Risk-Reducing Surgeries in Gynecological Cancers: A Review of the Current State

Year 2024, Volume: 57 Issue: 2, 74 - 78, 31.08.2024

Bilal Esat Temiz , Utku Akgör

https://doi.org/10.20492/aeahtd.1493135

Abstract

Risk-reducing surgery has an important role to play in the prevention of gynaecological cancers, particularly in women who are at high risk of these cancers. Risk-reducing bilateral salpingo-oophorectomy (rrBSO) has been shown to significantly reduce the risk of ovarian and fallopian tube cancers and all-cause mortality in women with BRCA1/2 mutations. Combined prophylactic hysterectomy and bilateral salpingo-oophorectomy is recommended for patients with Lynch syndrome and has been shown to reduce the risk of endometrial and ovarian cancer. Although long-term data are needed, opportunistic salpingectomy is considered to be an effective method of reducing the risk of epithelial ovarian cancer. Based on genetic mutations and individual risk factors, risk-reducing surgery for gynaecological cancers is an important component of personalised treatment plans. The aim of this review is to provide a comprehensive analysis of the different surgical strategies associated with BRCA1/2 mutations, Lynch syndrome and other hereditary conditions. It evaluates the role and potential benefits of surgical interventions such as risk-reducing bilateral salpingo-oophorectomy (rrBSO), prophylactic hysterectomy and opportunistic salpingectomy in clinical practice, and assesses their efficacy and feasibility.

Keywords

risk-reducing surgery, endometrial cancer, bilateral salpingo-oophorectomy, hereditary cancer syndromes, ovarian cancer

Jinekolojik Kanserlerde Risk Azaltıcı Cerrahiler: Güncel Duruma Bakış

Abstract

Risk azaltıcı cerrahi, özellikle yüksek risk altındaki kadınlarda jinekolojik kanserlerin önlenmesinde önemli bir rol oynamaktadır. Risk azaltıcı bilateral salpingo-ooferektomi (rrBSO), BRCA1/2 mutasyonları taşıyan kadınlarda over ve fallop tüpü kanserlerine bağlı mortalite riskini anlamlı şekilde azaltmaktadır. Lynch sendromu olan hastalarda kombine profilaktik histerektomi ve bilateral salpingo-ooferektomi önerilmektedir ve bu yaklaşımın endometriyal ve over kanseri riskini azalttığı gösterilmiştir. Uzun dönem verilerine ihtiyaç duyulmasına rağmen, fırsatçı salpenjektomi, epitelyal over kanseri riskini azaltmada etkili bir yöntem olarak değerlendirilmektedir. Genetik mutasyonlar ve bireysel risk faktörlerine dayanarak, jinekolojik kanserler için risk azaltıcı cerrahi, kişiselleştirilmiş tedavi planlarının önemli bir bileşeni olarak kabul edilmektedir. Bu derleme, BRCA1/2 mutasyonları, Lynch sendromu ve diğer kalıtsal durumlarla ilişkili çeşitli cerrahi stratejileri kapsamlı bir şekilde analiz etmeyi amaçlamaktadır. rrBSO, profilaktik histerektomi ve oportunistik salpenjektomi gibi cerrahi müdahalelerin etkinliğini ve uygulanabilirliğini değerlendirerek, bu prosedürlerin klinik pratikteki rolünü ve potansiyel yararlarını incelemeyi amaçlamaktadır.

Keywords

risk azaltıcı cerrahiler, endometriyum kanseri, çift taraflı salpingo-ooferektomi, kalıtsal kanser sendromları, yumurtalık kanseri

Thanks

Saygıdeğer Prof. Dr. M. Recep PEKCİCİ tarafından davet ile yazdığımız derleme için kendisine teşekkürlerimizi sunarız.

