Good for Angelina Jolie for speaking up about her recent surgery to remove her ovaries and fallopian tubes removed last week as a preventative measure against cancer. Below I have been sent some advice on ovarian cancer.
Commenting in the New York Times, Angelina has revealed that she had the surgery because she carries a gene that gave her a 50% risk of developing ovarian cancer. Her doctors have estimated she had an 87% risk of breast cancer and a 50% risk of ovarian cancer in her lifetime unless she underwent surgery. In 2013, Angelina had both her breasts removed to decrease her risk of breast cancer, and now just two years later, she has had both ovaries and fallopian tubes removed, to reduce her risk of ovarian cancer. She lost her mother and two other close family members to cancer, so completely understandable that she is taking these extreme preventative measures, regardless of the risks involved – early onset of menopause and so on.
Below I have some information from Ms Deborah Bruce, Consultant Gynaecologist at London Bridge Hospital to find out what the surgery involves, the side effects and the emotional impact, as well as details on the genetic influences and development of ovarian cancer.
Why would someone get the procedure?
“A women would request this surgery and obtain it if her and her gynaecologist, after detailed discussion and weighing up the pros and cons, decide that her risk of developing ovarian cancer outweighs the risk of surgical menopause.”
What does it involve?
“It would involve usually a laparoscopic (keyhole) procedure to remove the ovaries and fallopian tubes. It can also be performed by an open procedure but this would involve more risks to the patient and a longer recovery period.”
What is the recovery time afterwards?
“After a laparoscopy, which is usually a day case procedure, recovery should be quicker and easier than an open procedure which would involve an overnight stay of two to three nights. After a laparoscopy, most women are back to full activities within 4-6 weeks, compared to a laparotomy which can take up to 3 months.”
What can be some of the side effects of having your ovaries removed?
“The main risk of removing the ovaries in a premenopausal woman is inducing a surgical menopause which would be associated with all the complications of a natural menopause; hot flushes, night sweats, increased risk of osteoporosis/ cardiovascular disease, uro-genital issues such as vaginal dryness. Often the symptoms such as hot flushes are more severe following a surgical menopause than a natural menopause.”
What could also be some of the emotional fall out?
“The main emotional issues surround fertility, however if a woman has completed her family, this is less of a risk.”
What are the main symptoms of ovarian cancer?
“The problem with ovarian cancer is that the symptoms – if any – often present late in the process of ovarian cancer. The main symptoms, should they occur are swelling in the abdomen, weight gain, bloating or irritable bowel like symptoms.”
How is ovarian cancer normally diagnosed?
“Ovarian cancer is normally diagnosed with a combination of blood tests, scans and surgery. Like any cancer, it can only be 100% confirmed after surgical removal and histological examination. However, a blood test called Ca-125 is usually raised with ovarian cancer, and certain ultrasonographic changes can increase the index of suspicion. An MRI scan is often also performed to investigate further and exclude metastases (to determine if the cancer has spread or not).”
What is the role of genetics in the development of ovarian cancer?
“There is an association between BRCA1 and 2 genes and the development of ovarian cancer. This only contributes 5-10 % of all ovarian cancers. However, if the BRCA1 gene is present 39% of women will develop Ovarian cancer by the age of 70 years. The risk is less – 11-17% with BRCA2. These genes can be screened for in the presence of a positive family history of breast and/or ovarian cancer, but there are pros and cons to knowing your status.”
Do you have any advice or tips to help reduce the chance of developing ovarian cancer?
“Other factors that have been shown to alter the risk of developing ovarian cancer include the number of ovulatory menstrual cycles a women has in her lifetime – the more she has the greater the risk, hence late menarche, early menopause, pregnancy and breast feeding are all protective against this disease. The combined oral contraceptive pill is also protective as it stops ovulation. Tubal ligation and hysterectomy have also been shown to reduce the risk.
“Some environmental factors such as the use of talcum powder have been associated with an increased risk of developing ovarian cancer as well as some herbicides and pesticides. HRT has also been shown to increase the risk.”