Parulekar SV

Ovarian cancer is often asymptomatic until it is quite advanced. Thus it is more dangerous than other gynecologic cancers because it is diagnosed at a more advanced stage than others. There are no good and easy screening methods for its early detection. If its prevention is at all possible, it would be ideal from the women's point of view, the lifetime risk of developing ovarian cancer being 1-2%. Recently there has been quite a bit of interest in the role of salpingectomy in reducing the risk of development of ovarian cancers. It has been shown that both bilateral tubal ligation and bilateral salpingectomy before the age of 35 years reduces the risk of development of ovarian cancer by up to 50%. The benefit is greater with salpingectomy than with tubal ligation. The cancers prevented are mainly the endometrioid cancer. Significant benefit is also seen with serous epithelial cancers. There is no protection from the development of borderline cancers. The mechanism underlying this protection is not understood very clearly.

The process of ovulation causes surface injury to the ovary. If the process of healing of that injury is not proper, there is a possibility of mutations which could lead to the development of cancer. Gonadotropins could be involved in the development of the malignant change. Inflammatory agents and infection that reach the ovary by ascending route from the lower genital tract through the uterus and the fallopian tubes could also be causative agents. The process of tubal interruption would prevent such agents and endometrial cells reaching the ovary and protect it from development of cancer. Interruption of the tube could be associated with reduced blood flow from anastomosis between uterine and ovarian arteries to the ovary, reducing the amount of gonadotropins reaching the ovary and thus reduce the risk of development of ovarian cancer. It is also likely that the cancer, especially the serous type, originates in the adjacent fallopian tube and spreads to the ovary. Removal of the fallopian tube would afford protection from ovarian cancer, but not simple ligation. For women who desire permanent contraception, salpingectomy rather than tubal ligation should be offered. But that may be associated with higher morbidity and deterioration of ovarian function due to reduced blood supply. If a woman has a high risk of ovarian cancer, prophylactic removal of ovaries after completion of the childbearing function should be combined with salpingectomy, if the woman so desires.