Hysterectomy is not enough.

The Association between hysterectomy and ovarian cancer risk: A population-based record-linkage study

https://doi.org/10.1093/jnci/djz015

It is a long-held belief that hysterectomy without oophorectomy protects against ovarian cancer. This study follows the female adult Western Australian population (n= 837,942) across a 27-year period.

Hysterectomy without oophorectomy (n = 78,594) was not associated with any change in risk of ovarian cancer .

For women with endometriosis (5.8%) or with fibroids (5.7%), hysterectomy was associated with substantially decreased ovarian cancer risk.

In the absence of endometriosis or fibroids, having a hysterectomy is not likely to substantially alter the risk of developing ovarian cancer.

“Precursor Escape”: - What?

The fallopian tube, “precursor escape” and narrowing the knowledge gap to the origins of high-grade serous carcinoma

https://www.sciencedirect.com/science/article/pii/S0090825818314537

If the fallopian tubes are the origin of most high-grade serous carcinomas (HGSC), why do only 30 to 40 percent of women with advanced HGSC have cancer in the fallopian tube?

HGSC is the most common histological type of ovarian cancer. Serous tubal intraepithelial carcinomas (STIC) and premalignant, early serous proliferation (ESP) are recognised as precursor lesions of HGSC. While ESPs are relatively common in the general population, most women who have them never develop ovarian cancer.

Identical somatic mutations of TP53 (a tumour suppressor gene) in HGSC, STIC and ESP lesions suggest genetic mutation as a cause. HGSC may develop due to “precursor escape,” whereby TP53-mutated tubal epithelial cells from STIC or ESP escape from the fallopian tube, as a precursor of HGSC.

This pathway to HGSC show the challenge faced in preventing or intercepting HGSCs at a curable stage.  It also supports opportunistic salpingectomy in all women, especially high-risk women.

Unconventional drug use may prolong survival in ovarian cancer

https://doi.org/10.1073/pnas.1018892108

Records of hypertensive patients who received standard treatment for ovarian cancer at Mass General show that those taking losartan* at the time of diagnosis lived an average of 30 months longer than those taking other hypertension drugs.

Losartan, which targets the angiotensin-signaling pathway, might improve the effectiveness of chemotherapy agents used to treat ovarian cancer.

Animal studies show reduced extracellular matrix collagen content in ovarian tumours, increasing blood supply, oxygen levels and drug delivery.

It is predicted that adding losartan as an adjunct to cancer therapy, could improve outcomes, improving survival for cancer patients.

*Losartan (Cozavan) the first generic angiotensin II-receptor antagonist in Australia was listed on the Pharmaceutical Benefits Scheme on 1 December 2011 

Talking to women with cancer; what to say and what not

“A survivor’s guide to speaking with cancer patients

http://www.philly.com/philly/health/a-survivors-guide-to-speaking-with-cancer-patients-20181206.html

One year ago, I was a healthy 32-year-old woman. Then, with a flurry of medical tests, I became an ovarian cancer patient. It is hard to know what to say to someone in a life-or-death struggle. So here is a simple guide from a cancer survivor who has heard it all:

Whether the patient chooses modern medicine, a holistic approach, or a combination of the two, he or she did not arrive at the decision lightly. Don’t say you know better.

I knew I didn't look my best. So does everyone who is having cancer treatment. We don't need to be reminded.

It is not consoling to be told that your disease is improving your life. If the patient is finding any positives, wait for them to tell you about it.

I found advice about stress relief very useful; when it came from people who didn't try to equate their stress with mine, but just offered specific ideas.

Compliments are little flashes of bright light in a dark time.

Look for helpful actions when words fail. The worst thing you can do when a friend is suffering is nothing at all”.