Can ovarian cancer develop after having ovaries removed?

Posted in ovarian cancer, prevention, risk, recurrence; Posted 3 years ago by Andreas Obermair

Risk-reducing surgery may be recommended to remove both ovaries for prevention of ovarian cancer. While very uncommon, it’s possible to be diagnosed with ovarian cancer after the ovaries have been removed.

Hilary (not her actual name) inherited the BRCA2 gene from her father and decided to have her fallopian tubes and her ovaries removed once she was comfortable that she had completed her family. However, several years after the procedure, she noted abdominal swelling, and she was diagnosed with ovarian cancer by her doctor’s team. The patient and her family were wondering if the original surgery was incomplete or deficient.

There is a rare condition called ovarian remnant syndrome that may occur following removal of one or both ovaries where microscopic ovarian tissue can remain in the pelvis unknowingly to the surgeon. Those tiny, microscopic cells that are invisible by a naked eye can stay dormant for years, re-grow and then become functional again by continuing to produce hormones. This can occur even years following the original surgery. It has a higher risk of occurring in patients with endometriosis, pelvic inflammatory disease, pelvic adhesive disease, or after difficult or repeated surgery. You can read more about ovarian remnant syndrome here, including how it’s diagnosed and treated.

If the ovaries have been removed to treat ovarian cancer, it’s also possible that the cancer can recur and return after initial treatment.  Cancer recurrences can happen because microscopic cancer cells remain in the body after treatment, and over time may multiply and grow. This could be near the initial site of the cancer, or the remaining cells can travel elsewhere in the body to grow. It is less likely for early-stage ovarian cancer to recur than advanced ovarian cancer.

Can you develop ovarian cancer after hysterectomy?

It’s a common misconception that after a hysterectomy, a woman cannot be diagnosed with ovarian cancer.

In fact, in many cases, especially younger woman, one or both ovaries may be left in place after a hysterectomy to avoid early menopause. 

There are different types of hysterectomy:

• Total hysterectomy to remove the uterus and cervix.
• Subtotal hysterectomy to remove the uterus only, and leave the cervix behind.
• Radical hysterectomy which involves removal of the uterus, cervix, and removal of a safety margin for severe endometriosis or gynaecological cancer. 

For all three types of hysterectomy, the ovaries can be removed or preserved. The ovaries are separate organs to the uterus and cervix, and the surgery to remove ovaries is called an oophorectomy. If the fallopian tubes are removed too, this procedure is called salpingo-oophorectomy.

Whether a hysterectomy is total, subtotal or radical does not specify whether the ovaries have been removed or left behind.

A young woman will become menopausal if the ovaries are removed (if not already postmenopausal).

Depending on the reason for hysterectomy, I recommend removal of the ovaries at the same time of hysterectomy in women who have a high risk of ovarian cancer (BRCA1/2, Lynch, history of breast cancer) in premenopausal (young) women, and/or in postmenopausal women. 

Preserving ovaries is useful and recommended in young women who are not at increased risk of ovarian cancer. Surgical menopause at a younger age can increase the risk for osteoporosis, cardiovascular problems or dementia.

Reducing ovarian cancer risk

There is no definitive way to prevent ovarian cancer, some factors are associated with a lower chance of developing ovarian cancer. Cancer Council Australia report these include having children before the age of 35; breastfeeding; using the combined oral contraceptive pill for several years; and having your fallopian tubes tied (tubal ligation) or removed.

Learn more about the symptoms, diagnosis and treatment of ovarian cancer on the Ovarian Cancer page.

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