Hysterectomy after Breast Cancer?

kmglcg

I was diagnosed with invasive breast cancer in February '04. I Had surgeries, chemo and radiation therapy throughout most of the year last year. Chemo stopped my periods around June and put me in a "temporary" menopause. But, as luck would have it, wouldn't you know, last month, my period resumed. Now - my common sense tells me that, post breast cancer, at age 42, my uterus and ovaries are not providing me any benefit. My cancer was estrogen receptor positive. As I am taking tamoxifen, which increases the risk for certain cancers, I think I may benefit from a total hysterectomy, in that it will eliminate the possibility of those other cancers as well as eliminate the production of estrogen which seems to be a detrimental factor in the risk for recurrence of breast cancer. Now - I have had this discussion with my oncologist who believes it is neither necessary nor critical to treatment. - He just wants to see how my body progresses toward menopause while taking tamoxifen. - My Gynocologist, on the other hand, fully recommends a hysterectomy for all these reasons. Has anyone been faced with this dilemma? If so, what factors influenced your decision to have a hysterectomy or not?

hummingbyrd

Had a hys 4 years ago. Onc said no need, OB-GYN said sure go for it.
Deciding factors: get rid of as much estrogen as possible, don't have to worry about uterine or ovarian cancer now, no more periods, off of tamoxifen and onto aromatase inhibitor because they work better anyway, but can only be used post-menopausal. I think that was it as far as reasons go, good luck on your decision.
hummingbyrd

krisrey

Hi,
I posted something similar a while back. MY dx was 4/2003 and did 8 rounds of chemo, 38 rads and now tamox. My dx was invasive Ductal and chemo put me in menopause too. At the time I was 42 and had no period for 15 months. My oncol talked about keeping on tamox for 2 years and then switching me over. Like you, as luck would have it, my period decided to come back. I had it every 21 days like clock work for three months. Now, this month I am still waiting for it to come its been almost 6 weeks. So, now I walk around afraid that it may come at any second. My GYN did pelvic ultrasound and it showed ovarian cysts, which did go away. But I can tell they keep coming back. She also ran a few different times a CA-125 which came back normal. I do NOT want to go on the Lupron injection to shut off my ovaries so I can go on the newer drugs.
So if my ovaries persist on getting cysts (sometimes it kind of painful) then I am all for removing them and my uterus! Therefore alowing me to go onto the newer better drugs and eliminating those other cancers.
Now, some here will tell you NOT to have any surgery unless medically necessary, but my GYN didn't seem to really have a problem doing the surgery either. I have an oncol appt in Feb and my 6 month GYN in Feb which I am sure she will run another one of the blood test that shows your homone levels. The last time she did it was right before I ended up starting my period and it came back that I was pre-menopausal. She was very surprised after me not having a period for 15 months.
Good luck and keep me posted on your decision as it seems we are in the same boat!
Kris

epgnyc

You might want to consider just having a bi-lateral oopherectomy (only the ovaries removed) rather than the full hysterectomy. I had both ovaries removed when tests showed they had developed tumors (there was also a history of ovarian cancer in my immediate family). Strangely enough I was having the second opinion on the ovarian surgery when my breast tumor was found - I ended up having the lumpectomy and ovarian surgery within 3 weeks of one another. The gyn oncologist recommended that I not do the full hysterectomy (he was of the "why fix it if it ain't broke" school of thought). The surgery is done via laparoscopy and so is much less invasive and has a much, much shorter recovery time. It stops all the estrogen production too. I'm very happy with the result. Just another option. Good luck with your decision.

krisrey

epgnyc said:

You might want to consider just having a bi-lateral oopherectomy (only the ovaries removed) rather than the full hysterectomy. I had both ovaries removed when tests showed they had developed tumors (there was also a history of ovarian cancer in my immediate family). Strangely enough I was having the second opinion on the ovarian surgery when my breast tumor was found - I ended up having the lumpectomy and ovarian surgery within 3 weeks of one another. The gyn oncologist recommended that I not do the full hysterectomy (he was of the "why fix it if it ain't broke" school of thought). The surgery is done via laparoscopy and so is much less invasive and has a much, much shorter recovery time. It stops all the estrogen production too. I'm very happy with the result. Just another option. Good luck with your decision.

