Decisions: Oophorectomy or no oophorectomy

One thing that has been pretty tricky during this cancer debacle is second opinions.

It kind of just confuses me even more.

In life, I’m a huge fan of second opinions. And third. And fourth.

I’m sure this comes as no surprise to my family and friends, as I often lean on them for their opinions when making decisions. It isn’t that I’m unable to make decisions. In fact, I often have my mind made up when I ask others for their opinions, and I am rarely swayed by opposing opinions that I hear. But I really find peace in hearing all the different sides of an argument from people that I love and respect prior to making a decision … just to be sure I haven’t missed something big.

However, opinions when it comes to medical decisions are really tough.

I mean, in deciding if I should have a prophylactic mastectomy last year, I had a couple of local doctors recommend it. The doctors at MD Anderson didn’t. I can’t just call up friends and ask for an opinion. They don’t have the medical background to provide an educated opinion. Even if they’ve read articles about the subject, each person’s cancer situation is so unique that it isn’t a cut-and-dry answer. I’ve definitely had to soul search for that decision.

Based on all the pathology reports, it’s clear to me at this point that I should have that prophylactic mastectomy with my reconstruction. Now that we have more information about the cancer, all the doctors seem to have blessed my decision.

But when they disagreed last year, it was difficult.

Another big decision that I have is whether I should have my ovaries removed. Oddly, this is not something that I would ever have considered since I do not have the gene mutation that leads to ovarian cancer. In the slew of doctors I’ve seen over the past year, not one person has said this is something to consider given my situation.

Except my local oncologist.

She has been talking about doing this since before chemo. She seems very confident that it is the right move for me based on my age.

I was pretty leery about it, so when I met with her this past week, I asked her to explain why she thought this was necessary. Here is what she said (I’m paraphrasing):

The job of the drug that I will be taking for the next five years is to block the estrogen receptors in my body. If the Tamoxifen does it’s job, any renegade cancer cells in my body will not be fed by the estrogen it needs to thrive and grow. I guess if you are dealing with a post-menopausal woman, she is not producing much estrogen anyway so the combination of the reduction in estrogen and the Tamoxifen is effective.

However, because of my age, my body is still going strong with producing estrogen. So, all of the pressure is on the Tamoxifen to do its job. Removing my ovaries would reduce the estrogen which would help lower my chance of recurrence.

By 1 or 2 percent, she says.

Yep — that’s all. Removing your ovaries causes all kinds of problems, according to the Mayo Clinic. Seems like a pretty drastic change to my quality of life for 2 percent.

That said, I made a decision to do twice the number of chemo treatments as recommended by my local oncologist with a 0% difference in my chance of recurrence/mortality. MD Anderson had recommended the full treatment (“be as aggressive as possible”) while the local oncologist recommended half. I chose to be more aggressive. If this cancer came back, I didn’t want to have regrets.

This might be why I’m so confused on this ovary thing. Seems overly aggressive, but not being the most aggressive is inconsistent with my decision for chemo.

When I asked her, my MD Anderson oncologist did not recommend removing them. That was my second opinion.

It is just hard when medical professional have differing opinions on issues that could effect your life. It is left to you, the patient, to make a judgement call…on your life.

Ultimately, I have a really bad feeling about doing this. It seems very drastic.

But I do see the logical argument as to why I should do it. To use a basketball analogy, the Tamoxifen is like the blockers under the basket trying to block each shot. If you really wanted to keep the other team from scoring, wouldn’t it be more effective to just remove the basketball itself?

I have an appointment with my OBGYN on Monday. I intend to pick her brain a bit.

I’ll definitely take any prayers for clarity over the next few weeks.

8 thoughts on “Decisions: Oophorectomy or no oophorectomy

  1. Tough decisions are just that — tough! If you ask enough people and read enough research, you can find the answer you want. Ultimately, it means filter all the medical responses you get and make the decision that seems best for you. Prayers for you, Jenny!

  2. I’ll definitely be praying Jenny! This is a big decision for you and I hope you find the knowledge you need to make a decision that will give you peace moving forward.

  3. Well I’m down to one ovary, and I was pleasantly surprised to hear that I may have also inadvertently lowered my cancer risk as a result! Other than feeling like I may spontaneously combust on occasion, I haven’t noticed the difference. Of course there’s a big difference between one and none, I’m sure.

    In my humble, unprofessional, unsolicited opinion, I believe it’s how you feel about your decision that matters most of all. Whatever that decision may be.

    Prayers up, Namaste, WWJD, etc. 😉

  4. Well, to add to your confusion, my oncologist said that if I removed my ovaries, she would still have me take tamoxifen. Thing is, estrogen is produced in other areas of the body including fat. I am also contemplating this surgery down the road. And I am still confused.
    Good luck in whatever you decide. One thing that has helped me is that there is time to make the ovary decision. It is not something I am rushing into.

  5. Pingback: Busy February: MD Anderson Trip No. 1 | The Herzy Journey

Leave a Reply

Your email address will not be published. Required fields are marked *