A woman could have her fallopian tubes removed for many reasons. Sometimes, it\u2019s necessary to treat an ectopic pregnancy or to resolve an infection caused by pelvic inflammatory disease. Other times, it\u2019s done as a permanent form of birth control.<\/p>\n
But a growing body of evidence suggests that many cases of high-grade serous\u00a0ovarian cancer<\/a>\u00a0start in the distal fallopian tube \u2014 or flower-shaped section located nearest the ovary. High-grade serous is\u00a0the most common type of ovarian cancer and one of the most aggressive.\u00a0<\/p>\n Research also suggests that an opportunistic salpingectomy \u2014 the complete removal of the fallopian tubes during an unrelated abdominal or pelvic surgery \u2014 can help reduce the chances of one day developing ovarian cancer.<\/p>\n So, who should consider having their fallopian tubes removed, and when? And, should you seek out the procedure if you’re done having children, even if you\u2019re only at average risk<\/a> of ovarian cancer? We asked Michaela Grinsfelder, M.D<\/a>., a surgeon specializing in gynecologic cancers.\u00a0<\/p>\n Why do women typically have their fallopian tubes removed?\u00a0<\/p>\n Women don\u2019t usually go in just to have their fallopian tubes removed unless it\u2019s for permanent birth control or to treat an ectopic pregnancy.<\/p>\n Having your fallopian tubes removed is one form of surgical sterilization. It used to be more common for surgeons to use a metal clip or a ring to constrict and physically block the tubes, rather than removing the structures themselves\u202f. This is commonly referred to as \u201chaving your tubes tied.\u201d<\/p>\n But it\u2019s important to distinguish between these two procedures because they\u2019re very different \u2014 and some of the benefits of fallopian tube removal can\u2019t be obtained by simply clipping or blocking the tubes.\u00a0<\/p>\n Why is that?<\/p>\n A growing body of data suggests that many ovarian cancers start in the fallopian tubes. So, a lot of surgeons have changed their practice to remove the fallopian tubes entirely to give patients additional protection against it.\u00a0<\/p>\n In the United States, the Society for Gynecologic Oncology and the American College of Obstetricians and Gynecologists both support the removal of fallopian tubes as permanent sterilization for women at average risk for ovarian cancer. It\u2019s also recommended by professional organizations in Australia, Canada, Germany and New Zealand.<\/p>\n How was this information discovered?<\/p>\n After the BRCA gene<\/a> was linked to an increased risk for breast<\/a> and ovarian cancers, doctors started removing the ovaries<\/a> and fallopian tubes as a type of risk-reduction surgery, once BRCA-positive women were finished having kids.\u00a0<\/p>\n Most ovarian cancers are diagnosed at stage 3 or 4<\/a>, so we don\u2019t usually see it in its earliest stages. But what we noticed when we started performing these surgeries is that in some women, there were precancerous<\/a> lesions already present in the fallopian tubes.\u00a0<\/p>\n This was a really exciting discovery. Before that, we hadn\u2019t known there was a lesion that could one day become ovarian cancer. So, we were able to start finding ovarian cancers really early that we hadn\u2019t been able to catch before.<\/p>\n How did that discovery lead to the recommendation of opportunistic salpingectomies?<\/p>\n There was a lot of excitement in the medical community at that point about the possibility of reducing the risk of ovarian cancer by removing the fallopian tubes \u2014 either during hysterectomies or instead of patients having their tubes tied. Before that, whenever someone had a hysterectomy<\/a>, we would normally only take out their fallopian tubes if we were also taking out their ovaries.<\/p>\n But as the new data emerged, there was an increased interest in removing the fallopian tubes along with the uterus when performing hysterectomies. Because if a woman hasn’t gone through menopause yet, her fallopian tubes might still be benefitting her. But once she\u2019s finished having kids, the fallopian tubes serve no real purpose.<\/p>\n So, who should consider having their fallopian tubes removed?\u00a0<\/p>\n Only people who are at increased risk of developing ovarian cancer, such as those who carry the BRCA genetic mutation, are recommended to have a stand-alone surgery to remove fallopian tubes with both ovaries. This is called a risk-reducing salpingo-oophorectomy.<\/p>\n Otherwise, it\u2019s currently only recommended as an opportunistic salpingectomy: something to be done when you\u2019re finished with childbearing and are already having another type of procedure, and\/or prefer this option for pemanent sterilization.<\/p>\n Which surgical procedures can be combined with an opportunistic salpingectomy?<\/p>\n Initially, doctors only recommended it when you were having another gynecologic procedure done. Today, it can be done alongside almost any kind of surgical procedure that involves the pelvis or abdominal cavity.<\/p>\n Why is this a significant development in the cancer prevention world?<\/p>\n We didn\u2019t typically bundle other types of surgeries with the removal of fallopian tubes at first. That\u2019s because only OB-GYNs were specifically trained in that procedure.\u202f\u202f<\/p>\n Now, our gynecologic oncologists routinely team up with other UT MD Anderson surgeons to provide this service. It\u2019s really exciting to see this strategy being implemented to reduce our patients\u2019 risk of ovarian cancer even further.<\/p>\n Are any related clinical trials available?\u202f\u202f<\/p>\n We actually have two clinical trials<\/a> going on right now.<\/p>\n The first trial<\/a> is for women with certain genetic mutations who are done having kids, but not quite ready to have their ovaries removed.\u202fParticipants have their fallopian tubes removed now, but delay the removal of their ovaries until later \u2014 between ages 35 and 45 for patients with BRCA1, for example, and between ages 40 and 50 for those with BRCA2. The goal is to determine if it\u2019s safe to delay the removal of both ovaries for women at high risk of developing ovarian cancer.\u202fThis trial is being led by gynecologic oncologist Roni Nitecki Wilke, M.D.<\/a><\/p>\n The second trial<\/a> is for women at average risk of ovarian cancer, who are having an unrelated abdominal surgery, such as an appendectomy, gallbladder removal or hernia repair. Participants watch an educational video about the benefits of doing both procedures at the same time, then complete a questionnaire and decide how they want to move forward. The main goal is to find out if the video improves women\u2019s knowledge and if they would be interested in having this preventive procedure if they learned about it in advance. The study also seeks to understand how to best coordinate these procedures between surgeons and to measure how much additional time will be added to the original procedures. This trial is being led by gynecologic oncologist Larissa Meyer, M.D.<\/a><\/p>\n Can anyone get an opportunistic salpingectomy?<\/p>\n You don\u2019t necessarily have to be on a clinical trial to have an opportunistic salpingectomy. Women at average risk of ovarian cancer may also seek out an opportunistic salpingectomy. Talk to your care team for details.<\/p>\n