partial vrs total hysterectomy

I am a stage 2 breast cancer survivor of 5 years.My age is 52. I had a lump removed from the right breast followed with 4 chemo treatments and 32 radiation treatments. Currently I am taking tamoxifin (tamoxifen) and fosamax for previa osteoporosis. Within the last few years my bladder has been slowly desending to the point now where the doctor describes it as stage 4 prolapsed bladder. He has suggested a partial hysterectomy to remove the uterus and then repair the bladder and rectal area. My concern is leaving the ovaries and fallopian tubes to futher increase the chances of ovarian cancer. I have also have had a history of abnormal pap smears.What do I need to be concerned about?

[Elaine Brown, MD]

Hi!
If you were my patient, I would recommend removing everything.  Even though you are theoretically cured of breast cancer, removing ovaries will reduce your risk of a recurrence or a new primary.  It also (obviously) reduces your risk of ovarian cancer.

I would suggest a laparoscopic assisted vaginal hysterectomy--sometimes what my partners and I do is just take a quick peek with the laparoscope and then remove everything from below, other times we need to use the laparoscopic equipment to release the ovaries from above and then finish below.  Its not really possible to tell before-hand.

Also, make sure your surgeon feels comfortable with a culpopexy if that is needed.  That is a procedure to secure the vagina with a permanent suture so that you don't get vaginal vault prolapse a few years from now. (everything falls back down again) Again, it is difficult to tell if the procedure is necessary before-hand.

Another thing--I don't know whether you have any problem with urinary leakage, but if so have that fixed too!  Just to warn you-- sometimes that can start when the bladder is put back into place, if it hasn't happened before now.

Regarding your cervix, if your most recent paps have been fine, you probably have nothing to worry about there.  Your surgeon will submit your uterus, cervix AND ovaries for pathology and they will rule out any abnormal cells there. If it has been more than 3 years since your last pap though, get one done before surgery.

By the way, just so you don't think I am too radical--I advise just about everyone EXCEPT breast cancer survivors to keep their ovaries!

GOOD LUCK!
Dr B

[willow2008]

Thank you so much for the information. As it turns out I went for a second opinion from my oncologist about removing the ovaries. She agreed that being a breast cancer survivor that they should come out. Both physicians are now on the same page and I am scheduled for a lap assisted vaginal hysterectomy in less than 2 weeks. I feel so much calmer now thanks to your comments and and the decisions my doctors and I have made. I can't thank you enough.

[MZZLOVELYCARAMEL]

IS THERE ANY CHANCE A WOMAN CAN GET PREGNANT AFTER HAVING A PARTIAL HYSTERMONY OR WHAT WOULD BE THE REASON FOR HER TO HAVE BREAST LEAKAGE NOW AFTER 13 YEARS AND NOT HAVING ANY LEAKAGE BEFORE NOW/ PLEASE HELP!!!!!!  THIS IS FOR A FRIEND WHOM  HAS PREGANCY SYSTOMS AND IS VERY WORRIED...............