Thanks for the info. May I ask how old you are and what type of menapausal symptons you had after they removed your ovaries? I would have my uterus out too, I don't need it anymore and with the tamox we have an increased rist of uterine cancer. What type of tumors where on your ovaries?
Kristen

tlmac

Hi Kristen, My situation is a little different than yours. I was 53 when diagnosed in Jan. 2003 and had already stopped having periods as of Aug. 2000. My gynecologist watched me very closely following treatment and ordered tests, like transvaginal sonogram, which I'd never had before. It showed I had a condition called nonhomogenous hyperplasia which simply means my uterine wall was thickening irregularly and they didn't know why. Gynecologist nixed a D&C as a waste of time if biopsy came back positive for cancer. Her thinking was why wait till there's a serious problem if we could prevent it in advance. Oncologist didn't see a need for the hysterectomy but then, I never considered that in making my decision. I had a total hysterectomy in June 2004 and have never felt anything but relief. I've had 3 friends, all stage IV now, recurr while on tamoxifen and I would have never felt safe on it, though it was the "gold standard" at the time of my diagnosis and presented to me as the drug of choice for my ER+ cancer. I insisted on Arimidex and am reassurred, every time a new medical report comes out about the superiority of aromatase inhibitors, that I made the right decision. Though there's no guarantees, I feel much safer having taken the steps I did. Best of luck with your decision.
terri

SusanAnne

Hi. My situation is similar to Kris's. Went on Tamoxifen after chemo but after 13 months with no period and FSH levels showing I was in menopause, I convinced onc. to switch me to Arimidex. 2 months after the switch my period came back. Had 2 regular periods, skipped a month, had 2 in the next month and so far nothing in January. I have an appt. with GYN on Valentines day at which time I hope to set up a date for oophorectomy. I also have an ovarian cyst we've been watching and family history of ovarian cancer. I, too, refuse to take the Lupron shots to shut things down. Enough chemicals have been introduced into my body already. I'm not worried about the uterus staying, I was only on tamoxifen for 8 months. My oncologist isn't really recommending this (I'm ER-, PR+) but my GYN is behind me. Let us know what you decide.
Susan

rutaf

A friend of mine, lumpectomy and no treatment other than on tamoxifen now, just had her uterus drop out of her. She has an appt next week to see what they are going to do. She's wondering if this has anything to do with her cancer diagnosis. I'm also a bc survivor with a mastectomy, six months of chemo, and tamoxifen. I hate to complain of what seems little compared to what it could be: body swelling, ear ringing, weight gain... Any thoughts? Thanks,

epgnyc

krisrey said:

Thanks for the info. May I ask how old you are and what type of menapausal symptons you had after they removed your ovaries? I would have my uterus out too, I don't need it anymore and with the tamox we have an increased rist of uterine cancer. What type of tumors where on your ovaries?
Kristen

My situation at diagnosis was a little different - I was 53 years old and already in menopause. I had 1 1/2 years of hot flashes when I first went into menopause at age 50, which finally abated prior to my breast cancer and ovarian surgeries. I didn't have any recurrence of menopausal symptoms after the oopherectomy. Good luck.

Sandis

I had genetic testing after my diagnosis of breast cancer. I have the BRCA1 gene and my mom died of ovarian cancer, so I had a total hysterectomy 1 year after the bilateral mastectomy and reconstruction. I was 54 when I had the hysterectomy. The chemotherapy put me into menopause. I am delighted not to have to worry (as much) about ovarian cancer.

Hope15

So thankful you are done with treatment. No cancer is the same but my situation is very similar. I too had invasive, estrogen receptive, I had a dbl. mastectomy, chemo and radiation. I was 47 when diagnosed and still having periods every 28 days. Chemo put me into menopause. I only had my ovaries out after looking at the risks of uterine cancer. I am on Femara and I know Tamoxifen is different. You can be on Femara if you are post menopausal and that is the way my surgeon/oncologist wanted to go. I wanted to get rid of all sources of estrogen (our ovaries being the biggest one)...I am also trying to lose weight as estrogen is stored there. Good luck with your decision - the surgery was relatively minor, considering all we've been through. They did it with 3 small openings through my belly button and lower abdomen...recovery was minimal. God Bless!

hummingbyrd

rutaf said:

A friend of mine, lumpectomy and no treatment other than on tamoxifen now, just had her uterus drop out of her. She has an appt next week to see what they are going to do. She's wondering if this has anything to do with her cancer diagnosis. I'm also a bc survivor with a mastectomy, six months of chemo, and tamoxifen. I hate to complain of what seems little compared to what it could be: body swelling, ear ringing, weight gain... Any thoughts? Thanks,

Probably has what is known as a prolapsed uterus and is usually due to hard labor (lots of pushing), big babies (over 9#'s) or multiple births (3-4 or more). What does her doctor say?
hummingbyrd