Cholecystectomy and Oophrectomy at the same time???

[bejuce]

Hi everyone,

As if getting breast cancer is not enough, I spend Sunday morning at the ER with what turned out to be a couple of gallstones. I'm now scheduled to have my gallbladder removed (cholecystectomy) laparoscopically on Thursday.

I had a consultation with the surgeon on Tuesday and he raised the possibility of performing an oophrectomy at the same time. He said he'd consult with my oncologist over the school winter break this past week and yesterday he left me a voice mail saying that she had agreed that it may be a good idea.

Now, I had discussed having an ooph with her before, and she told me that for my age range (I'm 39) it's still controversial whether having an ooph may help to keep the cancer at bay, especially in light of all the side effects in becoming menopausal 10 years earlier. I'm somewhat weakly ER+ (30%) and an intermediate metabolizer of Tamoxifen (per the CYP2D6 test) and I'm doing just fine on it (started taking Tamoxifen during rads in October).

So can anyone please help me with my decision, making a case for or against an ooph and backing it up with some data/references? And for those of you who've had one, can you please let me know how you felt after the surgery and how you're feeling now?

Thank you so much!!!

Marcia

[Cannon]

Hi Marcia,

I've had both surgeries - but I had the ooph at the same time as the bilater mast, and the gallstones about 1.5 years later. Having had major abdominal surgery due to my Crohn's, I found the laparospcopic surgeries to be a breeze.

I insisted on having the ooph at time of bilat mast (I was 42). I don't know what % positive ER I am, but I do know that I wanted to do EVERYTHING I could to improve my chances of survival. I wanted the ovaries out and the ability to take AIs. I don't have a study to cite, but do remember having read that AIs were more effective than Tamoxifen for Her2, ER+.

Menopausal symptoms do suck -- but for me it was totally worth it for piece of mind that I did what I could.

Rebecca

[ammebarb]

Hi Marcia. I can't help with the oophrectomy decision, but I can say that my husband had the laproscopic cholesystectomy a few years ago and did beautifully. I had mine done the old fashioned way 38 years ago and it was a nasty surgery then....but way, way different now. He was home the same day and recovered with no particular difficulty. Wishing you wisdom in your decision making, and an easy surgery with a quick recovery. We were both so ready to be without gall stone pain!

Barb A.

[ElaineM]

I can't help you with your decision, but I want to send you get well wishes whatever you decide. Take good care of yourself.

[Shobha]

Hi Marcia,

In my case, since I am weakly ER+ (5% to 10%), my Onc and my OB. told me not to get ooph. They told me that side effects, especially, related to cognizance were not worth it. If I were strongly ER+, they would have considered it.

But, I often get cysts on my ovaries and so, every 3 months, I have an pelvic ultra sound. So far, most were simply cysts, some were a little complex, but they always disappear within the 3 month period.

Evista is my other tool against the hormone and to build the bones.

Wishing you the best!

hugs,
shobha

[suzan w]

Would the BRCA tests help with this decision??

[Karen Wheel]

Marcia -

Wow - bummer. I just saw this thread... sorry a few days late.

I'm 45 and pre-menopausal and haven't done any hormone therapy as I haven't found anything that is convincing enough that it actually helps with Her2....

I actually talked to my Oncologist (remember I live in Italy with free health care!) to see if they could take out my overies as they keep saying they want me to use 'condoms' for birth control as you know we can't get pg for 3 years after chemo --- and well, in 3 years I'll be 48 and not going to start trying to get pregers at 48! So, I figured I didn't need the girls and to have them out - she said I should just hang tight and not do anything. HUMMMM...

I too am very worried about going into menopause early - especially if I would do the hormone therapy as it chemically puts you there....

So.... well, I'm sure that my comments here didn't help you at all!? :-) Sorry! But its all a bunch of "if"s I think.... I will be following this closely to see what the docs and your research tells you.

If you have anything good (positive) on Her2 and hormone therapy - please share it.

Hang in there (FORZA! as they say in Italian - have strength!) and I'm sending you great positive energy!

