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Ovarian Cancer (Expert Forum)
Full hysterectomy or just one ovary???
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
Full hysterectomy or just one ovary???
by beyondthesea, Aug 26, 2006 12:00AM
Hello Doctor! My 79 y/o mom was diagnosed with OVCA in June. She had a cyst that turned out to be malignant. Her CA 125 was 100, so her GYN wasn't expecting it to be quite as involved as it was--she ended up with a bowel resection and a stent in her ureter due to all the adhesions. My mom's GYN suggested my sister and I talk to our GYNs about our future risk factors. I had also noticed I was having cramps at the wrong time of the month along with some lower back pain that I'd been seeing a chiropractor for, so I went in right away. After a TVUS, they found a 5cm cyst on my L ovary that showed "color doppler blood flow along the edge with some nonmobile internal echoes". We decided to watch it for 6 wks and repeat the US. I had the repeat done last Mon and it's still there--hasn't changed in size or shape. We ran a CA125 last month, and it came back at 12. I'm 40, and have had no other gyn problems. My new US report says he wasn't sure if I have one large cyst or three small ones, but neither the radiologist nor my GYN feel comfortable leaving it in. Because of my family history of OVCA (mother only) she will only do a laparotomy to minimize chances of the cyst bursting, but she also suggests doing a FAH so we aren't taking the chance of the same thing happening on the other side. I see that logic, but if my other ovary is healthy, should I try to keep it? I'm not sure I want synthetic HRT if I could have my other ovary for another 10 years. Then again, I know I'd always worry what it's doing in there, with OVCA being so sneaky. Are bioidentical hormones better? I'm confused
Doctor's Answer
by Annekathryn Goodman, M.D., Aug 27, 2006 12:00AM
, Aug 27, 2006 12:00AM
Hello,
I agree with the recommendation to remove that one ovary. if it is malignant, then the standard of care is to remove the right ovary and tube as well and to remove the uterus and check biopsies to look for spread. As most cysts are benign, the question arises, should you have your other ovary removed as a prophylactic measure.
If you have evidence of endometriosis at the time of your surgery, then you should consider removing the other ovary and uterus.This is because there is a small but increased risk of malignant change in the setting of endometriosis. If everything looks perfect, it becomes an individual decision.
There is no screening test for ovarian cancer. However, genetic testing for two genes, BRCA1 and BRCA 2 , are available. If your are considering not removing the other ovary if it looks normal, you should ask about genetic testing. However, your mother should be tested first. If she has the gene mutation that we presently can test for, then you and your sister need to get tested. If she does not have the gene mutation, it does not make sense for your to be tested at this time.
As for hormone replacement therapy, there is no hard data to suggest one form of estrogen therapy is better than another. There are alot of products out there so it can be an individual choice. You should ask your gyn what she thinks. At age 40, if you decide to have your ovaries removed, you should consider estrogen replacement to help with sexual function, vaginal dryness, hot flashes, bone strength.
Finally you can always go back later for more surgery. If you are having trouble making a decision, just have the one ovary removed for now.
best wishes to you.
I agree with the recommendation to remove that one ovary. if it is malignant, then the standard of care is to remove the right ovary and tube as well and to remove the uterus and check biopsies to look for spread. As most cysts are benign, the question arises, should you have your other ovary removed as a prophylactic measure.
If you have evidence of endometriosis at the time of your surgery, then you should consider removing the other ovary and uterus.This is because there is a small but increased risk of malignant change in the setting of endometriosis. If everything looks perfect, it becomes an individual decision.
There is no screening test for ovarian cancer. However, genetic testing for two genes, BRCA1 and BRCA 2 , are available. If your are considering not removing the other ovary if it looks normal, you should ask about genetic testing. However, your mother should be tested first. If she has the gene mutation that we presently can test for, then you and your sister need to get tested. If she does not have the gene mutation, it does not make sense for your to be tested at this time.
As for hormone replacement therapy, there is no hard data to suggest one form of estrogen therapy is better than another. There are alot of products out there so it can be an individual choice. You should ask your gyn what she thinks. At age 40, if you decide to have your ovaries removed, you should consider estrogen replacement to help with sexual function, vaginal dryness, hot flashes, bone strength.
Finally you can always go back later for more surgery. If you are having trouble making a decision, just have the one ovary removed for now.
best wishes to you.
