Should Ovaries Be Removed in Early Cervical Cancer Cases?

Cervical carcinoma in situ, total hysterectomy; ovaries not removed?

Hello Doctor: Last time I inquired about "cervical carcinoma in situ, and the ovaries are fine, is there a need for removal?" The response I received was: "At 65 years old, with ovarian function ceased, whether to remove is your decision." After considering for a few days (and researching historical functions), I am inclined not to proceed with removal.
I would like to ask if regular postoperative follow-ups and annual Pap smears can detect any issues with the ovaries? If they cannot detect issues, is removal necessary (I have heard that it may not be detectable, but in the Q&A section, some did not have removal, so I think this issue might not exist, but as a non-professional, I wanted to ask)? Are there any other disadvantages to not removing the ovaries? Thank you for your previous response.
Wishing you all the best.

Xiao Wu, 40~49 year old female. Ask Date: 2021/04/20

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, generally it is unlikely to detect any issues, but for cervical carcinoma in situ, the ovaries may not be covered by health insurance.
It depends on how you discuss this with your physician.
Wishing you good health.

Reply Date: 2021/04/20

More Info

When considering whether to remove the ovaries in cases of early cervical cancer, particularly in the context of a patient who is 65 years old and has a history of cervical intraepithelial neoplasia (CIN), there are several factors to weigh. The decision to remove the ovaries (oophorectomy) is not straightforward and should be based on a comprehensive evaluation of the patient's overall health, cancer stage, and personal preferences.

Firstly, it is important to understand that the ovaries produce hormones that play a crucial role in various bodily functions, including maintaining bone density, regulating mood, and supporting cardiovascular health. At the age of 65, many women are postmenopausal, meaning that their ovaries have significantly reduced hormone production. In such cases, the immediate necessity of keeping the ovaries may be less critical, but it is not without its implications.

In the context of early cervical cancer, particularly in cases of in situ cancer, the primary concern is to ensure that the cancer does not progress. If the cancer is confined to the cervix and there is no evidence of spread, the focus is often on monitoring and treating the cervical area. Regular Pap smears and follow-up examinations are essential for detecting any changes or progression of the disease.
Regarding your question about the ability to detect ovarian issues post-surgery, it is true that some ovarian conditions may not be easily detectable through routine screenings. However, if the ovaries are left intact, any abnormalities that arise can potentially be monitored through imaging studies (like ultrasounds) and blood tests (such as CA-125 levels, which can indicate ovarian cancer). It is important to maintain open communication with your healthcare provider about any symptoms or concerns that may arise.

If the ovaries are not removed, there are potential drawbacks to consider. For instance, there is a risk of developing ovarian cancer in the future, although this risk is relatively low in women who have had a history of cervical cancer. Additionally, if the ovaries are left in place, the patient may continue to experience hormonal fluctuations, which could lead to symptoms such as mood swings, hot flashes, or other menopausal symptoms, depending on individual health factors.

Ultimately, the decision to remove the ovaries should involve a thorough discussion with your healthcare provider, weighing the risks and benefits based on your specific medical history and preferences. If you choose to keep the ovaries, it is crucial to adhere to a regular follow-up schedule to monitor both cervical and ovarian health.

In conclusion, while the removal of the ovaries may not be necessary in all cases of early cervical cancer, it is essential to consider the individual patient's circumstances. Regular monitoring and open communication with healthcare providers are key components in managing health post-cancer treatment. Always feel empowered to ask questions and seek second opinions if you feel uncertain about the recommendations provided.

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