How the removal of your uterus affects the risk for ovarian, uterine, and other GYN cancers

Courtesy of Roswell Park Cancer Talk Blog

Women have hysterectomies — surgical removal of the uterus (womb) — for many reasons beyond cancer, such as uterine prolapse, heavy bleeding, or pain from fibroids or endometriosis. Hysterectomy is the second most common surgery among women in the United States (with childbirth by cesarean delivery ranking first), and as many as 600,000 women undergo it each year. Among women aged 50 and older in the U.S., nearly 32% have had a hysterectomy. If you fall into this group, what does it mean for your cancer risk?

What Did My Hysterectomy Include?

While the surgery significantly reduces your risk of developing uterine cancer, your risk for other gynecologic cancers — such as ovarian — may remain unchanged, explains gynecologic oncologist Peter Frederick, MD, Clinical Chief of Gynecology at Roswell Park. It largely depends on the specific type of surgery you had in addition to your hysterectomy. In other words, were other structures — your ovaries, fallopian tubes, cervix — removed or left in place?

For example, a total hysterectomy removes the uterus and cervix. A partial hysterectomy (also called subtotal or supracervical) removes only the upper part of the uterus, leaving the cervix intact. Ovaries and fallopian tubes may or may not be removed along with the uterus and cervix. Even a radical hysterectomy — removing all of the uterus, cervix, upper part of the vagina, and some surrounding tissue — may or may not include the removal of the ovaries and fallopian tubes.

Ovarian Cancer Still Possible After Hysterectomy.

When a hysterectomy is performed for benign (noncancerous) conditions, the ovaries are often left in place to maintain hormonal function and prevent sudden menopause. If you still have your ovaries, your risk of ovarian cancer is lower after a hysterectomy, but it remains. For most women without a family history or other risk factors for ovarian cancer, this risk is minimal — less than a 1 in 70 lifetime chance. New research suggests that many cases of ovarian cancer may originate in the fallopian tubes. Therefore, some women who choose to keep their ovaries decide to remove their tubes to reduce that risk.

For women at high risk for ovarian cancer who undergo risk-reducing surgery involving the removal of the ovaries and fallopian tubes (such as women with a BRCA mutation), the lifetime risk of ovarian cancer is greatly decreased. Unfortunately, this risk is not fully eliminated because peritoneal cancer (cancer originating from the lining of the abdominal cavity) can still occur. Peritoneal cancer is treated the same way as ovarian cancer.

When it comes to gynecologic cancers, the good news is that your hysterectomy removes your risk for the most common diagnosis — uterine cancer — and lowers your risk for other cancers, such as ovarian, fallopian tube, and peritoneal cancers. If your ovaries and fallopian tubes were also removed, then your risk for the most deadly gynecologic cancer, ovarian cancer, is significantly decreased, too. Your risk for other gynecologic cancers, such as cervical, vulvar, and vaginal cancer, can be lowered with regular exams and screenings.

September is Gynecological Cancers Awareness Month. For more resources and expert advice, visit roswellpark.org or call 1-800-ROSWELL (1-800-767-9355).