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Women who have BRCA1, BRCA2, or several other gene mutations have a much higher risk of developing ovarian cancer than the general population. Healthy versions of these genes produce proteins that prevent tumor growth. When these genes mutate, the proteins don’t function properly, allowing ovarian tumors to grow in some women.
Our doctors and genetic counselors can help you understand ovarian cancer prevention strategies, such as risk-reducing surgery.
These gene mutations can also increase the risk of breast cancer, and our doctors may recommend that you join our high-risk breast cancer screening program. They can also recommend support services to help you manage the emotional effects of testing positive for these mutations.
Doctors at NYU Langone’s Perlmutter Cancer Center may recommend using oral contraceptives, or “the pill,” to help prevent ovarian cancer. Using the pill for five or more years has been shown to reduce the risk of ovarian cancer. However, because the pill can also slightly raise the risk of breast cancer, our doctors carefully weigh the benefits and risks for each person.
Risk-Reducing Surgery for Ovarian Cancer
Women who are done having children may be candidates for surgery to remove both ovaries and fallopian tubes before ovarian cancer develops. This surgery, called a risk-reducing bilateral salpingo-oophorectomy, causes you to go through menopause if you haven’t already done so. Your doctor can help you prepare for and manage menopausal symptoms, such as hot flashes and vaginal dryness.
In addition to a bilateral salpingo-oophorectomy, some women may also be candidates for hysterectomy. A hysterectomy is the removal of the uterus—also known as the womb—and cervix, which connects the uterus to the vagina, the canal of muscular tissue leading to the outside of the body. This approach can be discussed with your doctor.
Women who desire risk-reduction surgery but are not ready to go through menopause or who want to preserve their fertility may be candidates for risk-reducing salpingectomy, or removal of just the fallopian tubes. Because this surgical approach preserves the ovaries, women can use egg retrieval and in vitro fertilization to get pregnant. A risk-reducing salpingectomy is considered the first of a two-part strategy, the second part being the removal of the ovaries at a later date.
Doctors generally use a minimally invasive procedure to perform risk-reducing surgery. Minimally invasive surgery involves less recovery time than open surgery and also results in less bleeding and tissue scarring.
Our doctors perform laparoscopic surgery through one or several small incisions in the lower abdomen and pelvic area. They inflate the abdomen with air to create a working space, and place a laparoscope, a lighted tube with a tiny camera on it, through one of these incisions. Through the remaining incisions, they insert small surgical tools that they use to perform risk-reducing surgery.
Laparoscopic surgery can reduce recovery time and result in less scarring than open surgery, or laparotomy, which requires a larger incision. Sometimes the procedure can be performed through a single abdominal incision less than one inch long. Most people go home the same day as the procedure.
Doctors at NYU Langone’s Robotic Surgery Center may use a robot-assisted laparoscopic system for risk-reducing surgery. This system consists of tiny surgical instruments mounted on two or three separate robotic arms. The fourth arm contains a camera, which creates magnified, three-dimensional images on a computer monitor to guide the surgeon during the procedure.
The surgical tools and camera are inserted through small, quarter-inch incisions in the abdomen and pelvis, and the surgeon controls them from a console in the operating room. Similar to laparoscopic surgery, robotic surgery can reduce recovery time and result in less scarring than open surgery.
Although rarely done, doctors can use open surgery, or a traditional laparotomy, which involves making a long incision in the pelvic area to perform risk-reducing procedures. This approach may be necessary if you have scar tissue from previous surgery. An open procedure may require that you stay in the hospital for a few days so that doctors can monitor your recovery and manage pain.
Genetic Testing for Family Members
If you have a BRCA1 or BRCA2 mutation or other mutations associated with ovarian cancer, one of our genetic counselors can meet with you about genetic testing. He or she can discuss your family history of ovarian cancer and the benefits and drawbacks of having other members of your family tested to assess their cancer risk.
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