When I was both a medical student and a pathology resident, I was intrigued by the fact that many ovarian cancers I looked at under the microscope consisted of columnar cells and often seemed to grow on the surface of the ovary. Various teachers told me that the neoplasms were mimicking peritoneal and tubal epithelium. Experts now assert that there is no such thing as "ovarian cancer" -- all such neoplasms are now thought to originate in the uterine tubes, thus explaining their histologic appearance (see: Tackling Cancer Myths: It’s time to accept that ovarian cancer doesn’t exist). Here is an excerpt from this article by Dr. Mark Boguski about this topic:
It’s been known for almost 10 years that the term “ovarian cancer” is a misnomer. Almost all of these diseases begin somewhere other than the ovary – most usually in the fallopian tubes, meaning that ovarian cancer as a defined entity doesn’t really exist....Once prophylactic removal of the tubes and ovaries became commonplace in people who carry the BRCA1 or BRCA2 mutations, pathologists were able to study the specimens and gain further insight. They found that all of the cancers, or pre-cancers, started in the fallopian tubes or other pelvic organs, but not in the ovaries. The information was published and is available in the pathology literature, but most gynecologists and oncologists aren’t reading it. Our increasing specialization is compartmentalizing and fragmenting medical knowledge – and creating a barrier between the different specialties.....The word is now beginning to spread: to prevent ovarian cancer, some women may only have to have their fallopian tubes removed, leaving their ovaries intact and preventing premature menopause along with all of the associated comorbidities. There are several small clinical trials now underway studying the comparative effects of removing the ovaries and fallopian tubes, versus just the tubes ....Eventually, studies like these could lead to a completely new way of diagnosing and screening for “ovarian cancer” – one that is grounded more solidly in the latest science, resulting in better understanding of pelvic diseases, and better outcomes for patients.
One of Mark's main points is that both physicians' residency training and subsequent education tends to be very insular and the discovery by pathologists that most "ovarian cancers" originate in the uterine tubes may not "migrate" from the pathology literature to the gynecology and oncology literature. This new knowledge also suggests that it may be sufficient to remove only the uterine tubes and spare the ovaries on a prophylactic basis in high-risk patients with BRCA1 and BRCA2 mutations (see: Evidence Points to Fallopian-tube Origins of Ovarian Cancer). Here is an excerpt from this latter article about treatment of "ovarian cancer":
For women with hereditary risk for ovarian cancer, such as those with BRCA1/2 mutations, the standard of care has been removal of both ovaries and fallopian tubes (bilateral salpingo- oopherectomy [BSO]). Although this procedure reduces the risk for ovarian cancer, it can affect quality of life, precipitate early menopause, cause sexual dysfunction, and contribute to increased risk for cardiovascular disease, osteoporosis, and all-cause mortality. Because HSGC (high grade serous cancer) constitutes the most common form of ovarian cancer among women with high genetic risk, the new approach (bilateral salpingectomy with ovarian retention [BSOR]) could also have a "large impact" on ovarian cancer mortality.... BSOR could also reduce ovarian cancer risk in women at average risk for ovarian cancer who are undergoing hysterectomy for benign conditions, such as fibroids. About 600,000 women undergo hysterectomies in the United States each year. Fifteen percent of women who have had a hysterectomy develop ovarian cancer, according to background information in the article.