Ovarian cancer: Identifying and managing high-risk patients
Two cases illustrate when to refer for genetic counseling and what to advise women concerned about prevention.
The operation should be reserved for women with known mutations in BRCA1 or BRCA2 or who have a family history consistent with one of the genetic syndromes associated with ovarian cancer.
The addition of hysterectomy does not appear to increase the efficacy of the operation and should be performed only for concurrent gynecologic indications or if the patient has HNPCC.
Patients should be informed that prophylactic surgery does not protect against subsequent papillary serous carcinoma of the peritoneum. They also should be warned that about 7% of operations detect occult ovarian or tubal carcinoma, which may not be identified until final pathology reports are issued.22 Pathologists should be instructed to submit the entire specimen for sectioning to reduce risk of missing microscopic occult malignancy.
In addition, the patient should be prepared for surgical menopause.
Effective primary prevention strategies such as chemoprophylaxis and prophylactic surgery, when appropriately applied, may spare many women the devastating consequences of this dreaded disease.
Internet resources
- Ovarian Cancer (PDQ): Prevention of ovarian cancer https://www.cancer.gov/cancerinfo/pdq/prevention/ovarian/healthprofessional
- Myriad Genetics: BRCA1/2 mutation prevalence tables https:///www.myriadtests.com/provider/mutprevo.htm
- National Society of Genetic Counselors: Locate a genetic counselor specializing in cancer risk assessment https://www.nsgc.org/resourcelink.asp
