1.What is the BRCA gene?
This is a gene that has a mutation that increases the risk of breast and ovarian cancer. Today, a friend in the outpatient clinic came in and said to me, "I'm just like Julie" (a Hollywood woman with this gene mutation, who has a prophylactic double breast and bilateral ovarian salpingectomy). Angelina Jolie's mother first got breast cancer, then ovarian cancer, and eventually died of ovarian cancer.
2."Anti-cancer" surgery?
Breast cancer can be detected by physical examination, including ultrasound and mammography, which can effectively detect tumors. Ovarian cancer, on the other hand, often has no symptoms in the early stages. On the other hand, because the ovaries are small, deep in the female pelvis, ovarian cancer is difficult to detect through examination. In summary, ovarian cancer, known as the "silent killer", has a very high degree of malignancy, and most of them are at an advanced stage (abdominal and pelvic metastases) when they are found. Therefore, in the NCCN guidelines (the definitive guidelines for tumors**), it is recommended that patients with BRCA mutations undergo risk-reducing bilateral ovarian salpingectomy.
3.When is surgery recommended?
NCCN guidelines state that if BRCA1 germline mutations are present, it is recommended to be 35-40 years old and have completed reproductive function;If BRCA2 germline mutations are present, the procedure can be considered at the age of 40 to 45 years. However, in clinical practice, we have encountered many patients who have been clearly diagnosed with breast cancer and have germline gene mutations, so this time should be considered individually according to the patient's situation.
4.Is the surgery difficult to do?How's the recovery?
Surgery itself is not difficult to do, the difficulty lies in the "concept", knowing how to do the operation, how to find possible lesions. On the other hand, the most difficult part of the operation is actually the pathology. Pathologists need to be very meticulous in slicing and taking materials (there are special methods) to find some possible lesions, such as the earliest p53 blot, tubal intraepithelial neoplasia (STIL), tubal intraepithelial carcinoma (STIC), and even very, very early cancer.
Minimally invasive laparoscopic surgery is generally used, and if there is a problem with the intraoperative exploration, such as cancer has developed, then it will be converted to laparotomy. Most of my friends are laparoscopic surgeries, and the recovery after surgery is very fast, and they are basically discharged from the hospital in 1-2 days.
5.What will happen to the pathology if it is surgically removed?
Pathologies can be: no problem, p53 blotting, tubal intraepithelial neoplasia (STIL), tubal intraepithelial carcinoma (STIC), and even very, very early stage cancer. At the end, I will share with you a few cases.
6.After surgical removal, do you have peace of mind?
Dear friends, I need to remind you that surgical resection does reduce the risk of ovarian cancer and fallopian tube cancer (the meaning of the name of the operation), but it still needs long-term follow-up and vigilance for primary peritoneal cancer (peritoneal cancer is rare, ** the same as ovarian cancer).
Finally, I would like to share with you a few of our best patients:
Case 1: 50 years old, 202011 Preventive surgery is performed in our hospital.
In 2013, he underwent surgery for double breast cancer in our hospital.
Genetic testing: BRCA2 germline gene mutation.
Family history: maternal history of breast cancer.
Pathology: p53 blotting.
Case 2: 50 years old, 202002Preventive surgery was performed at our hospital.
Genetic testing: BRip1 germline gene mutation.
Family history: sister ovarian cancer (currently olaparib**).
Pathology: P53-positive tubal intraepithelial neoplasia (STIL).
Case 3: 34 years old, 202101 Preventive surgery is performed at our hospital.
2021.01 Surgery for right breast cancer at the same time.
Genetic test: negative 3 times in the hospital.
Family history: maternal ovarian and breast cancers;Uncle pancreatic cancer.
Pathology: extensive p53 blotting and tubal intraepithelial neoplasia (STIL), focal tubal intraepithelial carcinoma (STIC).
Case 4: 49 years old, 202206 Preventive surgery is performed at our hospital.
2021.11 Breast cancer surgery (after neoadjuvant chemotherapy) was performed in our hospital
Genetic testing: BRCA1 germline gene mutation.
Family history: Denial.
Pathology: high-grade serous carcinoma of the ovary stage IA1.
Case 5: 40-year-old BRCA1 germline gene mutation.
2020.09Breast-conserving surgery for right breast cancer in our hospital.
Antecedent: 5 years after the discovery of the ovarian cyst (endometriosis cyst considered in the outer hospital, 2-3 cm).
Family history: Auntie had breast and ovarian cancer.
Last postoperative chemotherapy: 202012.31
Last postoperative radiotherapy: 202104.13
Genetic Counseling Clinic: 202103.15
2021.04.16 blood ca125 128 u ml
2021.04.26 I operate.
Pathology: high-grade serous carcinoma of the ovary stage IIB.
Case 6: 44-year-old BRCA1 germline gene mutation.
2018.09 Left breast cancer surgery in our hospital.
Antecedent: Nothing special.
Family history: maternal ovarian cancer.
2021.01-2021.08 Tumor markers CA153 and CA724 continued to increase.
2021.07-2021.08 Tumor marker CA125 continued to increase (2021.)09 CA125 12400
2021.04.25 PET-CT examination in our hospital showed that after chemotherapy for left breast cancer after surgery, there was no abnormal increase in radioactive uptake in the surgical area. The local density of the sacrum is slightly higher, the FDG metabolism is increased, and the FDG metabolism of the remaining bone heterogeneity is increased. 2021.05.08The results of ECT examination in our hospital showed that the lower lumbar spine and sacrum were unevenly distributed, please combine it with other imaging examinations.
Pathology: high-grade serous carcinoma of the ovary stage IIIC.