BRCA Gene Mutation Fallopian Tube Removal Option – Prophylactic Salpingectomy with Delayed Oophorectomy (PSDO)
Breast Cancer Diagnosis and BRCA Testing
After my 2009 diagnosis of breast cancer, I took the BRCA test. BRCA is a gene mutation that increases ones risk of breast and ovarian cancers. I tested positive for BRCA1 187 del AG which results in a stop codon at amnio acid 39 of the BRCA1 protein. In other words, my risk of getting breast cancer or ovarian cancer is a lot higher than the general population.
Since I have already had a bilateral mastectomy and chemotherapy for breast cancer, there is not much more I can do to reduce my risk of breast cancer. Now, I need to focus on reducing my risk of ovarian cancer.
BRCA and Increased Ovarian Cancer Risk
There are no effective methods of screening for ovarian cancer. When ovarian cancer is detected, it has often spread to other parts of the body. There are various options for BRCA+ women in terms of surveillance and risk reduction. Although not always effective, women may choose to have the tumor marker CA125 checked and ultrasounds performed every 6 months. Oopherectomy (removal of ovaries) is the most effective way to decrease ovarian cancer risk. Many doctors recommend oopherectomy around age 4o. Unfortunately, bilateral oophorectomy before natural menopause is associated with several negative outcomes such as cardiovascular disease, cognitive impairment, bone issues, emotional and sexual problems, and increased risk in premature death. That sounds pretty scary, right?
Ovarian Cancer May Start in Fallopian Tubes
Recently, there has been research suggesting ovarian cancer may start in the fallopian tubes. Now, because of this theory, doctors are starting to recommend salpingectomy (fallopian tube removal) for ovarian cancer prevention in pre menopausal women.
A study at M.D. Anderson Cancer Center, Prophylactic Salpingectomy With Delayed Oophorectomy is currently recruiting participants. The goal of this clinical research study is to compare ovarian cancer screening, risk-reducing salpingo-oophorectomy (RRSO), and prophylactic salpingectomy with delayed oophorectomy (PSDO).
After lots of discussion and my own research, I chose to participate in this fallopian tube removal option for BRCA+ women. For me, I felt like my body was a ticking time bomb. At the age of 37, I was having a hard time waiting around until age 40+ to reduce my risk of ovarian cancer. I was also not ready to face the issues associated with surgical menopause.
My Laparoscopic Prophylactic Salpingectomy with Delayed Oophorectomy (PSDO)
My husband and I arrived in Houston on September 14 for pre-op appointments and testing. Everything came back normal and my surgery was confirmed for the next day.
September 15, 2015, we arrived at MD Anderson at 6:30am for an 8:30am surgery. We waited a long time in the waiting room. Finally, I was given a room. The IV was started. I was given a scopolamine transdermal patch behind my ear to prevent nausea. By they time they wheeled me out and gave my the happy drugs it was about 9:15am or so.
The laparoscopic salpingectomy itself went well, but there was a complication during surgery. For some reason, perhaps due to IBS, my small intestine swelled during surgery. To be sure there were no punctures, both my doctor and a gastroenterologist spent a lot of time checking my whole small intestine. No injuries were found after a long time of pulling and stretching. The surgery was supposed to last only 1.5 hours, but because of the intestinal problems, my surgery lasted 3 hours.
Normally a laparoscopic salpingectomy is an outpatient procedure, but because of the intestinal complication, I had to spend the night at the hospital. My doctor wanted to monitor me overnight to make sure I had no intestinal complications.
The pain after surgery was not too bad. On a scale of 0-10, as I was asked frequently, the pain was around a 3. My stomach was bloated and gassy since they add a lot of air to the abdomen to improve surgical visibility. I was warned before surgery to expect to have a lot of gas after surgery. There’s only one way to get it out.
The most annoying part of recovery were side effects of either anesthesia or the scopolamine patch. Somehow, no one thought to remove my patch right after surgery as recommended. It was left on for a few days until I complained to my doctor the day we were going back to Austin.
My vision was blurry, especially up close. I had a hard time reading, texting, etc. for almost a week. I was nauseous, lightheaded, and dizzy for a while.
Finally, I’m feeling almost back to normal. I was able to drive today. I’m still weak and little nauseous, but the lightheadedness is gone.
I do have some post surgery restrictions for the next few weeks. After 4 weeks, I can resume running. After 6 weeks, I can start lifting more than 10 pounds and go back to doing abdominal exercises and Pilates.
I will come back and update this post and let you know how recovery is going.
Pictures of laparoscopic salpingectomy after surgery
Here are some pictures of my stomach now with the steristrips. You’ll see there are 4 incisions. Normally, with laparoscopic salpingectomy there are 3 incisions – 2 for fallopian tube removal and one for the camera. Since I had intestinal issues, another incision was made to check my bowels/ small intestine.
4 days after My Laparoscopic Prophylactic Salpingectomy Fallopian Tube Removal to Reduce Ovarian Cancer Risk
8 days after surgery – laparoscopic salpingectomy
If you would like to learn more about salpingectomy as a way to reduce ovarian cancer risk for BRCA+ women, here are some articles.
- Salpingectomy for Ovarian Cancer Prevention
- Intercepting pelvic cancer in the distal fallopian tube: Theories and realities
- Opportunistic and interventional salpingectomy in women at risk: a strategy for preventing pelvic serous cancer (PSC)
- Prophylactic oophorectomy in pre-menopausal women and long term health – a review
- Primary Fallopian Tube Malignancies in BRCA-Positive Women Undergoing Surgery for Ovarian Cancer Risk Reduction
Here is my YouTube Video – Fallopian Tube Removal Surgery for BRCA+ Ovarian Cancer Risk Reduction – Laparoscopic Prophylactic Salpingectomy with Delayed Oophorectomy (PSDO)