16 Gynecology O B .GYN. NEWS • March 1, 2006 Prophylactic Surgery Beneficial in Lynch Syndrome BY JEFF EVANS sociated with hereditary nonpolyposis col- from the number of women in the con- the investigators (N. Engl. J. Med. Senior Writer orectal cancer (Lynch syndrome), signifi- trol group who developed ovarian cancer 2006;354:261-9). cantly fewer endometrial cancers occurred (12 of 223). “These findings support consideration rophylactic surgery may help to pre- in women who had a prophylactic hys- The women underwent hysterectomy of prophylactic hysterectomy and bilat- vent gynecologic cancers in women terectomy (0 of 61) than in those who did or bilateral salpingo-oophorectomy at a eral salpingo-oophorectomy in women Pwith hereditary nonpolyposis col- not (69 of 210). median age of 41 years, whereas the me- with the Lynch syndrome after the age orectal cancer, reported Dr. Kathleen M. None of the 47 women who had un- dian age at diagnosis was 46 years for en- of 35, or once childbearing has been Schmeler of the University of Texas M.D. dergone a bilateral salpingo-oophorecto- dometrial cancer and 42 years for ovari- completed,” Dr. Schmeler and her col- Anderson Cancer Center, Houston, and my for cancer prevention or benign con- an cancer. leagues wrote. Only one complication her associates. ditions at the same time as their All but four of the endometrial and two (ureteral injury and repair) occurred in the In a retrospective study of a cohort of hysterectomy developed ovarian cancer, of the ovarian cancers occurred in 61 women patients who underwent pro- patients who had germ-line mutations as- but this was not significantly different women older than 35 years, according to phylactic surgery. Of the 107 women in the cohort who had colorectal cancer, endometrial or ovar- ian cancer occurred synchronously with colorectal cancer in 3 patients and at dif- ferent times in 38 patients. In 21 of those patients, gynecologic cancer was diagnosed a median of 5 years after they ‘Preoperative were diag- nosed with and counseling underwent should address surgery for col- the trade-offs orectal cancer. The gyneco- between the logic cancer reduction in the that occurred in that sub- risk of cancer group of 21 and the risks and women “could have been pre- side effects of vented if pro- surgery.’ phylactic hys- terectomy and bilateral salpingo-oophorectomy had been performed at the time of surgery for colorectal cancer,” the investigators noted. “Preoperative counseling should ad- dress the trade-offs between the reduc- tion in the risk of cancer and the risks and side effects of surgery, as well as the un- certainties regarding surveillance of gy- necologic cancer as an alternative man- agement approach,” the researchers concluded. ■ Ovarian Cysts Watch from page 1 Hoskins’ talk. “Clearly, the ovary is still dy- namic and still changes” in post- menopausal women, and small, simple ovarian cysts should not be removed but followed every 3 months for changes. “If it’s getting bigger or if we’ve had a lot of diastolic flow on Doppler on that cyst, then we worry about it,” said Dr. Preto- rius, professor of radiology and director of imaging at the University of California, San Diego. In premenopausal women, an unsus- pected ovarian mass larger than 8 cm calls for cystectomy. If the mass is found dur- ing surgery for other indications, get the consent of the patient’s spouse or a rela- tive before cystectomy, Dr. Hoskins said. An incidental ovarian mass smaller than 8 cm in a premenopausal woman may be managed with observation unless it is sus- picious for cancer. In 2004, an estimated 25,580 women de- veloped ovarian cancer and 16,090 women died of the disease. ■.