Removing Ovaries May No Longer Be the Only Way
Study finds that keeping ovaries intact doesn't alter survival rates
(HealthDay News) -- In young women with endometrial cancer, keeping ovaries intact or having them removed does not seem to change five-year survival rates.
Ovary removal has long been considered standard treatment for this type of cancer, but the study, reported in the Journal of Clinical Oncology, suggested that it could be safe for a woman to keep her ovaries.
The finding was described as "provocative" by the study's lead author, Dr. Jason D. Wright, an assistant professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons in New York City. The study was retrospective, looking back at procedures and outcomes that had already occurred, and Wright stressed that additional research was needed to follow women forward in time to assess outcomes.
But in the meantime, he urged communication between doctors and patients. "This is something that needs to be discussed with young women -- that this is available," he told HealthDay.
Endometrial cancer, the most common type of uterine cancer, starts in the endometrium, the inner lining of the uterus, or womb. It's the tissue that's shed during a woman's menstrual cycle.
In 2009, there were an estimated 42,160 new cases of endometrial cancer and 7,780 deaths in the United States, according to the U.S. National Cancer Institute. Most cases occur in women aged 50 and older, says the American Cancer Society. It is rare in women younger than 40.
The standard treatment is surgery to remove the uterus (hysterectomy) as well as the fallopian tubes and ovaries (salpingo-oophorectomy). This has been done because of concern that estrogen produced by the ovaries might cause the cancer to spread.
But having both ovaries removed induces menopause. Preserving the ovaries would spare young women from a host of side effects, including hot flashes and vaginal dryness.
The study by Wright and his colleagues involved 3,269 women aged 45 or younger who had early-stage endometrial center. Using data on women diagnosed between 1988 and 2004, the researchers found similar five-year survival rates for the 402 women whose ovaries were preserved and the 3,269 whose ovaries were removed.
Both groups had a 98 percent survival rate for cancers restricted to the uterine lining. For cancers that had begun to grow through the muscle wall of the uterus, 96 percent of those who had their ovaries removed lived at least five years, versus 100 percent of those whose ovaries were left intact. For cancers that invaded at least half of the uterine wall, the survival rates were 89 percent for women who had their ovaries removed and 86 percent for those who didn't.
More recently, a Korean research team reviewed data on 175 women with endometrial cancer, who averaged about 38 years old and included 101 who had ovary-saving surgery. After a median follow-up of 55 months, 94 percent had no recurrence of the cancer and 93 percent were still living. The study was published in Gynecologic Oncology.
The type of treatment selected, according to the cancer society, usually depends on numerous factors, including the stage of the disease.
When talking with their doctor about options, the cancer institute suggests patients ask the following questions:
What kind of operation will it be?
How will I feel after the operation?
What help will I get if I have pain?
How long will I have to stay in the hospital?
Will I have any long-term effects because of the operation?
When will I be able to resume my normal activities?
Will the surgery affect my sex life?
Will follow-up visits be necessary?
On the Web
To learn more about treating womb cancer, visit Cancer Research UK.
SOURCES: HealthDay News; Jason D. Wright, M.D., assistant professor, obstetrics and gynecology, Columbia University College of Physicians and Surgeons, New York City; Jan. 26, 2009, Journal of Clinical Oncology; October 2009, Gynecologic Oncology; American Society of Clinical Oncology (www.asco.org); U.S. National Cancer Institute (www.cancer.gov); American Cancer Society (www.cancer.org)
Author: Karen Pallarito
Publication Date: March 31, 2010
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