Oophorectomy
I am scheduled for oophorectomy next week. I will do this instead of the Zoladex shots which I've done for 5 months now. Has anyone had their fallopian tube or uterus removed as well? And did the insurance cover it? I went to a consultation with one surgeon and he had to be convinced even to do the ovaries. But my friend who is a nurse in gyny cancer said her doctor would at least take the tubes because of the increase risk of uterine cancer (which usually starts in the tubes)in breast patients. Input please. It kind of seems like a slippery slope issue. I'm not sure I'm interested in a more invasive surgery. Also not sure if the insurance would consider a surgery on tubes/uterus to be medically necessary.
Comments
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Jess, please put in a diagnosis. It is hard to know what advice to give unless we know your situation. I just had hysterectomy with double oopherectomy including tubes and cervix. With a bc diagnosis, insurance will usually pay the entire amount because you are at a greater risk for reproductive cancers. Depending on your age, where you are at in the phase of your life, pre vs. post menopausal, children/no children, doctors are careful to advise. My recovery period was brief and drove within a week, walked the very same day and have been walking 5 miles a day since. I was going to have to do Zoladex, and maybe be premenopausal in a couple of years. I take Tamoxifen now and have no worries of endometrial hyperplasia.
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Thank you, Michelle. It's invasive ductal carcinoma, ER positive, stage 1 breast cancer. I had a bilateral mastectomy followed by chemo. Taking an AI now.
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Jess, I think you will do just fine with the surgery. I am considering doing a bilateral mastectomy because of dense breast issues and I know my insurance would cover it this year. I am concerned about needing the surgery in a year or two and not being able to have it covered by insurance. That was also one of my reasons for having my tubes, ovaries and uterus removed. I have to say, there is less worry.
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got all of mine out last year. McKenzie at Cleveland Clinic was a magician..hurt less than a heavy period. Check off.like four other cancers to worry about and good riddance to nasty cysts from Tamoxifen. Ovaries were still healthy and churning out hormons after chemo. Wish they'd taken all of it the first time.
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Jess, I had ooph two years ago. Easy laparoscopic surgery, quick recovery. They took ovaries and tubes. Insurance covered it, minus the deductible and co-pays of course. Good luck next week!
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Hi jessillinois:
If you are not sure whether you should be receiving either bilateral oophorectomy alone or a bilateral salpingo-oophorectomy ("BSO", removes both ovaries and the Fallopian tubes), please do not hesitate to seek a second opinion from a professional with relevant expertise. A "gynecological oncologist" at a major medical center with experience doing such surgeries in patients with breast cancer or at high risk may be a good choice.
I am not sure if you understood your nurse friend correctly and/or perhaps she is confused re some link between the Fallopian tubes and uterine cancer. For the purpose of cancer risk reduction, the rationale for the removal of Fallopian tubes along with the ovaries is that certain ovarian cancers are believed to initiate in the Fallopian tubes. See for example:
George (2016): "Ovarian Cancer: The Fallopian Tube as the Site of Origin and Opportunities for Prevention"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852190/pdf/fonc-06-00108.pdf
The paper also notes that "Olivier et al. demonstrated that risk-reducing salpingo-oophorectomy reduced the risk of ovarian, fallopian tube, and peritoneal papillary serous carcinoma in BRCA1 and BRCA2 mutation carriers (some women still developed peritoneal disease)(73)."
You mentioned that you are seeking oophorectomy so that you can continue to take an aromatase inhibitor without ovarian suppression drugs. You did not mention your age, family history of cancers (e.g., breast, ovarian, epithelial ovarian, tubal or peritoneal cancers, uterine, or other cancers), or whether you have received any genetic counseling or any genetic testing results. Factors that affect cancer risk profile could influence the surgical recommendation you would receive. For example, for ovarian cancer risk reduction purposes in the appropriate case, BSO (not oophorectomy alone) would likely be the recommended procedure).
NCCN Guidelines regarding "Genetic/Familial High-Risk Assessment: Breast and Ovarian" (Version 2.2017) set forth various criteria for considering genetic risk evaluation, one of which is that an individual with a breast cancer diagnosis and early-age-onset breast cancer (defined as age ≤50 y) "[c]onsider referral to cancer genetics professional." If this applies to you and/or you have family history of various cancers, then prior to any surgery, you may wish to inquire with your medical oncologist whether you are a suitable candidate for referral to a genetic counselor. A genetic counselor would collect a personal medical and family history, conduct a genetic / familial risk assessment, and provide advice about whether genetic testing (and the scope of such testing) is recommended, and if so, discuss the pros and cons of such testing (if of interest).
BarredOwl
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Probably late to respond but I had my ovaries and tubes removed a couple of months ago but kept my uterus as it wasn't causing problems and I wanted to keep some stability in my core. I had the surgery in late December and it was a laparoscopic surgery. My insurance covered it -- when I called to check to see if it was covered, they said it was covered as long as it wasn't for "infertility treatment" -- I got a bit of a chuckle about that because I'm pretty certain having my ovaries and tubes removed would render me infertile??? I had heard that there is a good chance of cancer in the tubes as well so it was recommended to me to have them removed too.
My MO recommended that my ovaries get removed as I wasn't anywhere near menopause based on my hormone levels and she felt that Tamoxifen would not be a good fit for me based on risks of blood clots with my family history. She said I could get shots to surpress ovulation but I didn't want to mess with that for years until I went into menopause so I went ahead with the surgery. I got a referral to a GYN surgeon who was totally on board with the decision so it wasn't a hard sell for me.
