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I have a few questions
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10-14-2011, 12:04 PM
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HysterSister
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Posts: 233
Hysterectomy: August 9th, 2011
Surgery Type: DvH
Ovaries: Kept 1 or both
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I have a few questions
1. Is there a way to do a robotic radical parametrectomy and pelvic lymph node dissection for cervical cancer without cutting the bladder nerve? Is cutting the bladder nerve necessary with an abdominal incision too? I'm concerned my bladder nerve won't grow back right and I'll have to either wear diapers or use a catheter for the rest of my life. Is permanent damage like that common or extremely rare?
2. Why is it safe for women with cervical cancer to take estrogen but unsafe for women with uterine cancer? Does the answer depend on the type of cancer adenocarcinoma vs squamous? If so, not all cervical cancer is squamous. Why would estrogen trigger growth in uterine adeno but not cervical adeno? I'm asking because my gyn/onc wants to remove my ovaries as a precaution and says I'll be able to take estrogen. I don't want to take estrogen if it's going to make my cervical adeno recurr. Is uterine adeno different than cervical adeno or is adeno the same regardless of location and growth triggered by estrogen regardless of location? I'm only 38 and don't want my bones and heart to deteriorate because of lack of hormones. At the same time, until 2014 Medicaid only covers cancer located in the breast and cervix, not ovarian cancer (they go by location not mets) so I might be ineligible for coverage until 2014 if I develop mets in my ovaries. Should I refuse to allow ovary removal? Is my gyn wrong about cervical adeno (not squamous) and estrogen?
Please advise before I reschedule my surgery. I don't know what to do and I'm really confused about location of adeno and estrogen.
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10-14-2011, 12:18 PM
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HysterSister
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Posts: 3,327
Hysterectomy: May 15th, 2006
Surgery Type: TAH
Ovaries: Kept 1 or both
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Re: I have a few questions
Cervical cancer (both adeno and squamous) is related to the HPV virus, it is not estrogen fed. Because of this, it is safe for CC patients to recieve hormone replacement. The main risk in receiving HRT is the estrogen. This can increase the risk of breast cancer though.
Uterine cancer is not related to the HPV virus. Maybe one of those sisters will be along to explain it further, as i don't know the exact forces behind it.
I've been on HRT since Oct of 2006, so far I haven't had any cancer issues from it.
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10-14-2011, 12:29 PM
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HysterSister
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Posts: 930
Hysterectomy: October 2nd, 2009
Surgery Type: TAH
Ovaries: Removed both
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Re: I have a few questions
I don't think any of us here are surgeons, and I know I haven't been here forever, but in the time I've been here I've never known anyone to mention issues with their bladder nerve.
A radical paremectromy sounds similar to the extended "radical" part of the hysterectomy. My Gyno/Onc was very specific about the potential for nicking a ureter, but never once mentioned anything about the bladder nerve. She did say I had a slight chance of having to go home with a catheter but I never had a problem. After your hysterectomy did you have a problem in that area?
And Vega is right, cervical cancer is squamous or glandular cell carcinoma (adeno or non-adeno) - and does not have the potential to grow or feed on estrogen.
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10-14-2011, 02:51 PM
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HysterSister
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Posts: 233
Hysterectomy: August 9th, 2011
Surgery Type: DvH
Ovaries: Kept 1 or both
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Re: I have a few questions
So both adenocarcinomas have the same name but neither cervical adeno or cervical squamous are affected by estrogen. What effect, if any, does estrogen have on endometriosis?
With my simple robotic hysterectomy performed by another doctor, the catheter was taken out the day after surgery before I went home. When my gyn/onc gave me the choice between a second surgery and radiation, she mentioned having to cut something leading to my bladder and needing a catheter for at least a week because of it. I read that bladder dysfunction can occur as a result of radical hysterectomy and pelvic lymph node dissection. Does anyone know how common this is? I thought surgery would be a better choice, but if there's a good chance I'll have to wear diapers or catheters for the rest of my life, I might change my mind and go with radiation instead. Depending on the surgery pathology results, I might need radiation anyway. Only problem is radiation can only be done once so if I recur, I'll die. I wish there was a way to do this without taking a chance with my bladder. I've considered seeking a second opinion, but I don't know how long that will take and I don't want cancer cells spreading all over my body in the meantime.
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10-14-2011, 02:57 PM
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HysterSister
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Posts: 3,327
Hysterectomy: May 15th, 2006
Surgery Type: TAH
Ovaries: Kept 1 or both
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Re: I have a few questions
The doctor will need to cut something, but I don't believe its a nerve going to the bladder. Possibly nerves around it though. I had a cath in for 10 -12 days (can't recall the exact number now) after surgery. It really wasn't a big deal. My gyn/onco said with the extent of the surgery, she wanted to give my body a chance to "rest" and heal. The cath came out the same day as my staples.
I had mild issues for a few weeks afterwards, but they resolved as the nerves woke up. I didn't have notable bladder problems until after my bowel obstruction surgery a year later. The urologist said the mix of surgery, rads, and more sugery PO'd my bladder. Meds have helped keep it under control.
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10-14-2011, 03:17 PM
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Posts: 15,365
Hysterectomy: November 29th, 2005
Surgery Type: TAH
Ovaries: Removed both
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Re: I have a few questions
Ditto for me. Prior to surgery, I don't recall being told there was a large risk for having severe, permanent bladder damage, and my doc and staff were pretty up front with everything. I haven't had any bladder issues at all.
Have you discussed these concerns with the gyn/onc? I'm sure they'd be glad to help clarify things for you.
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10-15-2011, 02:10 PM
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HysterSister
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Posts: 2
Hysterectomy: September 29th, 2011
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Re: I have a few questions
Had radical hyst/lapro surgery for cancer 9/29. My doc warned me about the nerve in question being severed and as far as I can tell (with all this numbness) it was. I can however, still void on my own but I have just put myself on a schedule to use the restroom because I no longer have the "feeling" of needing to go. No diapers or catheter needed...just a routine. Hoping the best for you. Ang
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10-16-2011, 08:06 AM
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Posts: 1,726
Hysterectomy: October 18th, 2004
Surgery Type: TAH
Ovaries: Removed both
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Re: I have a few questions
Hi Laana - My gyn/onc also wanted to take my ovaries (and my appendix, of all things). I said "no" to the appendix removal, but because of my ignorance, I thought the ovaries might be at risk and said "yes" to their removal. The gyn/onc told me that since I was past child-bearing age (I was 52), I didn't need my ovaries any longer. Since then, I've read other opinions about that, which is why I would say "No" to ovary removal now if I were to do it all over again (although it's sort of a moot point since I had to have radiation, which would have zapped them anyway.) However, if ovarian cancer ran in my family, I would let them take them. I wonder if that rationale is behind the widespread practice of removing the whole shebang.
Before my surgery, my gyn/onc told me that I could lose the ability to pee and have bowel movements because of possible nerve damage. I wonder if the placement or depth of the tumor has anything to do with that. After surgery, I could not pee on my own for months and months. Eventually, I was able to create a technique to make me go, and a little while after that, I was able to go pretty much like I always had although I still have to use my little technique to void completely. I've had trouble with bowel movements since surgery; my rad/onc said there was nerve damage and after this long (7 years), I could no longer hope for regeneration. However, I've devised ways to manage that as well.
I have to add that either most hystersisters do not have these problems or don't write about them. In fact, my rad/onc told me that most women don't have the problems I've had and that my gyn/onc cuts deeper than most, so maybe you could ask your gyn/onc if s/he thinks you might have these problems or not. Best to you!
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