Oophorectomy or ovarian conservation at the time of hysterectomy for benign disease TOG 2022

Question 1

What is the lifetime risk of ovarian cancer?

Answer 1

1.4%

Question 2

What proportion of ovarian cancers have BRCA mutation?

Answer 2

10-15%

Question 3

What proportion of ovarian endometriosis can become cancer

Answer 3

2.5%

Question 4

RF for ovarian cancer

Answer 4

FHx BRCA, Lynch, Peutz-Jeghers
Obesity
PCOS

Question 5

Ovarian endocrine function after menopause

Answer 5

Produce androgens (testosterone and androstenedione) which are converted to estone → estradiol in adipose tissues.

Question 6

If BSO performed aged 50-54 what is the impact on all mortaility/morbidity

Answer 6

Increase in 10%

Question 7

If BSO <45 years, impact on CVD risk?

Answer 7

• CV disease – BSO <45yrs, 1.5x greater risk death from CVD, if remove those no HRT 1.84 X

Question 8

Effect of decline of ovarian sex steroid on bone health?

Answer 8

Increased osteopenia, increased risk fractures and bone mets. HRT only offers 20% protection against osteoporotic bone fractures

Question 9

Effect of BSO before menopause on cognitive function

Answer 9

Cognitive decline starts from time from BSO, small increased risk of Parkinsonism

Question 10

Effect on surgical menopause on sexual function

Answer 10

decrease in sexual function, low oestrogen and testosterone levels, decline in sexual pleasure even with addition postop oestrogen.
PM low levels of ovarian oestrogen important role in genital tissue, reducing vulvovaginal atrophy/UTI/lubrication with arousal

Question 11

What are the 2 main categories of ovarian cancer and where do they originate?

Answer 11

o Type 1 – low grade endometrioid/clear cell/mucinous and transitional (brenner) – stable low grade

o Type 2 – aggressive, epithelial incl high grade serous carcinoma, undifferentiated carcinoma and carcinosarcoma - seem to originate from Fallopian tube. Same for women with BRCA. TP53 mutations, transcoelomic metastasis in the abdominal cavity

Question 12

Does BL salpingectomy effect ovarian reserve?

Answer 12

No

Question 13

Impact of reducing number of lifetime ovulation on risk of ovarian cancer?

Answer 13

Ovarian cancer risk reduced 20% for every 5 years hormonal contraception is used.
Pregnancy and BF >12 months also reduces risk

Question 14

Ovarian risk reduction with hysterectomy and tubal ligation

Answer 14

Hsterectomy reduces risk 34%
Tubal ligation 34%

RCOG recommends BL tubal ligation with hysterectomy

Question 15

In high risk women - long term contraception + tubal ligation leads to what reduction in ovarian cancer

Answer 15

72%

Question 16

What is impact on future surgery if ovaries left in situ?

Answer 16

Future removal of ovaries may be very difficult due to development of adhesions.

If already significant adhesions e.g. endometriosis may be better to remove ovaries

Question 17

Indications for bilateral BSO

Answer 17

Question 18

When to consider BL salpingectomy instead

Answer 18