Recovery wasn't as easy as I had thought since it was laparoscopic. I was surprised at the amount of pain I had. I was out of work for a full week and then went back for 3 hours/day for another week. Looking back, I really should have had another week off of work as I was in pain. I guess I thought it wouldn't hurt so much?? But after 4 weeks, the pain was pretty much gone completely and it's been fine since, except for the immediate onset of menopause plus now I started Femara about a month ago and I have some pretty frequent hot flashes!!
Good luck to you.
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Hi gailpet, i just started Tamofixen yesterday, but have now read the warnings etc, and have seen that you shouldn't take it if you have a close family history of blood clots. I'm now having a panic! My oncologist asked if I'd had any blood clots but not family, my dad died of a massive heart attack caused by a blood clot in his leg breaking free and reaching his heart, after he died, the young said he also had blood clots in his brain, that sounds like a close family history to me!! I will ring my breast care nurse once I can this morning, but seeing your post I more than a little worried, you said a family history of blood clots, are you talking lots of people, or just one person, like me? My oncologist said said that my cancer has to treated fairly aggressively as it was a grade 3.
Should I be looking at having my ovaries removed instead??
Any reassurance you can give me?
Thanks
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Hi Shaz1970 -- Sorry you are going through the worry about Tamoxifen. I would definitely share your family history to see if your oncologist still feels Tamoxifen is still your best bet. I have high blood pressure (I am 50 and have been on high blood pressure meds since I was 33) and my Dad is 75 and has been on high blood pressure meds since he was in his 30's. My grandma on my dad's side died of a brain aneurysm when she was 52 (I never met her) back in the 1960's so I believe the combo of those relatives plus my own issues made my oncologist wary of Tamoxifen for me and why she wanted to have me on AI instead. I could have done the ovary suppression shots but since my blood tests showed I wasn't near menopause yet, ovary removal was another option so I could do it and move on vs. having to go in monthly or so for shots. I had to have a bone scan to see how strong my bones were -- no issues there -- I guess Femara causes osteoporosis so she wanted to be sure I was ok on that end -- I will continue to have that monitored. None of these meds are without risks though -- I know that Femara also has a risk of increasing cardiovascular/heart issues?? So that gets me worried too.
Anyway, my suggestion is to follow up with your oncologist to make sure he/she is aware of your family history as well and talk it through with them and ask straight out about your worries.
Good luck with everything!!
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I have a very difficult situation here. I am 41 this year. I was diagnosed with breast cancer end of 2013. I was 38 then. I was very blessed to have found the cancer early. It was stage 1 (I was told), grade 2, HER2 +. Because of my age (being young) and the risks involved, I underwent chemotherapy, radiotherapy, and herceptin. I am now taking tamoxifen (2.5 years now, and was told I had to take it for 10 years), and also zalodex injection each month.
I had a vagina bleeding last year and found that I had a polyp and it was removed then. I was informed it could be because of tamoxifen. I had another bleeding this year and found another polyp. I will be removing the polyps this Thursday. Apart from that, a cyst was found on my left ovary. After seeing the gyne, I was informed that I can remove the cyst by taking off 1 ovary. One thing lead to another, I decided to have 2 ovaries removed instead as it makes sense to remove both during the key-hole-surgery. My thought is I will complete my zalodex treatment when I am 44 years old and my period may come back and my ovaries start working again as I would not reach menopause age yet.
My questions are :
- Has anyone been through the situation I have been through or similar and have decided to go ahead with removing both ovaries ? If yes, how are you coping with having both ovaries removed ? Are there very bad side effects ?
- After the removal of my ovaries, do I still take tamoxifen or do I change medication ? If I change medication, do I have to change it immediately after the removal of the ovaries or can it wait ? How is the transition period like and what is done in the process of the medicine change ? I am in a panic state here as the gyne and onko are separate and I have only realised today that the medications has to be aligned to the state of my ovaries.
- I am worried about the long term effect of the removal of my ovaries. I read it may cause much complications in the long run. Ex - heart attack, cognitive impairment, parkinson decease. I wonder if anyone here has had years of experience in the removal of their ovaries to comment on this ? Or do you have any other findings, etc on the regards ?
- Please could anyone share anything at all on the above situation, etc ?
I must be honest to say I am having cold feet as we speak as, would really appreciate hearing from anyone at all on the regards.
Thank you.
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What did you decide ? I'm currently in a similar situation, medical oncrecommended bilateral oopharectomy, I'm 48 and chemo has put me into menopause so my surgical onc doesn't think I need this ? I am concerned about losing what little estrogen I have left and the effects on my heart and bone density. What's the point of beating cancer if you drop dead of a heart attack ?
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What did you decide ? I'm currently in a similar situation, medical oncrecommended bilateral oopharectomy, I'm 48 and chemo has put me into menopause so my surgical onc doesn't think I need this ? I am concerned about losing what little estrogen I have left and the effects on my heart and bone density. What's the point of beating cancer if you drop dead of a heart attack ?
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If you test positive for BRAC 1/2 or other genetic tests, you should have an endoscopic removal of your ovaries and your Fallopian tubes to minimise your risk of ovarian cancer. Its a minimalistic procedure and can be lifesaving
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