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A preventative procedure
Removing fallopian tubes may prevent the risk of ovarian cancer

By JEN HUNHOLZ

October 2015

Ovarian cancer accounts for just 3 percent of all cancers in women, but it causes more deaths than any other cancer of the female reproductive system. According to the Centers for Disease Control and Prevention, an estimated 20,000 U.S. women are diagnosed with ovarian cancer each year, and about 14,000 die from the cancer.

So why is the mortality rate so high? "The major challenge is that we cannot detect ovarian cancer in its early stages," explains Dr. Ali Mahdavi, a board-certified gynecologic oncologist at Aurora Health Care. Early screenings, like how mammography is used to detect breast cancer, don’t currently exist, so prognosis is often poor.

Fortunately, an emerging procedure that lowers the risk of developing ovarian cancer — one that involves removing the fallopian tubes during a routine hysterectomy — is gaining traction and medical approval. Fallopian tubes serve as the conduit between the uterus and the ovaries, so their function in women who have completed their families is essentially nonexistent. "In the past, we had thought that most ovarian or pelvic cancers originated from the ovary, but over the last few years and with new research, we now know that many of these cancers originate from the fallopian tubes," says Mahdavi. "Removing the fallopian tubes after childbearing doesn’t have any impact on female hormone levels, and it could potentially prevent cancer of the tube and the ovary."

The American College of Obstetricians and Gynecologists formally addressed the topic earlier this year, recommending that the surgeon and patient discuss the benefits of removing the fallopian tubes during a hysterectomy in women at risk of ovarian cancer who are not having an oophorectomy (surgical removal of the ovaries). Mahdavi stresses that this procedure should not be treated as a preemptive measure — that is to say, the surgery should not take place for the sole purpose of removing the tubes. "However, if a woman is undergoing a hysterectomy for other conditions, consideration (to removing the tubes) should be given," he explains.

Mahdavi says that adding this procedure to a routine hysterectomy increases the operating time by about 10 to 15 minutes — a relatively minimal length of time considering a hysterectomy’s typical one- to two-hour time frame. "The vast majority of studies have shown that removing the fallopian tubes won’t have any adverse effects on the surgery as far as complications," he adds, noting that the recovery time remains the same.

Since screening methods for ovarian cancer are not yet available, maintaining a healthy lifestyle — one that includes a balanced diet, normal body weight and regular exercise — is recommended for those at risk of developing ovarian cancer. Mahdavi says that persistent bloating, pain, changes in bowel function and abdominal swelling are symptoms to be aware of, but that undergoing "any preventative measures, such as removing the tubes, are extremely important."

PortableCAT Scan Improves Accuracy for Treatment

The fight against cancer is more than a battle of inches. Microscopic measurements can sometimes mean the difference between life and death. A portable CAT scan is now helping patients undergoing brachytherapy, a cancer treatment where radiation implants, called catheters, are inserted directly into the tissue.

"To have the patient in position where sources of radiation will be loaded and to be able to have a mobile CAT scan where instead of moving the patient to another table, which might affect where you position the catheters just by physically dislodging them, the patient can stay in place and the CAT scan moves over the patient," says Dr. Michael Bassetti, assistant professor of human oncology at the University of Wisconsin School of Public Health and Medicine. The school started using the technology this year.

Implant shifts can affect the quality of the CAT scan image. "We plan our treatments based on the CAT scan that we get," Bassetti says. "If that’s different than reality, that will impact the treatment."

The device, which looks like an oversized washing machine, is 8 ½ feet wide by 6½ feet tall but can easily be wheeled to different locations.

The portable CAT scan is particularly beneficial to patients being treated for prostate, breast and gynecologic-related cancers.

"We’re getting more accurate pictures. Just knowing 100 percent what your seeing on the pictures is exactly where those catheters are placed, you’re 100 percent certain where that radiation is going," concludes Bassetti.

— Mark Concannon

 







 


This story ran in the October 2015 issue of: