If you’ve had a hysterectomy, you may assume that you cannot be diagnosed with ovarian cancer. In many cases, one or both ovaries are left in place after a hysterectomy. While having your uterus removed decreases your risk of developing ovarian cancer, it is still possible.
Ovarian cancer is cancer that develops from the ovarian cells. The ovaries are where eggs are produced and are the main source of the female hormones estrogen and progesterone. Most ovarian cancers start in the epithelial cells that cover the outer surface of the ovary. Cancer can also develop inside the germ cells that produce eggs or in the hormone-producing stromal cells.
A hysterectomy is a surgical procedure in which your uterus is removed. There are different kinds of hysterectomies:
- partial or supracervical hysterectomy: The uterus is removed but the cervix is left intact.
- total or pan hysterectomy: The uterus and the cervix are removed
- radical hysterectomy: The uterus and the cervix are removed along with the tissue on both sides of the cervix and the upper part of the vagina.
In all of these procedures, the ovaries are left in place.
According to the American Cancer Society (ACS), having a hysterectomy (even when the ovaries are left in place) may reduce the chance of ovarian cancer by one-third. Sometimes the Fallopian tubes and both ovaries are removed during a hysterectomy. This is called a bilateral salpingo-oophorectomy or BSO.
Without ovaries, your risk of developing ovarian cancer is lower, but there’s still some risk. That’s because ovarian cells can migrate to the perineum, which is the area between the vagina and anus. If this migration happened before your ovaries were removed, those cells remain behind. These remaining ovarian cells can become cancerous just like the ovaries can. And if they do, it is still considered ovarian cancer even if the ovaries are removed before the cancer develops. Cancer can also develop from cells in the peritoneum, the tissue lining the wall of your abdomen and while this is not ovarian cancer it behaves in much the same way as ovarian cancer and is treated similarly.
Some women are genetically predisposed to develop ovarian cancer. In that case, you may consider taking preventive measures. One option is to have your ovaries removed. When this is done preventively, it’s called prophylactic bilateral oophorectomy.
Without ovaries, you can still be diagnosed with ovarian cancer, but your risk is significantly lower. If you carry BRCA1 or BRCA2 gene mutations, it can reduce your risk by 80 to 90 percent, according to the Mayo Clinic. Women who carry these genes are also at an increased risk of breast cancer, so removing the ovaries prior to menopause can also lower your risk of hormone-positive breast cancers.
No matter what type of hysterectomy you have, you should still have regular examinations. However, there’s no routine screening test for ovarian cancer. Signs of ovarian cancer can seem rather vague and mild at first. Some common symptoms include:
- abdominal bloating and discomfort
- trouble eating, or feeling overly full
- frequent urination, or the need to urinate often
- heartburn, or upset stomach
- back pain
- painful intercourse
When caused by ovarian cancer, these symptoms won’t respond to treatment or lessen over time. It’s important to report symptoms to your doctor as soon as possible because women who are diagnosed and treated in the early stages tend to have a better prognosis.
A pelvic examination is a good place to start, but small tumors in your pelvis can’t always be felt. Imaging tests, such as the transvaginal ultrasound or MRI can help to detect tumors. A blood test for the CA-125 tumor-associated antigen may also be helpful.
However, the only way to confirm the diagnosis of ovarian cancer is with a biopsy of the ovary or other suspicious tissue.
Ovarian cancer is a relatively rare form of cancer. The National Cancer Institute (NCI) puts a woman’s lifetime risk at 1.38 percent. This risk is higher for women who carry certain gene mutations. About 39 percent of women with the BRCA1 mutation and 11 to 17 percent with the BRCA2 mutation will get ovarian cancer by age 70.
A lot of factors affect your individual outlook. One of these is stage at diagnosis. The five-year relative survival rate for all stages of ovarian cancer is 44 percent, according to the ACS. When diagnosed and treated in the early stages, the five-year relative survival rate is as high as 92 percent. Unfortunately, only about 15 percent of ovarian cancers are detected in stage 1. That’s why it’s so important to be aware of the symptoms of ovarian cancer and to report them to your doctor as quickly as possible.