The role of the fallopian tubes in reducing ovarian cancer risk

Posted 10 years ago by Andreas Obermair

Named after one of the most influential physicians of the 16th century - Gabriele Fallopio - the “fallopian” tubes (or uterine tubes) link a woman’s ovaries with her uterus, and during ovulation they act as a transport channel for the female egg. 

Just like in other parts of the female anatomy, it's possible that cancer can develop in the fallopian tubes. However this type of cancer is considered quite rare, accounting for under 0.5% of all cancers affecting women in Australia.

That being said, early-stage fallopian tube cancers and pre-invasive lesions have been incidentally detected in tubal specimens removed from women who have had risk-reducing, prophylactic bilateral salpingo-oophorectomy (BSO). These lesions were always located in the distal, fimbrial end of the fallopian tube.

How are the fallopian tubes linked to ovarian cancer? 

It has been found that women who have had a tubal ligation (the surgical procedure in which the fallopian tubes are “tied” or blocked as a permanent birth control measure) have a significantly reduced risk of ovarian cancer. According to two large US studies, the risk reduction is between an impressive 50% and 60%. 

The Society of Gynecologic Oncologists of Canada has proposed that woman undergoing a hysterectomy for benign gynaecological conditions should also be given the option to have their fallopian tubes removed (salpingectomy). They also recommend the removal of the fallopian tubes as a favourable alternative to tubal ligation, for women who request to have their “tubes tied” for birth control purposes.

In Canada, it has been found that the rate of salpingectomy as part of hysterectomy for benign conditions has increased from 5% to 35% in 2014. During the same period, the rate of salpingectomy for permanent birth control increased from less than 1% to 33%. 

An important thing to remember is that salpingectomy shouldn’t be performed instead of prophylactic BSO in BRCA1 and BRCA2 carriers. (That is, the removal of both the ovaries and fallopian tubes in those at a very high risk of ovarian cancer.) But it should be offered to all women who require pelvic surgery for another reason.

How is the procedure carried out? 

The operation is either done as part of a laparoscopic hysterectomy or independently as a separate procedure. It should always be completed through laparoscopy or keyhole surgery. If performed as part of a hysterectomy it will not prolong the hospital stay. If performed as an independent procedure it will be done as day surgery or one night stay. The fallopian tubes should always be labeled and sent for pathology testing. 

How long does it take and are there any side effects? 

On average, it has been found that salpingectomy adds just 10 minutes to the operating time of a hysterectomy, and the procedure has not been found to have any impact on blood loss, duration of hospital stay or any other complications.  An Italian study suggested the ovarian hormone function in women who had the fallopian tubes removed did not change immediately or three months after surgery.

Is it a reversible procedure? 

Women considering a salpingectomy need to be aware that it's not a reversible procedure and tubal re-anastomosis (reconnecting or restoring the fallopian tubes) is not possible. Women under the age of 30 or those unmarried at the time of the procedure have been found as the patients most likely to regret the decision. Should these women still want the option of having children in the future, they would need to undergo IVF treatment to fall pregnant.

Are you a candidate for the surgery? 

If you are someone considering undergoing a salpingectomy, you must be aware that the procedure is only recommended for women who fall under one of the following three categories:

Women who require a hysterectomy for benign gynaecological conditions and who have completed their family. 

Women in their thirties and forties who are BRCA1 or BRCA2 positive (at very high risk of ovarian cancer) who have not finished having children and who may require IVF to fall pregnant. 

Women who finished having children and wish to have permanent birth control. 

To find out more about salpingectomy and whether or not you are a suitable candidate, please consult your gynaecologist, who will be able to give you the most reliable advice on your treatment options.