Multiple Surgeries After a Breast Cancer Diagnosis
- After Olivia Munn, 43, was diagnosed last year with breast cancer, she had her breasts removed and underwent a hysterectomy, removing her uterus, with additional surgeries to remove her fallopian tubes and ovaries to avoid taking an estrogen-suppressing drug, but is surgery enough to keep the disease from coming back?
- The TV and film star’s type of breast cancer, called hormone receptor-positive (HR+), means that the hormones estrogen or progesterone stimulate cancer cell growth, which is why HR+ cancer is typically treated with hormone therapy drugs that lower estrogen levels or block estrogen. Munn’s sub-type, luminal B, meant that her cancer was specifically estrogen-fueled.
- After a hysterectomy, women are not able to birth a child. However, if the ovaries have not been removed, which is called a oophorectomy, pre-menopausal women can still produce estrogen. If a woman has had both surgeries, they can still keep producing estrogen via their adrenal glands, which are two small, triangular-shaped glands above each kidney, and this is why our experts say that additional endocrine therapy is still needed.
- Breast cancer can be complicated, be sure to seek out multiple opinions and consults to make sure you know the pros and cons of every surgery and treatment that you are considering moving forward with.
Her type of breast cancer, hormone receptor-positive (HR+), means that the hormones estrogen or progesterone stimulate cancer cell growth, which is why HR+ cancer is typically treated with hormone therapy drugs that lower estrogen levels or block estrogen. The American Cancer Society states that women with this type of cancer “tend to have a better outlook in the short-term, but these cancer can sometimes come back many years after treatment.”
Before her surgery, the Violet star, who is married to comedian John Mulaney, 41, went through another egg retrieval process (she had already gone through several prior to her diagnosis), and produced two healthy embryos. She and her husband were overjoyed, since the mom of one said she is not yet done growing her family.
Hysterectomy vs. Oophorectomy
After a hysterectomy, women are not able to birth a child. However, it is important to know that women can still keep producing estrogen via their adrenal glands, which are two small, triangular-shaped glands above each kidney, and this is why Dr. Eleonora Teplinsky on a June 18 social media post says that a “hysterectomy isn’t enough.” And neither is Lupron, she says, noting that you need additional therapy to help “block the rest of that estrogen” that is still getting produced.
Exciting New Option For HR+, HER2- Breast Cancer Recurrence with Approval of Truqap, More Women Can Be Treated With Targeted Therapy
Dr. Teplinsky is head of breast and gynecologic medical oncology at Valley Health System in New Jersey, recently explained that she gets these questions from women a lot.
Clarifying her points, she said that with premenopausal women, a hysterectomy is not enough, because with those ovaries still intact, your body is still making estrogen. Post-menopausal, if you’ve had a hysterectomy and a oophorectomy, removal of the ovaries, you will still produce estrogen “in those other areas” she mentioned in the adrenal glands.
That is why a hysterectomy alone is “not sufficient,” she reiterates.
It is unclear if Munn is still taking any other endocrine therapy or drugs as part of her treatment plan. The film and TV performer also underwent a double mastectomy to remove both breasts
Bottom line, breast cancer can be very complicated, so be sure to seek out multiple opinions and consults to make sure you know the pros and cons of every surgery and treatment that you are considering moving forward with.
What If My Cancer Comes Back?
It’s critical to remember there are still many treatment options available for patients with later-stage breast cancer. The treatment approach will depend on many factors about your individual disease — and may involve surgery, chemotherapy, radiation, targeted therapies, or a combination of multiple approaches.
Therapies for Hormone Receptor-Positive Breast Cancer
CDK4/6 inhibitors are now a preferred first line regimen for the treatment of metastatic hormone receptor positive breast cancer in combination with hormone therapy for post-menopausal women and pre-menopausal women receiving ovarian suppression.
These inhibitors work by disrupting the cell cycle preventing the cells from “committing” to cell division.
The side effects include but are not limited:
- Low white blood cell counts
- Fatigue
- Nausea
- Vomiting
- Diarrhea
- Headache
- Respiratory infections
Learning More About CDK4/6 inhibitors
If the first attempts at therapy do not work, or stop working, there are other options for women with metastatic HR+ cancer.
These include:
- Alpelisib (Piqray) — A PI3K inhibitor (for PIK3CA activating mutation)
- Elacestrant (Orserdu) – An estrogen receptor blocker (for ESR1 mutated receptors)
- Olaparib (Lynparza) – A PARP inhibitor (for BRCA1/2 mutated breast cancers)
- Capivasertib (Truqap) — An AKT inhibitor
- Fam-trastuzumab deruxtecan-nxki (ENHERTU) – An antibody drug conjugate
- Sacituzumab govitecan (Trodelvy) — An antibody drug conjugate
- Pembrolizumab (Keytruda) – PD-L1 immunotherapy, for patients with high tumor mutational burden
- Trodelvy was recently approved by the Food and Drug Administration (FDA) for patients with HR+, HER2- metastatic breast cancer that had stopped responding to at least two earlier courses of therapy.
Drug therapies in the setting of metastatic breast cancer are constantly changing as new drugs and drug combinations are introduced. As a result, there are a plethora of treatment options, especially for those who progress or cannot tolerate a specific treatment.
Cancer treatment is becoming more personalized thanks to next generation sequencing. Please speak with your oncologist about which options are right for you.
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