References

• 1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229- 263. doi:10.3322/caac.21834
• 2. Iijima M, Banno K, Okawa R, et al. Genome-wide analysis of gynecologic cancer: The Cancer Genome Atlas in ovarian and endometrial cancer. Oncol Lett. 2017;13(3):1063-1070. doi:10.3892/ ol.2017.5582
• 3. NCCN Guidelines. Available online: https://www.nccn.org/ professionals/physician_gls/pdf/genetics_bop.pdf (accessed on 20 November 2022)
• 4. Petrucelli N, Daly MB, Pal T. BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer. In: Adam MP, Feldman J, Mirzaa GM, et al, eds. Seattle: GeneReviews: University of Washington; 1993.
• 5. Conte C, Pelligra S, Sarpietro G, et al. Hereditary Women’s Cancer: Management and Risk-Reducing Surgery. Medicina (Kaunas). 2023;59(2):300. doi:10.3390/medicina59020300
• 6. Evans O, Gaba F, Manchanda R. Population-based genetic testing for Women’s cancer prevention. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020;65:139-153. doi:https://doi. org/10.1016/j.bpobgyn.2020.02.007
• 7. Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. Jama. 2017;317(23):2402-2416. doi:10.1001/jama.2017.7112
• 8. Marchetti C, De Felice F, Palaia I, et al. Risk-reducing salpingo- oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers. BMC Womens Health. 2014;14:150. doi:10.1186/s12905-014-0150- 5
• 9. Boyd J, Sonoda Y, Federici MG, et al. Clinicopathologic features of BRCA-linked and sporadic ovarian cancer. JAMA. 2000;283(17):2260-5. doi:10.1001/jama.283.17.2260
• 10. Antoniou A, Pharoah PD, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet. 2003;72(5):1117-30. doi:10.1086/375033
• 11. King MC, Marks JH, Mandell JB. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science. 2003;302(5645):643-6. doi:10.1126/science.1088759
• 12. Daly MB, Pal T, Berry MP, et al. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(1):77-102. doi:10.6004/jnccn.2021.0001
• 13. Kauff ND, Domchek SM, Friebel TM, et al. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol. 2008;26(8):1331-7. doi:10.1200/ jco.2007.13.9626
• 14. Society of Gynecologic Oncologists Clinical Practice Committee Statement on Prophylactic Salpingo-oophorectomy. Gynecol Oncol. 2005;98(2):179-81. doi:10.1016/j.ygyno.2005.05.002
• 15. Kurman RJ, Shih Ie M. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol. 2010;34(3):433-43. doi:10.1097/PAS.0b013e3181cf3d79
• 16. Kwon JS, Tinker A, Pansegrau G, et al. Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers. Obstet Gynecol. 2013;121(1):14-24. doi:10.1097/ aog.0b013e3182783c2f
• 17. Lugo Santiago N, Smith E, Cox M, et al. Ovarian Cancer After Prophylactic Salpingectomy in a Patient With Germline BRCA1 Mutation. Obstet Gynecol. 2020;135(6):1270-4. doi:10.1097/ aog.0000000000003864
• 18. SGO clinical practice statement: Salpingectomy for ovarian cancer prevention. Available at: www.sgo.org/clinical practice/ guidelines/sgo-clinical-practice-statement salpingectomy-for-ovarian- cancer-prevention/ (Accessed on December 11, 2019).
• 19. National Comprehensive Cancer Network (NCCN) guidelines. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, version 3.2024. Available at: https://www.nccn.org/ guidelines/guidelines-detail?category=2&id=1503 (Accessed on April 17, 2024).
• 20. Dowdy SC, Stefanek M, Hartmann LC. Surgical risk reduction: prophylactic salpingo-oophorectomy and prophylactic mastectomy. Am J Obstet Gynecol. 2004;191(4):1113-23. doi:10.1016/j. ajog.2004.04.028
• 21. Kauff ND, Barakat RR. Surgical risk-reduction in carriers of BRCA mutations: where do we go from here? Gynecol Oncol. 2004;93(2):277-9. doi:10.1016/j.ygyno.2004.03.016
• 22. Alvarado-Cabrero I, Young RH, Vamvakas EC, Scully RE. Carcinoma of the fallopian tube: a clinicopathological study of 105 cases with observations on staging and prognostic factors. Gynecol Oncol. 1999;72(3):367-79. doi:10.1006/gyno.1998.5267
• 23. Sherman ME, Piedmonte M, Mai PL, et al. Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from Gynecologic Oncology Group Trial GOG-0199. J Clin Oncol. 2014;32(29):3275-83. doi:10.1200/jco.2013.54.1987
