UterCa: Should I keep my ovaries and tubes?

I just had my hysterectomy (only my uterus and cervix) were removed on 1/22/2010. I knew going in my biopsy had come back pre-cancerous, I had polyps, and suspected adenomyosis. Thought they would see the cancer in surgery and if they did would remove my tubes and ovaries. Otherwise would leave them in. No sign of cancer in surgery so I still have my tubes and ovaries in. Then pathology report came back positive for uterine cancer grade 1. Now I have to decide if I want my ovaries and tubes removed or left in. There are benefits and risks either way and I don't know what to do. I am 34 and because the cancer is an estrogen driven cancer may not be allowed to take hormones which would mean immediate menopause for me. Has anyone ever been in this position? Any advice? Any help is appreciated!

I am sort of in your position. I am also 34, but my cancer was confirmed going into surgery (I had a D&C that confirmed it even though my biopsy just showed hyperplasia). My ovaries were removed during surgery. I actually asked my gyn-onc yesterday about estrogen therapy (I was put on estrogen before I left the hospital because I was already having hot flashes). He said that the major studies have a median age of about 70, and that he felt that the quality of life issue at my age outweighed the small increase in risk. If I were you I would try to talk to your doctor about this before making a decision, but do know that not all doctors agree on this.

I am 45, so I did come at this decision from a different perspective.
I had surgery because we knew from a polyp that I had grade 1 cancer in my endometrium. My gyn/oncologist originally told me we would remove the uterus, cervix, ovaries, and tubes. I have always been a fan of living as 'natural' as possible, and had never expected to ever have a hysterectomy. I had never even seriously researched the symptoms that would be associated with removing the ovaries. But I did know women often opt to leave at least 1 ovary in.
I asked about leaving the ovaries. My Dr explained that I could opt to leave them, but that there have been some studies which show an increased risk of cancer recurrence for women who opted to leave the ovaries. I had to digest all the information , but any hint of an increased cancer recurrence risk was really all I needed to hear. I am far more concerned about cancer than menopause.
I am so glad I decided up front to have the ovaries removed! The pathology of the surgery showed my cancer was actually very aggressive, and had spread into the cervix. Pathology on the ovaries showed they were clear. Just the peace of mind of knowing for certain they were clear, is worth it.
Being 34 makes a difference, but to me the biggest 'change' is that a future pregnancy is not possible. That change has already occurred. I am only a few weeks from surgery so I can not speak from experience, but in researching I decided my biggest menopause concern is 'drying out' and care can be taken to guard against that. I am also concerned about bone density loss, but that also can be monitored and attended to.
I would suggest you carefully way your concerns about the impact of loosing your ovaries so young, to the cancer related concerns.

Hi, I'm in the same boat too - left the ovaries and then final path is making me re-think the risk/benefit of keeping them.

From conversations with my gyn onc and my second opinion gyn onc one thing is clear - for younger women there is just not enough evidence for them to do anything more than an educated guess. There is not strong science to guide this choice, because there haven't been enough patients in this age range studied. Many gyn oncs will advise removing the ovaries simply because that's what's been done for so many years and for so many (mainly older) women, plus their focus is on preventing recurrence of gyn cancers.

Basically you're balancing the risk of endometrial cancer recurrence & potential ovarian cancer against a risk of increased cardiovascular risk from having the ovaries removed (there are other benefits to the hormones from ovaries, but cardiovascular risk is the main one for life expectancy).

My doctors have said that the balance of these risks is very individual and depends a lot on your own family history. My family history on the cardiovascular side is pretty scary, and is without a lot of cancers of any kind, so I am leaning towards keeping the ovaries because of that. If I had a clear cardiovascular family history & someone in the family tree who died of ovarian cancer I think I'd make the opposite choice.

I'm still waiting for one more re-read of the pathology to make the final choice (hopefully in the next few weeks).

I know it's hard enough to navigate this, let alone when you realize that there is no "correct" answer.

Round, that's a good point - I should have mentioned I don't have a family history of ovarian cancer or CV issues, so we are pretty much working with a clean slate as far as that goes. I'm the only one in my family to have had endo cancer, too.

Thank you everyone for the information. I love this website and it is so reassuring to know I am not alone! I did hear back from my dr. this morning. They too had to re-read the path report. She consulted with the oncologist she referred me to and he advised her that in early low grade cancers such as this that the norm is to now give hormones. Knowing that I can have hormones is making me lean toward going forward with having them out. I do worry about osteoporosis and heart issues but to this point have been healthy. I have battled my weight my whole life so the heart issues concern me, but the cancer coming back I think concerns me even more. And there are things I can do to prevent the others (I think). I guess I've got a major decision to make now. I am so tired of thinking about this and cannot wait to put it behind me! Thanks for the advice everybody - keep it coming!

If I were you, I would keep the ovaries. Nothing can prepare you for the hell of sudden surgical menopause when you haven't even started peri-pause. Depression, volatility, change in eye sight, change in skin texture, loss of sexual desire, facial hair, increase in blood pressure, weakened bones, dry hair, and change in body shape. (The hot flashes were nothing.) The list goes on and on. Sorry to be so negative, but it was awful. The only good thing was it cured my acne.

I am on a very small dose of estrogen and it helps.

If you do opt to have your ovaries removed, opt to have your eggs frozen.