A potential shift in how risk is detected and managed
Researchers at the University of Manchester have uncovered a promising new way to detect the earliest molecular warning signs of ovarian cancer – not in the ovary itself, but in fluid flushed through the fallopian tube.
The findings, published in Clinical and Translational Medicine, suggest that analysing this fluid could reveal subtle molecular changes linked to the very earliest stages of cancer development. In one striking case, signals identified through the technique prompted researchers to re-examine archived tissue, leading to the retrospective discovery of a pre-invasive, early cancerous lesion that had previously gone undetected.
Where ovarian cancer often begins
It is now widely understood that most ovarian cancers do not originate in the ovary. Instead, they begin as microscopic pre-cancerous lesions in the fallopian tube before spreading.
“This is important as it is now known most ovarian cancers don’t start in the ovary itself. Instead, they start from pre-cancer lesions which develop in the fallopian tube before spreading to the ovary and beyond,” said Dr Christine Schmidt, Senior Lecturer at The University of Manchester’s Division of Cancer Sciences.
Despite evidence suggesting a lengthy window between these early changes and advanced disease, there are currently no clinical tests that can reliably detect them without surgery.
A less invasive alternative – with fertility in mind
For women at high genetic risk of ovarian cancer – particularly the 1 in 250 in the UK who carry BRCA1 or BRCA2 mutations – preventive surgery to remove the ovaries and fallopian tubes is often the only option. While effective at reducing risk, the procedure comes at the cost of fertility and early menopause.
Although ovarian cancer remains rare among women at average risk, research shows that between half and three-quarters of high-risk women currently opt for this surgery.
The Manchester study raises the possibility of a different future: one where some women could delay or avoid surgery altogether.
Proteomics reveal early warning patterns
In an exploratory study involving 27 women who had their fallopian tubes surgically removed, researchers tested whether fluid washed through the tubes could reveal molecular patterns linked to cancer risk.
Participants were divided into groups: those with BRCA mutations or abnormal ovarian growths, and those undergoing surgery for unrelated gynaecological conditions. Samples were taken from the fimbriae – the soft, finger-like end of the tube closest to the ovary, where early lesions most often form.
Using proteomic analysis, the team detected distinct protein patterns in fluid from high-risk tubes and those associated with ovarian cancer, compared with normal samples. Some of the proteins identified overlap with biomarkers already linked to later-stage disease, while others could inform future research into cancer prevention.
A step towards changing risk management
While still at an early stage, the findings point towards a potential shift in how ovarian cancer risk could one day be monitored.
“While further exploration and validation in larger cohorts is needed, our findings point to a promising direction for less invasive ovarian cancer risk management strategies that could – in the longer term – help reduce reliance on invasive prophylactic surgeries while preserving fertility in some high-risk women,” Dr Schmidt said.
“We look forward to taking this novel approach forwards and hope that one day the findings can contribute to the development of an approach that might eventually be used in the clinic.”
