Remove fallopian tubes during hysterectomy: study

B.C. researchers are urging gynecologists to remove a woman’s fallopian tubes during a hysterectomy or tubal ligation as a means of preventing ovarian cancer, one of the deadliest malignancies affecting Canadian females.

B.C. researchers are urging gynecologists to remove a woman’s fallopian tubes during a hysterectomy or tubal ligation as a means of preventing ovarian cancer, one of the deadliest malignancies affecting Canadian females.

Researchers from the B.C. Cancer Agency and Vancouver General Hospital are asking all gynecologists in the province — and indeed across Canada — to change the standard surgical practice of leaving the fallopian tubes intact when performing the surgeries.

The fallopian tubes, the conduits for eggs between the ovaries and the womb, have typically been left in place because doctors saw no reason to remove the structures when taking out the uterus, especially if the ovaries were also left untouched.

In a tubal ligation — or getting one’s “tubes tied” — the fallopian tubes are not removed but severed and sealed or clamped shut to prevent conception.

But Dr. Sarah Finlayson, a gynecological oncologist at Vancouver General, said recent research has shown that at least half of the cases of the deadliest form of ovarian cancer originate in the fallopian tubes — not the ovaries.

That malignancy, called a high-grade serous tumour, represents about 70 per cent of all ovarian cancers.

And because there is no screening test and symptoms can be non-existent or vague, diagnosis too often occurs once the cancer is at an advanced stage and has spread to other tissues.

“Something that we had thought of in the past as an ovarian cancer is really, in fact, a fallopian tube cancer,” said Finlayson.

“Removing the fallopian tube becomes a way of preventing these cancers.”

The Canadian Cancer Society estimates that 2,600 Canadian women will be diagnosed this year with ovarian cancer of one form or another; about 1,750 will die of the disease.

High-grade serous carcinoma is the most common form of ovarian cancer, accounting for 90 per cent of advanced-stage ovarian cancer.

Finlayson said most post-menopausal women who have a hysterectomy have their fallopian tubes taken out along with their ovaries, which stop producing estrogen over time.

“So it’s really the pre-menopausal women we’re interested in talking to or getting this information out to — women who are having hysterectomy prior to the menopause,” she said.

The surgery is done for a number of reasons, including fibroids, endometriosis and malignancies.

Researchers aren’t sure why tumours arise in the fallopian tubes.

But they speculate that an infectious or inflammatory process may occur during a woman’s monthly period that sets up a repeated process of injury and repair, eventually leading to cancerous lesions.

“So we believe that probably at the time of the hysterectomy, the die has been cast,” she said.

“The point is to take out the fallopian tube before whatever damage leads to a pre-cancer or a cancer … and then spreads.”

The research team, which is made up of surgeons, oncologists and pathologists, also made another important discovery: they found one in five serous tumours occur because a woman carries a BRCA genetic mutation. Women with a BRCA1 or BRCA2 mutation have an elevated risk of developing breast and-or ovarian cancer.

“What this means is that in 20 per cent of cases, we are discovering the index case,” Dr. Blake Gilks, a pathologist with B.C.’s Ovarian Cancer Research Program, said in a statement.

“A woman may have no prior history of ovarian cancer in her family, but we now know that her children and their children could be at risk, and we have the ability to screen them genetically and act proactively.”

That’s why, Finlayson noted, the researchers want every women diagnosed with a high-grade serous tumour to be referred to the B.C. Cancer Agency for genetic testing and counselling.

These two steps — changing practice to remove the fallopian tubes and genetic testing — “will allow us to decrease the rate of ovarian cancer in B.C. by up to 50 per cent over the next two decades,” she said.

“The ability to do surgery for prevention is going to rest with gynecologists who see women before cancer develops,” said Finlayson, who hopes to see a national strategy within the next year for getting the message across to women and their doctors.

