A bilateral salpingo-oophorectomy is the surgical removal of both ovaries and fallopian tubes. In addition to treating ovarian cancer, this procedure is sometimes performed as a preventive measure for women who have been identified as having a heightened risk of developing cancer of the ovaries and/or fallopian tubes. Less commonly, a bilateral salpingo-oophorectomy may be recommended for patients who have endometriosis, an ectopic pregnancy or benign ovarian cysts.
The term ovarian cancer is often used to describe cancer from the ovary, fallopian tube, or the peritoneum (the lining of the abdominal cavity). It is becoming increasingly recognized that the majority of these are actually from the fallopian tubes. This may be particularly true for those often found in women with BRCA gene mutations. For this reason, prophylactic bilateral salpingo-oophorectomy can help reduce a patient’s ovarian cancer risk.
In consideration of these factors, some experts recommend that women with BRCA gene mutations contemplate bilateral salpingo-oophorectomy:
- Between ages 35 and 40, partly depending on the exact gene mutation and the family history
- After completing childbearing
A decision to undergo prophylactic bilateral salpingo-oophorectomy is highly personal and complex. In some patients, it might be acceptable to consider removal of the fallopian tubes alone when childbearing is complete, followed by an oophorectomy at a later age. Therefore, it is advisable for a patient to consult with experts in both genetics and gynecologic oncology who can thoroughly analyze her risk of developing ovarian cancer and help her make informed risk-management decisions that are best-suited for her individual circumstances and lifestyle.
The surgical technique to perform these optimally requires the ability to remove the entire fallopian and ovarian epithelium, which may require more dissection than is typically performed by surgeons who are not gynecologic oncologists. Furthermore, the pathology must be specially performed to examine the entire specimens at intervals based in millimeters. This is different than the typical processing for non-cancer preventative cases and is necessary because microscopic cancers can be missed otherwise.
It is important to have a specialist who can correctly counsel you about the facts of hormone replacement therapy and symptom management. The removal of tubes and ovaries will result in immediate menopause, which could have short- and long-term health consequences if not advised appropriately with up-to-date information.
Women who have questions about bilateral salpingo-oophorectomy can turn to Moffitt Cancer Center, where we take a multispecialty approach to ovarian cancer prevention, diagnosis, treatment and support. In one location, each patient has access to multiple experts – not just a single physician. Our talented tumor board, composed of highly specialized medical professionals, reviews complicated patient cases in detail and then meets weekly to monitor her progress and refine her treatment plan as necessary.
Medically reviewed by Robert Wenham, MD, Chair, Gynecologic Oncology Program
To learn more about bilateral salpingo-oophorectomy and the other ovarian cancer surgery and prevention strategies available at Moffitt’s gynecological clinic, call 1-888-663-3488 or schedule an appointment online. We do not require referrals.