August 2nd Lady Parts Surgery

Here we go. I have a Bilateral Salpingo Oophorectomy (or BSO) surgery scheduled for Aug. 2 to remove my ovaries and fallopian tubes as risk prevention for ovarian cancer.

You may ask yourself, well, how did I get here?

  • Sister diagnosed with breast cancer 15 years ago at age 40
  • I began mammograms at age 30; began aggressive surveillance at age 38
  • 5 years ago, among other cancers in my immediate family, I am diagnosed with melanoma and undergo surgery (it’s caught early and I don’t need treatment)
  • 4 years ago sister tests positive for the BRCA2 mutation; I choose to continue aggressive surveillance
  • I continue skin cancer checks 4x/year and subsequently have had 2 pre-melanomas removed
  • Sister gets 2nd breast cancer 3 months ago
  • After aggressive surveillance for nearly a decade, with active BRCA2 in my family, and with my own melanoma diagnosis, it’s time to know if I’m a carrier
  • I test positive for BRCA2 on May 29
  • Research, surgeon referrals, read the book Positive Results, talk to other women with BRCA mutations, work with insurance on identifying doctors and implications on my plan, organize questions to ask: Breast and Lady Parts
  • Begin consultations…

I’m doing a BSO only, not a hysterectomy (uterus and cervix) in addition which some women choose to do and which I was seriously considering previously. After a long discussion with my wonderful oncologist/gynecologist about the options we discussed that there have been no cases of cancer reported from the remnant of fallopian tube cells left (minuscule amount) on the uterus. Doing a BSO only will be less risks to other organs, less risky surgery and easier recovery. He feels very confident with this plan. I trust him.

It’s worth mentioning that my sister also had cervical cancer. A family history does increase my risks. Those risks are minimal however, and I have had 10 years of normal pap smears so in talking with my oncologist, I am confident that not doing a hysterectomy at this time is a perfectly reasonable choice. I will continue to have pap smears and should I ever need to do a hysterectomy, there is always the option later on.

This will be a laparoscopic surgery through the abdomen. Ovaries and fallopian tubes will be removed and biopsied and within days we’ll know if there are any pre-cancerous cells. If we need to go back in, that would happen a week later but my oncologist feels the chances of that will be very very low. He will see me for follow up 2 weeks after surgery. And he expects that I should be pretty well recovered after a week and remaining discomfort pretty well minimized after the 2nd week. I’m planning on taking 2 weeks off of work to recover.

Because of removing the ovaries, I will experience surgical menopause and will likely need hormone replacement therapy (HRT) depending on need (symptoms include not flashes, sleep disturbance, mood changes, sexual side effects, fatigue, weight gain). HRT would not start until 2 weeks after surgery regardless. There is risk of clotting immediately after so they wait until it’s safe. And if, we’ll start with low doses of estrogen and progesterone and within days we can increase the dose as needed depending on my symptoms in order to find the right level quite quickly. The oncologist said once we find my level, I should have few symptoms… Here we go!

With the BRCA2 mutation, he does not feel there is risk of breast cancer for being on estrogen and progesterone because I’m planning on scheduling the double mastectomy in November. The risk would be if I was on HRT longterm. My new breast oncology surgeon (whom we loved) reconfirmed yesterday in our consultation that she agrees with this plan. I’ll do the Prophylactic Bilateral Mastectomy (PBM) in November. The reconstruction process is approximately 5 months with a final surgery at the end, so approximately April. If I had any thoughts of waiting to do the PBM, they’re minimized by the personal stories of friends and friends of friends with the BRCA gene mutation who have had cancer within 6 months of being negative at their last surveillance. These mutations are active and I’m super clear that risk-reducing surgery is going to give me an extended quality of life with no worries of at least these two battles to deal with.

Feeling great about the decisions and getting this first phase behind me.

Letting the days go by, water flowing underground…