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Recommendations for management of

Clinical practice recommendations

The recommendations are based on the statements of evidence for management of women at high risk of ovarian cancer. The level of evidence assigned to the recommendation is based on the NHMRC Evidence Intervention Hierarchy.10

Recommendations to individuals should be based on their circumstances, the absolute benefits and harms of treatment, and their personal preferences. These factors should be discussed with the woman.11


RECOMMENDATIONS

LEVEL OF EVIDENCE10 REFERENCE
For women at high/potentially high risk of ovarian cancer
For women at high risk of ovarian cancer due to a confirmed BRCA1/2 gene mutation, risk-reducing gynaecological surgery should be recommended. This should include complete removal of the extra-uterine component of both fallopian tubes as well as ovaries, and should be considered around the age of 40. III-2

Rebbeck 20093

Domchek 2010a12

For women at high risk of ovarian cancer due to confirmed Lynch Syndrome, risk-reducing surgery should be considered. This should include hysterectomy and bilateral salpingo-oophorectomy and should be considered from around the age of 35. III-2 Schmeler 200613
For other women at potentially high risk of ovarian cancer, referral to a familial cancer clinic is recommended for risk assessment, possible genetic testing and management planning (which may include risk-reducing surgery). NBOCC 20105

Information about procedures should be discussed with the patient. The patient should be adequately prepared for the procedure.

For women at high risk or potentially high risk of ovarian cancer this includes:

  • a clear description of the risk-reducing surgery technique
  • clear information about the objective of the procedure
  • discussion of management of menopausal symptoms and other long-term side-effects post risk-reducing surgery, including use of hormone replacement therapy (HRT)
  • discussion of factors influencing psychosocial wellbeing post risk-reducing surgery.
I NBCC & NCCI11
Ongoing assessment of the effects of surgical menopause is required after surgery
Risk-reducing surgery should be performed by a surgeon appropriately experienced in gynaecological surgery
All removed tissue should be embedded and examined for full pathological assessment, and cut through at no more than 3mm intervals, including the fimbrial end of the fallopian tube sectioned longitudinally
Ovarian cancer surveillance is not recommended for women at high or potentially high risk. Evidence shows that ultrasound or CA125, singly or in combination, is not effective at detecting early ovarian cancer. NBOCC7

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