Karen

[bejuce]

Thank you everyone for your advice and support! I decided against the oomph as I didn't want to make a rushed decision before researching the issue at length. So on Thursday I just had the gallbladder removed and the surgery was a success. The surgeon also looked around while he was in there with the video camera and told me my liver is perfect, which I was very glad to hear.

I'm feeling better everyday, but I still have a little bit of discomfort in my back (?!) and my belly button. It is quite amazing actually that they can take a body part with tiny incisions...

As for the genetic test, I have one of those variants of unknown significance that favors polymorphism, so who knows what it really means...

Hope you'll all have a great week!!!

Marcia

[Jackie07]

Marcia,

Glad your surgery is over and everything looked good. Sounded like you are recovering quite well.

I was also only 5% ER+, according to my oncologist. (He did not even think that I needed Tamoxifen - he only prescribed it after I had called his office asking why all the other doctors I'd seen after my surgery were asking me about taking Tamoxifen. So I did not start Tamoxifen until almost a full year after my lumpectomy.) Then during my recurrence he let me continued my Tamoxifen (when chemo was completed) without telling me that my recurrence was ER-) I'm mentioning this to you because there's evidently some kind of controversy over the weakly ER+ protocol.

[Your signature says ER 5%; your posting says 30 %. Has there been a change of the number?]

I did get a second opinion from my Sister-in-law's oncologist in Taiwan. He e-mailed me that even 'weakly ER+' will benefit from Tamoxifen.

You can get a free 'decision guide' published by Fox Chase Cancer Center by calling the toll-free number 1-800-325-4145 of the Margaret Dyson Family Risk Assessment Program.

It's a 140-page spiral-bound, well-organized, well-written 'guide' presenting pros and cons in every aspects of the surgical decision including Section 4 which is entitled "If you do not want to have surgery right now: What you need to know."

You might also want to ask for 'genetic counseling' - I had talked to a geneticist in my hospital and she drew a very neat family history chart for me while interviewing me. At the time when I talked to her, only my Mother's Non-Hodgekins Lymphoma was known to us. Then my 2nd Brother had a surgery for colon cancer last fall... And I decided that was 'it' and got my prophylactic hysterectomy/oophorectomy in mid January. I noticed on my chart that the reason for my surgery was BRCA + and family cancer history.

Rest well and take your time...

When my 1.2 cm, Grade III tumor was found, my surgeon told me that she thought it probably had been growing for 2.5 years. I would think your tumor probably had been growing since you were 35. That would make you a 'young survivor' and put you at high risk. I had had 'chemopause' just 3 months into my chemotherapy in 2003. My period never came back. Theoretically I would think that after another full-course of chemo in 2007 my ovaries should be 'dead'. But then I read that older women (over 70) have higher risk of ovarian cancer...

[bejuce]

Thanks, Jackie. I updated my signature - it was getting too long and I couldn't post anything new to it anymore, lol! I guess that means I'm becoming a veteran at this :)

I was initially diagnosed at 5% ER+ and told I was not eligible to take Tamoxifen. Well, when I decided to be treated at Stanford, my oncologist told me that she believed it would provide a benefit at anything above 0 %, so I started taking it. I asked Stanford to retest my original biopsied tissue, and when they did it came back as 30%. I heard that it is pretty common to have different results and I'm glad I did it.

I had a genetic counseling appt early on at my diagnosis and was told that there wasn't anything in my family history that they could point at, so we'll see... My maternal grandfather passed away of stomach cancer, a paternal great aunt most likely had breast cancer, and my father has had bladder cancer twice and was just diagnosed with a basal cell carcinoma in his skin. So there's a cancer history but they say it's too far off to show anything. In any case, I'm not taking any chances and I'm pushing for the most aggressive treatment possible as I do want to be here a long time for my kids. I may end up having the oomph at some point, but I need to research it and be in peace with my decision before I do so.

Thanks again!

Marcia

[Karen Wheel]

Glad to see you are doing good - and that your surgery went well!

And... I think you were smart to not make a quick decision and wait on the other.

:-)

Take care! Keep us updated!
Karen