Risk Reducing Gynaecological Surgery for Lynch Syndrome

What is Risk Reducing Surgery (RRS)?
Surgeries that are performed to remove at-risk organs prior to the development of cancer are called risk-reducing (or prophylactic) surgeries. Some people opt to undergo risk-reducing surgery in order to prevent cancer.

Why consider RRS in Lynch Syndrome?
In Lynch syndrome, the lifetime risk of womb (uterus) cancer is 40% and that of ovarian cancer is 10% so some women choose RRS to eliminate this risk. The current surveillance that includes a yearly pelvic ultrasound and a sample from the lining of the womb has not been shown to be that effective but we know that risk reducing surgery is.

What would this involve?

Total Hysterectomy
A hysterectomy refers to surgical removal of the uterus. Removing the uterus eliminates the possibility of developing uterine cancer in the future; however, it also eliminates the possibility of pregnancy. Unless contraindicated this could be done by key- hole surgery, this decreases the down time and recovery period.

Salpingo-oophorectomy
This is a surgical procedure to remove both tubes and ovaries. Once done having children, many women with Lynch syndrome choose to undergo hysterectomy and oophorectomy (removal of the uterus, ovaries, and fallopian tubes) in order to reduce their risk of cancer. This is usually done at the same time as a hysterectomy.

When is the best time to have surgery?
Cancers in the womb in women with Lynch Syndrome occur at a younger age then in the normal population with the average age of 49 years old. However, the risk of womb cancer was low at the age of 40 years old so it is women who have completed their families and older than 40 that we should focus on with RRS.

What are the risks and benefits?
Removing the womb and both tubes and ovaries was shown to significantly reduce the risk of womb cancer in women with Lynch syndrome. It also prevents any side effects that could occur with cancer treatment.

However, all surgery carries risk and the risk of the procedure is up to 5%.
In women who are premenopausal, the surgery will render them menopausal so it is very important to discuss this with your doctor and have a plan in place before surgery.

What about the Menopause?
Estrogen replacement therapy after RRS is not contraindicated in women with Lynch Syndrome, as there is no evidence that this adversely affects the incidence of other cancers.

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