Yes, one can develop ovarian cancer after a hysterectomy, but the risk depends entirely on the extent of the surgery. A hysterectomy is the removal of the uterus and does not always include the ovaries or fallopian tubes. When the ovaries remain, the risk of developing ovarian cancer persists, remaining at the pre-surgery baseline. The degree of risk reduction is directly related to which organs were removed.
Defining the Types of Hysterectomy
A hysterectomy is the surgical removal of the uterus. A total hysterectomy removes the uterus and the cervix, while a partial hysterectomy removes only the main body of the uterus, leaving the cervix intact. Neither procedure involves removing the ovaries or fallopian tubes.
To reduce cancer risk, a hysterectomy is often combined with other procedures. An oophorectomy removes one or both ovaries, and a salpingectomy removes one or both fallopian tubes. The most comprehensive procedure is a total hysterectomy with bilateral salpingo-oophorectomy (BSO), which removes the uterus, cervix, fallopian tubes, and ovaries.
The decision to remove the ovaries and fallopian tubes alongside the uterus is based on a patient’s age, cancer risk factors, and the condition being treated. Knowing precisely which organs were removed is fundamental to assessing any remaining cancer risk.
Ovarian Cancer Risk When Ovaries Are Left In Place
When a hysterectomy is performed without removing the ovaries, the lifetime risk of developing ovarian cancer is unchanged. The ovaries continue to function, producing hormones until natural menopause, which is a common reason for retaining them, particularly in younger women. The cancer risk remains because the organs themselves, the site of origin for ovarian cancer, are still present.
The ovaries are still exposed to the same environmental and genetic risk factors as before the surgery, even though the uterus is gone. Research suggests that a large proportion of the most common type, high-grade serous carcinoma, may begin in the fallopian tubes. Therefore, removing the uterus alone does not address this primary source of cancer risk.
A hysterectomy alone may reduce the chance of ovarian cancer by about one-third, though the exact mechanism is not fully understood. The most significant risk reduction is achieved when the fallopian tubes are also removed, even if the ovaries are retained. This procedure is known as opportunistic salpingectomy.
Residual Cancer Risk After Ovaries Are Removed
Even after a bilateral salpingo-oophorectomy (BSO), which removes the ovaries, fallopian tubes, and uterus, a small but quantifiable cancer risk remains. This residual risk is primarily due to Primary Peritoneal Carcinoma (PPC). PPC is a rare cancer that is microscopically and clinically almost identical to the most common type of ovarian cancer.
PPC arises from the peritoneum, the thin tissue lining the abdominal cavity. The cells of the peritoneum, ovaries, and fallopian tubes derive from the same embryonic tissue. This means peritoneal cells can undergo the same malignant changes that cause ovarian cancer. For women who have undergone a BSO, the risk of developing PPC is estimated to be around 1.7 cases per 100,000 person-years.
The fallopian tubes are recognized as the likely origin for many high-grade serous cancers, previously classified as ovarian cancer. Complete removal of the fallopian tubes during a BSO is essential for maximum risk reduction. For women with inherited high-risk mutations, such as BRCA1 or BRCA2, the risk of PPC persists even after BSO.
Proactive Steps for Risk Management
The primary step for managing risk is obtaining and understanding detailed surgical records. Knowing exactly whether a salpingectomy (fallopian tube removal) or oophorectomy (ovary removal) was performed is paramount to accurately assessing future cancer risk. Patients who had a hysterectomy but retained their ovaries require the same ongoing monitoring as the general population.
For women at average risk undergoing a hysterectomy for benign conditions, surgeons often perform an opportunistic salpingectomy. This involves removing the fallopian tubes while leaving the ovaries intact. This procedure significantly reduces the risk of high-grade serous carcinoma, thought to originate in the tubes, without triggering surgical menopause. This approach is not recommended for women with a high genetic risk, who still require BSO for maximum risk reduction.
Genetic counseling and testing are important for those with a strong family history of breast, ovarian, or related cancers. Identifying mutations like BRCA1/2 can lead to personalized risk-reducing strategies, including timely prophylactic surgery. Consulting with a gynecologic oncologist or a women’s health specialist provides current advice based on individual surgical history and genetic profile.