We need your opinion on whether it is advisable to have a hysterectomy while on Tarceva… My wife has been on Tarceva as a first line treatment since March 2011 when she was diagnosed with Stage 3B NSCLC. At this point, thankfully, the Tarceva has eliminated or stopped the progression of her cancer.
My wife is strongly considering a hysterectomy. She has been struggling with 15 - 21 day periods for the last 6 years. Initially we tried three different oral birth control pills but the periods kept getting longer (but lighter). 3 years ago she had a mirena IUD put in but that only caused nearly non-stop spotting with a week of regular bleeding every 2/3 weeks. A year and a half later she was given a low dose estrogen pill, but only took it for a few weeks before she was diagnosed with stage 3B lung cancer and told to go off all hormones.
She kept the IUD to prevent pregnancy, but the near constant bleeding coupled with Tarceva rash (& sensitive skin in the genital area) as well as a few cysts showing on an ovary led to a visit w/ an oncology gynecologist. The cysts are non-cancerous but he really responded to her discomfort with the bleeding. He removed the IUD since it really wasn't helping much (except for pregnancy prevention) and she enjoyed almost 8 weeks without bleeding - the longest since she was pregnant with our 7-year old. Then, she had another 4 months where only about 10 days were "dry".
The Options: (a DNC or a uterine ablation) but a laproscopic hysterectomy leaving one ovary is looking like the best choice. No more bleeding + one less "high risk" system to get cancer?
The oncologist says a hysterectomy won't affect the Tarceva & Tarceva won't cause complications in healing. She is ok skipping the pill the morning of surgery with no risk. Her gynecologist says the risk of the lung cancer going to my reproductive system is low, but the ovary he removes will be the one w/ cysts on it. He also says that being young & healthy helps.
Any thoughts? TH
Reply # - August 3, 2012, 12:55 PM
Reply To: Hysterectomy while on Tarceva ???
Hi TH,
I'm glad to hear that your wife is responding well to Tarceva, but sorry to hear of her other difficulties. Unfortunately the question of whether she should undergo this procedure while taking Tarceva is one which is beyond the scope of what the faculty can do here, since she is not their patient and they do not have access to all of her medical records nor have they had an opportunity to examine her.
On the other hand, GRACE faculty have often stated that a brief treatment break, whether due to side effects or the need for a medical procedure, is not likely to cause a problem, so that should not stand in the way.
I will forward your question to a faculty member to see if they have additional comments.
JimC
Forum moderator
Reply # - August 3, 2012, 01:16 PM
Reply To: Hysterectomy while on Tarceva ???
Jim's correct that we really can't provide a medical opinion about whether she should have a hysterectomy, but I certainly agree with her oncologist's reasoning. I don't know of any association of Tarceva with bleeding, can't envision how Tarceva would lead to problems with the surgery, and don't have any hesitation in having my patients take a few days off of Tarceva a little before and after surgery (I don't know that it's necessary to do so, except when someone isn't able to take anything by mouth pre-surgery, but a few days off is extremely unlikely to lead to any significant issues.
-Dr. West
Reply # - August 4, 2012, 11:45 AM
Reply To: Hysterectomy while on Tarceva ???
Just wanted to offer my experience in case it is any use to you and your wife. I'm glad she has responded so well to the Tarceva. I regularly have minor thoracic surgery and have been taking Tarceva for about the same length of time as your wife. I'm not aware of any problems arising from the conjunction of the two.
I've also had recent episodes of gynaecological bleeding (from uterine cysts/polyps) that caused me a lot of inconvenience and distress, although nothing on the scale that your wife is experiencing. They've now resolved but if they hadn't I would gratefully have accepted the MIrena coil, which was offered by the gynaecologist I saw. If a hysterectomy had been the only option I would have accepted that too. Best to you and your wife.
Reply # - August 5, 2012, 08:33 AM
Reply To: Hysterectomy while on Tarceva ???
Hello - I want to be very mindful of JimC's comments above and further note that I mention the following only so you have a sense of my wife's experience. Of course, this does not mean it is an appropriate approach for your wife (sorry for the disclaimer, but I'm a lawyer by training). I do, though, want to let you know that my wife had a complete hysterectomy (including removal of both ovaries) last October after having been on Tarceva for exactly one year. She did not take Tarceva on the day of the surgery and the day afterwards. Other than the two-day break, she maintained her normal dose (one 100 mg pill a day) and had a normal recovery (nothing out of the ordinary). In my wife's case, she had a number of gynecological issues that advocated for the surgery. However, she also had a tumor on her left ovary that we suspected was lung cancer and the post surgery biopsy confirmed it was. We believe it was a "holdover" tumor from her original diagnosis one year before (not progression). In any event, good luck with your decision. Best, Dan
Patient Bio:
09/2010: Wife, Hispanic, DX at 46 with NSCLC, Adeno, Poorly Diff. (EGFR +, Exon 19) (T790M negative, we think); source tumor left hilar mass, 5 bones mets, one tiny brain met, and one tumor at left ovary;
10/2010: radiation to lung and breast bone, 150mg Tarceva;
08/2011 PET and CT Scans: source tumor and bone mets resolved; ovarian tumor stable (Tarceva reduced to 100mg);
10/2011: ovarian mass removed per hysterectomy;
08/02/2012 PET: all's clear
Reply # - August 5, 2012, 08:38 AM
Reply To: Hysterectomy while on Tarceva ???
Hi Dan, Your wife is doing really well, Great!
It's good to have her experience added to this thread.
Good luck moving forward,
Janine
Reply # - August 10, 2012, 11:13 AM
Reply To: Hysterectomy while on Tarceva ???
Dan, may I ask if your wife felt that her gynaecological problems were in any way aggravated by the Tarceva?
It's so good to hear of her response to treatment and surgery. Long may it last.
Reply # - August 10, 2012, 01:45 PM
Reply To: Hysterectomy while on Tarceva ???
Certain Spring - My wife's gynecological issues were unrelated to Tarceva, as they existed before her NSCLC diagnosis for many, many years (and I should add that I don't think we have ever thought that they were aggrevated by her being on Tarceva -- but plenty of other things have been so aggrevated!). The only odd thing post diagnosis was with respect to her one ovarian NSCLC tumor, as the tumor appeared to have gone away according to an ultra-sound 3 months after she started Tarceva. However, the tumor appeared again on her 1 year PET scan 8 months later, so we were a bit perplexed as to whether its re-appearance was progression or whether the ultra-sound 8 months earlier was wrong (we always leaned towards an errant ultra-sound). Now, as of the two year anniversary of her diagnosis, we are quite convinced that it was a hold-over tumor from her original diagnosis and that the ultra-sound was wrong, as there have been no other signs of progression over the past year. Thanks for the good wishes. Wishing you the best as well...
Dan
Reply # - August 10, 2012, 03:36 PM
Reply To: Hysterectomy while on Tarceva ???
Thank you, that is useful to hear. I am trying very hard to learn not to jump to conclusions in the context of cancer and cancer treatments ("x happened at the same time as y, therefore must be caused by y"), but I had some gynaecological problems earlier this year which were tempting me to make a connection. In fact my age and (pre-cancer) medical history are far more likely explanations. It's just that, as you say, Tarceva does so many strange and unexpected things, it's hard not to blame it for anything troublesome!