Ovaries are small, but mighty. Did you know that? I’ve just read in Woman’s Day that although they are no bigger than a couple of almonds, they produce the eggs and hormones which are the ‘seeds’ of life in the human species. For this reason, when a diagnosis of ovarian cancer is given, this impacts a woman on so many levels. In addition to the invasive nature of the cancer, it has also been called a ‘silent killer’, being one of the leading causes of death in woman.
However, science and research have a way of constantly reframing our perspectives and this is what happened when I came across recent findings suggesting that not all ovarian cancers are as their name suggests. Let me explain. For decades, ovarian cancer has been understood as a disease which begins in the ovaries, and understandably so. However, breaking news highlights that many cancers traditionally classified as ovarian cancer actually begin in the fallopian tubes. This demands a perspective shift, not so?
The reports say that the discovery demands more than a change in terminology. It could influence how doctors think about the prevention and diagnosis of the cancer.
The recent findings are especially true with the most common and aggressive form of ovarian cancer, known as high-grade serous carcinoma.
High-grade serous carcinoma accounts for the majority of epithelial ovarian cancers and is responsible for a large proportion of deaths from the disease. Researchers have increasingly traced these tumours back to abnormal cells in the fimbriae. These are the delicate finger-like structures at the end of the fallopian tubes closest to the ovaries. These abnormal precursor lesions are known as serous tubal intraepithelial carcinomas, or STICs. Evidence indicates that they can develop in the fallopian tubes before invasive cancer appears elsewhere in the pelvis.
This has fundamentally altered the understanding of what is sometimes called ovarian cancer.
What Do These Findings Mean For Ovarian Cancer Treatment?
This does not mean that every cancer diagnosed as ovarian cancer originates in a fallopian tube. Ovarian cancer is a group of different diseases with different biological characteristics, and some types genuinely arise in the ovary.
Endometrioid, clear cell, mucinous and other ovarian tumours can have different origins. The fallopian-tube explanation is particularly strong for high-grade serous carcinoma. This is the subtype which has driven much of the research into the origins of ovarian cancer.
The implications are potentially enormous because prevention becomes possible when the earliest stages of a cancer’s development can be identified.
If an important proportion of high-grade serous cancers begin in the fallopian tubes, removing the tubes before cancer develops could prevent some tumours from forming. This approach is called salpingectomy. In this medical procedure, the tubes are removed while leaving the ovaries in place.
Why does this matter?
The ovaries produce hormones which have important effects throughout the body. Removing them before natural menopause causes an abrupt loss of ovarian hormones and can have significant consequences.
The evidence so far is encouraging, although it needs to be interpreted carefully. A major systematic review covering 158 publications found that salpingectomy was associated with an approximately 80% reduction in ovarian cancer risk. For this reason, the researchers concluded that the procedure appears feasible and potentially cost-effective as a prevention strategy.
However, the evidence largely comes from observational studies rather than definitive randomised trials.
Still, other large studies have also found a significant reduction in ovarian cancer following salpingectomy. A Swedish population-based study involving millions of women found that those who had undergone salpingectomy had a lower risk of ovarian cancer than women who had not undergone the procedure. Bilateral removal appeared to provide greater protection than removal of only one tube.
The Possibility Of Earlier Cancer Diagnosis
The fallopian-tube discovery may also have implications for diagnosis. Ovarian cancer can be difficult to detect early because symptoms may be vague.
What are thse symptoms?
They include bloating, abdominal or pelvic discomfort, feeling full quickly and changes in urinary or bowel habits. These same symptoms are also common in other conditions, and their vagueness makes it difficult to pin then to a more serious underlying condition.
There is also currently no reliable screening test for early detection of ovarian cancer. This makes prevention particularly important.
The identification of precursor lesions in the fallopian tubes raises the possibility of detecting disease even earlier than was previously thought possible. Researchers are investigating whether STIC lesions and other molecular changes could eventually provide clues which allow cancers to be identified before they become invasive. The discovery of a potential interval between the appearance of abnormal tubal cells and the development of advanced disease has created a new window for researchers to explore early detection and intervention.
Historically, the idea of preventing ovarian cancer in women at particularly high risk often involved removing both ovaries and fallopian tubes. However, the new hope of not having to remove the ovaries for ovarian cancer prevention is significant for many women. This is especially true for those who have not yet reached menopause.
For me, this breaking medical news demands a perspective change, as stated. Time and again, I have found that identifying the source of a problem and tackling this can save a lot of trouble later. It seems the same is true for health and wellness. In this instance, professionals have highlighted that the keys of diagnosis and treatment rest where the cancer begins, and not where it is found.
The headline-making news is therefore both surprising and hopeful. In understanding the origin of a cancer, in this case, ovarian cancer, medicine can be given an opportunity which was previously difficult to imagine.