• 24. Owens DK, Davidson KW, Krist AH, et al. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement. Jama. 2019;322(7):652-65. doi:10.1001/jama.2019.10987
• 25. Kauff ND, Satagopan JM, Robson ME, et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2002;346(21):1609-15. doi:10.1056/NEJMoa020119
• 26. Paley PJ, Swisher EM, Garcia RL, et al. Occult cancer of the fallopian tube in BRCA-1 germline mutation carriers at prophylactic oophorectomy: a case for recommending hysterectomy at surgical prophylaxis. Gynecol Oncol. 2001;80(2):176-80. doi:10.1006/ gyno.2000.6071
• 27. Rebbeck TR, Kauff ND, Domchek SM. Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst. 2009;101(2):80-7. doi:10.1093/jnci/djn442
• 28. Chai X, Domchek S, Kauff N, Rebbeck T, Chen J. RE: Breast Cancer Risk After Salpingo-Oophorectomy in Healthy BRCA1/2 Mutation Carriers: Revisiting the Evidence for Risk Reduction. J Natl Cancer Inst. 2015;107(9):djv217. doi:10.1093/jnci/djv217
• 29. Arora S, Yelikar BR, Karigoudar MH. Evaluation of SEE-FIM (Sectioning and Extensively Examining the FIMbriated End) Protocol in Identifying Fallopian Tube Precursor Lesions in Women with Ovarian Tumors. J Obstet Gynaecol India. 2019;69(Suppl 2):153-9. doi:10.1007/s13224-018-1155-z
• 30. Koc N, Ayas S, Arinkan SA. Comparison of the Classical Method and SEE-FIM Protocol in Detecting Microscopic Lesions in Fallopian Tubes with Gynecological Lesions. J Pathol Transl Med. 2018;52(1):21-7. doi:10.4132/jptm.2016.06.17
• 31. Garrett LA, Growdon WB, Goodman A, Boruta DM, Schorge JO, del Carmen MG. Endometriosis-associated ovarian malignancy: a retrospective analysis of presentation, treatment, and outcome. J Reprod Med. 2013;58(11-12):469-76.
• 32. Yoon SH, Kim SN, Shim SH, Kang SB, Lee SJ. Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: A meta-analysis. Eur J Cancer. 2016;55:38-46. doi:10.1016/j. ejca.2015.12.003
• 33. Pölcher M, Hauptmann S, Fotopoulou C, et al. Opportunistic salpingectomies for the prevention of a high-grade serous carcinoma: a statement by the Kommission Ovar of the AGO. Arch Gynecol Obstet. 2015;292(1):231-4. doi:10.1007/s00404-015-3697-y
• 34. de Jonge MM, de Kroon CD, Jenner DJ, et al. Endometrial Cancer Risk in Women With Germline BRCA1 or BRCA2 Mutations: Multicenter Cohort Study. J Natl Cancer Inst. 2021;113(9):1203-11. doi:10.1093/jnci/djab036
• 35. Obermair A, Youlden DR, Baade PD, Janda M. The impact of risk-reducing hysterectomy and bilateral salpingo-oophorectomy on survival in patients with a history of breast cancer--a population- based data linkage study. Int J Cancer. 2014;134(9):2211-22. doi:10.1002/ijc.28537
• 36. Moreira L, Balaguer F, Lindor N, et al. Identification of Lynch syndrome among patients with colorectal cancer. JAMA. 2012;308(15):1555-65. doi:10.1001/jama.2012.13088
• 37. Schmeler KM, Lynch HT, Chen LM, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med. 2006;354(3):261-9. doi:10.1056/NEJMoa052627
• 38. Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110(2):223-62; quiz 263. doi:10.1038/ajg.2014.435
• 39. Giardiello FM, Allen JI, Axilbund JE, et al. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-society Task Force on colorectal cancer. Am J Gastroenterol. 2014;109(8):1159-79. doi:10.1038/ajg.2014.186
• 40. Vasen HF, Blanco I, Aktan-Collan K, et al. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts. Gut. 2013;62(6):812- 23. doi:10.1136/gutjnl-2012-304356
• 41. Stoffel EM, Mangu PB, Gruber SB, et al. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology Clinical Practice Guideline endorsement of the familial risk-colorectal cancer: European Society for Medical Oncology Clinical Practice Guidelines. J Clin Oncol. 2015;33(2):209-17. doi:10.1200/jco.2014.58.1322
• 42. https://www.nccn.org/professionals/physician_gls/pdf/genetics_ colon.pdf (Accessed on April 08, 2019).
• 43. National Comprehensive Cancer Network (NCCN) guidelines. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, version 3.2024. Available at: https://www.nccn.org/ guidelines/guidelines-detail?category=2&id=1503 (Accessed on April 17, 2024).