Removal of tubes and ovaries (risk reducing procedures)
Minimizing the chance of gynecological cancer in BRCA mutations carriers
The study of ovarian cancer (defined as ovarian, tubal, and peritoneal cancer) presents many vital challenges. It is a low-incidence disease and a particular difficulty at initial diagnosis, while at the same time, it includes an extensive range of morphological, molecular, and genetic subtypes.
Epithelial subtype (Epithelial Ovarian Cancer: EOC) accounts for 90% of all ovarian carcinomas, with 80-85% of them resembling serum carcinomas. Depending on the grade of cellular atypia and cellular architecture disorder, tumors show a different grade of differentiation. Low grade is considered more aggressive, invasive, and includes a disease with rapidly evolving characteristics and genetic instability. In contrast, the high grade describes slow progression, is rarer, and usually has a more unsatisfactory response to chemotherapy.
Deleterious mutations in the BRCA1 and BRCA2 genes are common in patients with ovarian epithelial cancer as they are associated with an increased likelihood of lifetime risk of developing cancer.
Lifetime risk of ovarian cancer for BRCA1 and BRCA2 mutation carriers
In particular, in the case of mutations in the tumor suppressor gene BRCA1, the incidence of ovarian cancer by the age of 70 approaches 45%, whereas the similar mutations in the BRCA2 gene present a 16.5% risk by the age of 70. The existence of other genes associated with ovarian cancer has also been confirmed, while Variants of Unknown Clinical Significance (VUS) are still pending to be interpreted.
Prevalence of hereditary ovarian cancer
It is estimated that about 13-15% of ovarian cancer patients carry germline mutations in the BRCA1 & BRCA2 genes. This rate may be even higher, given that the number of variations that remain unknown.
Patients that are aware of having one of the above mutations (BRCA1 and BRCA2) or any other of the 43 genes related to the Hereditary Breast Ovarian Cancer (HBOC) syndrome should attend a clinical genetic consultation. That issues as well for patients unaware of their genetic status nonetheless with a strong family history of breast cancer at a young age or ovarian cancer at any age.
Risk-reducing procedures such as the removal of both tubes and ovaries would affect the likelihood of having ovarian cancer by reducing it up to 98%. This option should always be discussed with a gynecologist and clinical genetics. However, if that would be the best treatment for you, special care should be taken for the ovaries to be removed intact and at their entity.
Multiple cases reported mention ovarian remnants to be left inside the abdomen after removal of both ovaries and tubes for different purposes. Robotic surgery adds to the successful completion of such surgical procedures avoiding leaving behind ovarian remnants due to increased adhesions or poor visualization of the surgical field.
Robotic-Assisted Laparoscopic Risk Reducing Procedures
Surgeons dedicated to performing minimally invasive procedures are committed to personalized treatment for every individual patient. Robotic-assisted procedures are considered safe and effective. It is appropriate for most patients, but not for all.
Let’s discuss your treatment options.
If you are a surgical candidate for robotic surgery, skilled robotic surgeons with high-end equipment will be able to offer you treatment and relief of your symptoms.