My name is Colleen Feltmate. I'm a gynecologic oncologist working at Brigham and Women's Hospital
and Dana Farber Cancer Center. I'm a specialist who operates on women's cancers but also performs
prophylactic surgeries. Women who have Lynch syndrome related mutations are at risk for
endometrial, ovarian, and fallopian tube cancers. Endometrial cancer requires removal of the uterus
and cervix, while ovarian fallopian tube cancers require the removal of those two organs.
The idea of prophylaxis is to find women where we can prevent disease.
As surgeons who specialize in the care of Lynch syndrome patients we'll recommend that once women
have completed childbearing, that they really consider at a minimum, removal of the uterus,
cervix and fallopian tubes. There are different risk levels with the ovaries and for the most part
that can be a second surgery and can occur before the age of 50.
Prophylactic surgery is very effective near 100%. We can never say 100% effective.
The risk of ovarian and fallopian tube cancers after someone has had those removed
is less than two to 3% that they might have a cancer related to that type of organ.
In terms of endometrial cancer, once the uterus
and the cervix have been removed the likelihood of having endometrial cancer diagnosis is near zero.
The decision to undergo prophylactic surgery is really a complex surgical decision between your
provider and you and relies upon a number of different factors. Part of it is the specific
mutation that you carry. The other is that family history can play a really large role in your
elevation of risk, regardless of the mutation that you have, because that tells us something about
the fact that that mutation somehow led to a cancer developing in your family. And the age
of that person who had the cancer is a marker for your risk of that of developing that disease in
our minds. Thankfully, most of our surgeries are done laparoscopically, which requires a very small
incision, a camera, and oftentimes you're able to go home the same day. If for some reason, the
uterus is abnormally large or you've had multiple surgeries that have a lot of scar tissue involved,
then we may need to perform an open surgery. After surgery, most women will have a recovery
of approximately four weeks where they will feel fatigue, they may feel bloated and crampy for a
few weeks for open surgery, that's going to be pushed out a couple more weeks. Longer term,
the recovery especially for young women or women who are sexually active, the main constraint is
not being able to have intercourse for eight weeks after surgery until things have healed well.
But long term you can expect full recovery and full function. Surprisingly, your body doesn't
really miss the uterus or cervix as much as it misses the ovaries because of hormonal function.
I'm a true believer that you do not have to go through real menopause, we have ways to replace
hormones that can make you feel like yourself. If any woman's ever been on a birth control pill,
they won't feel any different afterwards. If they have their ovaries removed,
and we put them on hormone replacement. Now that may not be true for 100% of women. And if
a woman has a condition, for example, breast cancer, that's an estrogen dependent disease
and they cannot go on hormone replacement then if they aren't in menopause, before the surgery,
then they would go through menopausal symptoms afterwards, potentially. But I
think we can do a lot to help women overcome that transition from having their ovaries
to not having their ovaries and still having reasonable function and hormone replacement.