Can you get ovarian cancer without fallopian tubes? The short answer is yes, but the risk is significantly lower once the fallopian tubes are removed. Ovarian cancer is a group of cancers arising in the ovaries, fallopian tubes, and the abdominal lining. Understanding why the risk is lowered, but not eliminated, requires looking at recent scientific discoveries about where the most common form of the disease starts. This new understanding has fundamentally changed prevention strategies, leading to a major shift in surgical recommendations for women seeking to reduce their lifetime risk.
The New Understanding of Ovarian Cancer Origin
For decades, medical professionals believed that the most aggressive and common form of the disease, High-Grade Serous Carcinoma (HGSC), began on the surface of the ovary. This view shifted when researchers noted that HGSC cells more closely resembled the cells lining the fallopian tube than those of the ovary. HGSC accounts for approximately 70% of all ovarian cancer cases. Scientists now recognize that the majority of HGSC cases originate in the fimbriae, the delicate, finger-like ends of the fallopian tubes that hang near the ovary.
The earliest identifiable precursor to HGSC is a microscopic lesion called Serous Tubal Intraepithelial Carcinoma (STIC). Studies have shown that these STIC lesions, which harbor initial genetic changes, develop in the fallopian tube epithelium. These cancerous cells are thought to detach from the tube and implant on the ovary or the abdominal lining. This process provides a window of approximately seven years between the initial development of a STIC lesion and the formation of a tumor.
Impact of Fallopian Tube Removal on Risk
The discovery of the fallopian tube origin for HGSC led directly to recommending salpingectomy as a risk-reduction strategy. A salpingectomy involves the complete surgical removal of the fallopian tube, unlike a tubal ligation where the tubes are merely cut, tied, or blocked for sterilization. A bilateral salpingectomy (BS) is the removal of both tubes. This procedure removes the tissue where the majority of high-risk lesions begin.
For women at average risk, removing the fallopian tubes during a hysterectomy or for sterilization provides a substantial protective effect against ovarian cancer. Studies show that a bilateral salpingectomy reduces the risk of developing ovarian cancer by a significant margin, with estimates ranging from 42% to 77% in the general population. The risk reduction for the most aggressive serous and peritoneal cancers may be even higher, nearing an 80% decrease. This protective effect is greater than traditional tubal ligation, which is associated with a more modest risk reduction of about 30%.
The procedure is increasingly offered as an opportunistic salpingectomy. This means the tubes are removed during a separate, planned pelvic surgery for a benign condition. This approach leverages an existing surgery to remove the tissue of origin for HGSC, effectively lowering the population-wide risk of the most lethal gynecological cancer. By removing the tubes, the primary site for the initiation of HGSC is eliminated, which dramatically reduces a person’s risk.
Remaining Cancer Risk
Despite the significant protection offered by a salpingectomy, the risk of developing cancer is not completely eliminated. This is due to two primary factors: other cancer types and the remaining tissue. The most important residual risk is Primary Peritoneal Carcinoma (PPC), a rare cancer biologically and genetically almost identical to HGSC. PPC arises from the peritoneum, the thin membrane that lines the abdominal cavity and covers the pelvic organs, which remains after the fallopian tubes are removed.
Since PPC cells behave like HGSC cells and can arise directly from the peritoneal lining, removing the fallopian tubes does not eliminate this pathway, though the risk remains very low. This remaining risk is a concern for women who carry a genetic mutation, such as BRCA1 or BRCA2, which significantly increases their lifetime risk of developing pelvic cancers. For these high-risk individuals, the risk of PPC persists even after the removal of the fallopian tubes and ovaries, estimated at 3% to 4% over twenty years.
Not all ovarian cancers are of the serous, fallopian tube-origin type. Less common subtypes, such as mucinous, clear cell, and endometrioid carcinomas, are not as strongly linked to the fallopian tube origin. These may still develop from the ovarian tissue itself or nearby structures. For example, clear cell and endometrioid ovarian cancer are sometimes associated with endometriosis, and the risk for these subtypes is not profoundly reduced by salpingectomy alone. While salpingectomy removes the origin of the most common and aggressive ovarian cancer, a small possibility of developing a different subtype from the ovary or PPC from the peritoneum remains.