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    Prophylactic salpingectomy: The future of ovarian cancer prevention?

     

    Advances in understanding ovarian cancer

    In recent years, researchers at the Massachusetts General Hospital (Boston) and other institutions have found strong p53-positive sites at the fimbriated ends of the fallopian tubes of both BRCA-positive and BRCA-negative women.1 In their 2007 paper, Crum et al used a protocol for sectioning and extensively examining the fimbriated end (SEE-FIM) to search for p53-signatures, sites where there were multiple copies of the p53 tumor suppressor genes.2 They also looked for signs of early tubal intraepithelial carcinomas (TICs) and p53 signatures in women with a history of BRCA mutation who had undergone prophylactic surgery, and women who had surgery for other benign or malignant conditions (eg, fibroids or endometrial cancer).

    They found that 80% of women with BRCA mutations and 89% of women without that genetic history had p53 signatures in the fimbriated end of the fallopian tube, and 100% of the TICs they found were associated with the p53 signature.

    Inflammation from consistent ovulation, as well as retrograde flow during menstruation, could be the trigger that sets off the cascade of p53 expression, mutation, and metaplasia (Figure 1).4,7 Although ovarian cancer may originate from these p53 signature sites in the fimbria, ovarian cancers are not referred to as primary tubal cancers because the tubal component is not the dominant component, nor is it the first to be identified in most cases of ovarian cancer (Figure 2).7,8

    This new theory of ovarian carcinogenesis presents new questions for gynecologic surgeons. Can a simple salpingectomy be offered to BRCA-positive patients in the future? Would a prophylactic salpingectomy at the time of hysterectomy or tubal ligation be the best way to help BRCA-negative women avoid the potential risk of developing ovarian cancer? Should all such women be offered a bilateral salpingo-oophorectomy (BSO)?

    Morphologic development of high-grade serous carcinoma from the fallopian tubeOrigination of high-grade serous ovarian cancers in fibrimated end of fallopian tube

     

    NEXT: THE BRCA-NEGATIVE AND BRCA-POSITIVE POPULATIONS >>

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    • Anonymous
      Двухстороннее сальпингэктомия во времия гистерэктомии является профилактикой рака яичника и хронического салпингита.
    • Anonymous
      Двухстороннее сальпингэктомия во времия гистерэктомии является профилактикой рака яичника и хронического салпингита.

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