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

A cleaner goes into Red Deer’s Canada Post sorting facility near 67th Street and Taylor Drive on Thursday morning. Photo by PAUL COWLEY/Advocate staff
Employee tests positive for COVID-19 at Red Deer Canada Post mail sorting facility

Canada Post has confirmed an employee at the Red Deer mail processing… Continue reading

Two people (not in photo) are facing charges following a Sept. 20, 2020 anti-racism rally in Red Deer.
Advocate file photo
Woman charged in Red Deer anti-racism rally going to trial

Calgary woman facing a charge of assault with a weapon in connection with Sept. 20, 2020 rally

Alberta NDP leader Rachel Notley was in Red Deer Wednesday and addressed a number of different political topics affecting central Alberta. (Photo by BYRON HACKETT/Advocate Staff)
Notley talks RDC, UCP draft K-6 curriculum in visit to Red Deer

Rachel Notley had only proposed a solution hours before she arrived in… Continue reading

The Bowden Institution medium security facility near Bowden. THE CANADIAN PRESS/Jeff McIntosh
UPDATED: COVID-19 cases reported at Bowden Institution

Bowden Institution is dealing with seven active COVID-19 cases. The two positive… Continue reading

Photo by RANDY FIEDLER/Advocate staff BUDGET RURAL MEDICINE 2 - Dr. Fred Janke in his Sylvan Lake practice Wednesday. for story
Sylvan Lake doctor formerly accused of child sex crimes can practise again

Crown prosecutors dropped all charges against Dr. Fred Janke last November

Westerner Park’s Exhibition Hall was used as a vaccination clinic on Wednesday. A steady stream of people came to get their COVID-19 shots either by appointment or as walk-ins. Photo by PAUL COWLEY/Advocate staff
No long lineups at walk-in vaccination site in Red Deer

A steady stream of people walked into Westerner Park on Wednesday to… Continue reading

Letisha Reimer is shown in a photo, part of a memorial to her outside Abbotsford Senior Secondary School in Abbotsford, B.C., Monday, Nov.7, 2016. A B.C. Supreme Court judge is expected to deliver her decision today over whether a man who stabbed two high school students is not criminally responsible because he had a mental disorder. THE CANADIAN PRESS/Geordon Omand
Judge to rule on criminal responsibility of man who stabbed two B.C. students

NEW WESTMINSTER, B.C. — A British Columbia Supreme Court judge is expected… Continue reading

File photo
Expert says Saskatchewan should consider more targeted vaccine plan as variants surge

SASKATOON — Nazeem Muhajarine says he feels a sense of relief after… Continue reading

Canadian Prime Minister Justin Trudeau and United States President Joe Biden smile as they say farewell following a virtual joint statement in Ottawa, Tuesday, February 23, 2021. THE CANADIAN PRESS/Adrian Wyld
Trudeau pledges to cut emissions by 40% to 45% by 2030, short of U.S. goal

OTTAWA — Prime Minister Justin Trudeau is promising Canada will slash its… Continue reading

Finance Minister Chrystia Freeland holds a press conference in Ottawa on Tuesday, April 20, 2021. THE CANADIAN PRESS/Sean Kilpatrick
More supply needed to ease housing price crunch, but always more to do, Freeland says

OTTAWA — Finance Minister Chrystia Freeland says the country needs a boost… Continue reading

Smoke pours from the stacks at the Portlands Energy Centre in Toronto on Thursday January 15, 2009. THE CANADIAN PRESS/Frank Gunn
Risk experts say climate change to take big chunk of Canadian economy by 2050

One of the world’s largest insurers says Canadians will be more than… Continue reading

A Blanding’s turtle (Gabrielle Fortin/Contributed)
Earth Day: Finding hope in an old sweater

During the pandemic, many of us have spent several months at home.… Continue reading

Education Minister Adriana LaGrange says 1.7 million reusable masks have been ordered at a cost of $4.2 million.” (Advocate file photo).
Alberta teachers and education minister swap accusations of politicizing curriculum

EDMONTON — Education Minister Adriana LaGrange says the group representing Alberta teachers… Continue reading

FILE - In this March 19, 2021, file photo, people take pictures of the Olympic rings installed by the Japan Olympic Museum in Tokyo. The vaccine rollout in Japan has been very slow with less than 1% vaccinated. This of course is spilling over to concerns about the postponed Tokyo Olympics that open in just over three months.(AP Photo/Hiro Komae, File)
Olympic bodies launch competitive series in virtual sports

Olympic body hopes to reach more young people

Most Read