Fibroid, ovarian cyst caused by Tamoxifan?

Hy cherryblossom.

My mum is 48 years old and she was diagnosed with breast cancer in 2008 (lumpectomy ER+ / PR+ / HER2-). She has been on Tamoxifen since September. The check-up abdominal ultrasound examination showed something in her right ovary. (This was at the end of September, one month after the beginning of the treatment). The oncolgyst was worried about the cyst, so my mum had an MR examhination in November and the diagnosis was "atypical ovarian cyst, it is needed to be monitored", because it had both fluid and semi-solid part.  (The cyst was thought to be cancerous, because of the semi-solid part). Her surgery was two weeks ago, both of her ovaries and fallopian tubes were taken out laparoscopically. Eventually, the cyst turned out to be a dermoid cyst, which is benign. So I think Tamoxifen can cause such things.

One of the side effects of Tamoxifen is abnormal cell growth in the uterus, which can include both benign and malignant growth.  While it would be extremely uncommon for this to be uterine cancer, it is worth checking out.  I had similar symptoms to what you describe.  I'm 31 and have been on Tamoxifen for about three years now.  My OB/GYN did a pelvic ultrasound to see what was going on.  I did have both an ovarian cyst and fibroids in my uterus.  The ovarian cyst seemed to come and go over my cycle, so we left it alone.  I ultimately had a D&C to remove the uterine fibroids.  Everything was benign and my cycle is pretty much regular now and no spotting in between.  Like I said, I would certainly have this looked into.  I consulted both my oncologist and OB/GYN to make sure I had both of their expertise.  I'm not quite sure what you mean by "go on a menopause," but there may be some other options to consider.

cherryblossom

 I was googling in the afternon searching for articles which deal with the side effects of Tamoxifen. And yes it can cause ovarian cysts and what is more that if you are before menopause, the risk of developing ovarian cysts is higher. I've also read that it can cause complex cysts which have both a fluid and a solid / semi-solid tissue part, but it's worth taking them out (in my opinion and my mum's oncolgyst said to my mum that only biopsy is sure. And she was right actually, because my mum's cyst wasn't an atypical cyst which can be cancerous or it can turn to be cancerous, it was a dermoid cyst and the transvaginal ultrasound was wrong, and even my mum's experienced gyncologist couldn't decide what kind of cyst it was), because on the one hand it won't cause any problems in the future and on the other hand you make sure.

Have you been tested for BRCA gene mutation and CA-125 tumor marker? These factors must be taken into consideration.

hmmmm... 

http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen 

"Although tamoxifen acts against the effects of estrogen in breast tissue, it acts like estrogen in other tissue. This means that women who take tamoxifen may derive many of the beneficial effects of menopausal estrogen replacement therapy, such as a decreased risk of osteoporosis."

Here's my history, and why I am interested in this topic: 

1979: multiple bilateral dermoid ovarian cysts (about 6lbs total) removed during emergency exploratory surgery the day after my 17th birthday.

2004: exploratory surgery, Dr. removed pedunculated fibroids (exterior to the uterus, growing on "stalks")

2006: apparently ran out of eggs, "natural" menopause at age 44.

2009: age 47 Dx with intial stage 4 pleomorphic lobular bc. Very aggressive, mets to the liver (confirmed by biopsy) and now mets to abdominal lymph nodes.

Statistically speaking, all of the above are pretty far from normal, especially the first (dermoid cysts that are bilateral, at a young age, and of such size.)

I've long suspected a causal link between environmental estrogen exposure (combined with genetic factors) and every other gyn problem I have had, including the bc. Read years ago that many chemicals used on farm fields are estrogenic in nature, and that when present in combination their effects increase exponentially. I grew up right next to farm fields. As a child and teenager I played in the rainwater runoff from the fields, breathed and lived with the blowing dirt and dust from the farmers working the fields and swam in a lake fed by streams and rivers that receive runoff from farm fields- the same lake used for the public water supply.

So... in addition to this thread, I find this very interesting as well (dermoid cysts fall in this category):

Topic: atypical ovarian cysts after bc treatment

http://community.breastcancer.org/forum/105/topic/732226?page=1

I also had difficult periods, and was told my ovaries were trying to ovulate but could not due to the cysts, so the lack of periods can be due to that.

Two problems with dermoid cysts are that they may cause ovarian torsion (twisting) and omg, that hurts like very few things do... I literally fell to the floor and curled up in a fetal position. And, as mentioned above, can also rupture, which I think may have happened with me- intense abdominal pain, vomiting, very high fever.  My appendix was removed during the surgery in 1979, as symptom of appendicitis can be similar.  They also initially thought I was pregnant, but this was back when x-rays were the only option.

Sorry to hear you are all going through this,

Lynne 

(btw, premature menopause sucks big time... it's not something I would consider lightly.)