Can Cervical Cancer Spread to the Ovaries?
In Australia, approximately 900 patients are diagnosed with cervical cancer every year. Cervical cancer is one of the most preventable types of cancer due to Australia's highly developed cervical cancer screening and vaccination program. Screening means that cancers that would have otherwise been found at advanced stages, are found at the early stages with screening. If cervical cancer is diagnosed at an early stage, its survival rates are high.
If cervical cancer is diagnosed at advanced stages, the most common places for cervical cancer to spread is to the parametria and vagina (tissues next to the cervix), lymph nodes (in or outside the abdomen), liver or lungs.
In some rare cases, cervical cancer may spread to the ovaries - this is called ovarian metastasis. Unfortunately, ovarian metastasis is more likely to decrease a patient’s survival rate.
In a review of 12 studies including 18,389 patients with cervical cancer researchers found the incidence of ovarian metastasis was low, between 1.46% to 3.61% depending on the cervical cancer sub-type.
It was more likely for the cervical cancer subtype “adenocarcinoma” to spread, compared to “squamous cell carcinoma”. Squamous cell carcinomas are the most common type of cervical cancer (about 70%), followed by adenocarcinomas (about 25%).
The review found the risk of ovarian metastasis was higher in women 40 years of age and older, and/or those who had locally advanced disease and a larger tumour size (more than 4cm). The risk of ovarian metastasis also increases in patients with cancer spread to the uterus or lymph nodes.
You can read more about the how cervical cancer spreads and stages of cervical cancer here.
Cervical cancer recurrence
If you have been diagnosed with cervical cancer, whether preservation of the ovaries is appropriate depends on individual patient factors including age and desire for fertility.
The stage of the cancer, and whether hormonal treatments or surgery is recommended will also be determining factors in the decision to remove the ovaries.
Removal of the ovaries (a surgical procedure called oophorectomy) in young patients will result in surgical menopause and increases risk of osteoporosis, heart disease, depression or anxiety, or musculoskeletal disease. Surgical menopause means that menopause symptoms will start immediately, this may cause symptoms such as hot flushes, vaginal dryness and discomfort, problems sleeping, mood changes, skin changes, or weight gain among others.
Oophorectomy has been suggested to prevent cervical cancer recurrence in patients with adenocarcinoma, while preserving the ovaries in younger patients with early-stage cervical cancer, especially in squamous cell carcinomas is widely practiced.
In my clinical practice, I discuss the pros and cons of removing ovaries with all patients who need surgery for cervical cancer. These pros and cons need to be discussed in the background of the individual patients’ personal circumstances and tumour factors. As a gynaecological oncologist, I see my role as presenting facts to my patients. The actual decision however, is always made by the patient herself.
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