Can ovarian cancer occur after ovaries have been removed?

Can Ovarian Cancer Occur After Ovary Removal?

Yes, you can still develop cancer after ovaries are removed, though the risk is substantially reduced by 80-90%, with a residual 4.3% cumulative risk of primary peritoneal carcinoma at 20 years post-oophorectomy. 1, 2

Understanding Post-Oophorectomy Cancer Risk

Even after complete bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), cancer can still develop because:

• Primary peritoneal carcinoma can arise from the peritoneal lining of the abdomen, which shares the same embryologic origin as ovarian tissue 3, 1
• The peritoneum remains susceptible to the same malignant transformation that affects ovarian tissue, particularly in women with BRCA1/2 mutations 1, 2
• Among BRCA mutation carriers who develop peritoneal carcinomatosis after risk-reducing surgery, 86% carry a BRCA1 pathogenic variant specifically 1

Specific Cancer Risks After Ovary Removal

Primary Peritoneal Cancer

• Occurs in approximately 217 per 100,000 women per year after prophylactic oophorectomy 2
• The estimated cumulative incidence reaches 4.3% at 20 years following oophorectomy 2
• Typically occurs within 2 years of primary therapy in 75% of patients with advanced disease 1
• Women with serous tubal intraepithelial carcinoma found in their surgical specimen face higher risk 1

Ovarian Remnant Syndrome

• Rare but documented complication where residual ovarian tissue is inadvertently left behind during difficult surgical procedures 4
• Most commonly occurs when surgery is complicated by endometriosis, pelvic inflammatory disease, or prior abdominal surgery 4
• Malignant transformation has been documented in ovarian remnants, with 12 reported cases including clear cell adenocarcinoma, mucinous tumors, and endometrioid tumors 4
• Endometriosis increases this risk, with 30-50% incidence in ovarian remnant syndrome patients who develop ovarian carcinoma 4

Critical Surgical Considerations

Complete removal of the fallopian tubes should be standard care during any hysterectomy and/or oophorectomy, as the fallopian tube is increasingly recognized as the origin site for many high-grade serous ovarian cancers 1

Surgical Technique Matters

• Risk-reducing bilateral salpingo-oophorectomy must include complete removal of both ovaries AND fallopian tubes 1, 5
• Careful pathologic review of removed ovaries and tubes is essential, as occult ovarian cancer is sometimes discovered after prophylactic surgery 3
• When endometriotic adhesions are present during surgery, complete surgical resection is critical to prevent ovarian remnant syndrome 4

Monitoring After Ovary Removal

Surveillance Recommendations

• Serum CA-125 monitoring remains important even after ovary removal for detecting peritoneal cancer 1
• Human Epididymis Protein 4 (HE4) can serve as an additional marker when CA-125 is not elevated 1
• Circulating tumor DNA and circulating tumor cells provide early indicators of disease development 1
• Women should remain vigilant for symptoms including bloating, pelvic/abdominal pain, difficulty eating, or urinary symptoms 3

For BRCA Carriers Specifically

• Continue breast cancer surveillance according to BRCA carrier guidelines after oophorectomy 5
• Despite reduced ovarian cancer risk, all-cause mortality decreases by 77% with risk-reducing surgery 5
• Short-term hormone replacement therapy until natural menopause age (50-51 years) is recommended to mitigate bone loss and cardiovascular risks without significantly compromising cancer risk reduction 5

Common Pitfalls to Avoid

• Incomplete fallopian tube removal: Ensure both tubes are completely excised, not just the ovaries 1
• Inadequate pathologic examination: Demand thorough pathologic review of surgical specimens to detect occult cancer 3
• False reassurance: Patients must understand that while risk is dramatically reduced, it is not eliminated 1, 2
• Neglecting surveillance: Even after ovary removal, appropriate monitoring for peritoneal cancer should continue, especially in high-risk populations 1