostate, stomach and gall bladder.

If you have not yet completed your family surveillance is offered. Surveillance is also offered if surgical removal of the ovaries is not indicated or declined. Surveillance includes an annual consultation, physical examination, Pelvic Ultrasound and a blood test for CA125 (tumour marker). If there are any suspicious findings further investigations and/or surgery may be necessary.

Lynch Syndrome

Lynch Syndrome, sometimes called Hereditary Non Polyposis Colorectal Cancer (HNPCC), is a genetic condition where there is a mutation of the mismatch repair genes.

If you are diagnosed with Lynch Syndrome there is an increased risk of colorectal (80%), uterine (40%) and ovarian (10%) cancers developing. Removing the uterus, fallopian tubes and ovaries will decrease this risk. Ideally this procedure is performed laparoscopically, but your full medical history would be obtained and a physical examination would need to be performed in order to ascertain if this approach is suitable for you.

If you have not completed your family or are unsure about having a surgical procedure, surveillance can be offered. An annual consultation and physical examination, urine sample, pelvic Ultrasound and pipelle sample (uterine tissue sample) will be performed. If there are any suspicious findings further investigations and/or surgery may be necessary.

Annual colonoscopy is also required for this condition and you will need to see a gastroenterologist or colorectal specialist for this.

Menopause

Prophylactic surgery to remove the ovaries will result in menopause if you were still menstruating prior to the procedure. Menopausal symptoms can be treated with hormone replacement therapy, however not all women are suitable for this. Dr Andrea Garrett will discuss this with you in more detail.