切除卵巢 我做出了艱難但明智的決定

LOS ANGELES — TWO years ago I wrote about my choice to have a preventive double mastectomy. A simple blood test had revealed that I carried a mutation in the BRCA1 gene. It gave me an estimated 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer. I lost my mother, grandmother and aunt to cancer.

洛杉磯——兩年前，我寫過一篇文章，解釋自己爲何選擇進行預防性的雙側乳腺切除術。一次簡單的血檢揭示出，我是BRCA1基因突變攜帶者。因此，我罹患乳癌的風險估計達87%，而患卵巢癌的風險有50%。我的母親、外祖母和姨媽均死於癌症。

I wanted other women at risk to know about the options. I promised to follow up with any information that could be useful, including about my next preventive surgery, the removal of my ovaries and fallopian tubes.

當時，我想讓其他同樣有患癌風險的女性瞭解可以作何選擇。我許下了諾言，會跟進任何可能有用的訊息，包括我接下來要做的預防性手術——摘除卵巢和輸卵管。

I had been planning this for some time. It is a less complex surgery than the mastectomy, but its effects are more severe. It puts a woman into forced menopause. So I was readying myself physically and emotionally, discussing options with doctors, researching alternative medicine, and mapping my hormones for estrogen or progesterone replacement. But I felt I still had months to make the date.

那時候，我計劃這麼做已經有一段時間了。相比切除乳腺，這個手術沒那麼複雜，但後果卻更爲嚴重。它會讓一個女人提前絕經。所以，我一直在從生理到心理上做準備，和醫生探討各種選擇，研究替代療法，籌劃我要使用的雌激素和黃體酮替代藥物。不過，我原本覺得，這一天到來之前，自己還有不少時間。

Then two weeks ago I got a call from my doctor with blood-test results. “Your CA-125 is normal,” he said. I breathed a sigh of relief. That test measures the amount of the protein CA-125 in the blood, and is used to monitor ovarian cancer. I have it every year because of my family history.

然而兩週前，我接到了醫生的電話，告知血檢結果。“你的CA-125指標正常，”他說。我舒了一口氣。這個檢查測的是血液中的CA-125蛋白含量，用來監控是否有卵巢癌的跡象。因爲家庭的病史，我每年都做這項檢查。

But that wasn’t all. He went on. “There are a number of inflammatory markers that are elevated, and taken together they could be a sign of early cancer.” I took a pause. “CA-125 has a 50 to 75 percent chance of missing ovarian cancer at early stages,” he said. He wanted me to see the surgeon immediately to check my ovaries.

不過，這並非最終結果。醫生還有話要說，“好幾項炎症標記物的數據有所上升，綜合考慮，可能是早期癌症的跡象。”我頓了一下。“CA-125的數據有50%到75%的概率會察覺不到早期的卵巢癌，”他說，並且希望我馬上去找外科醫生檢查卵巢。

I went through what I imagine thousands of other women have felt. I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren.

就像成千上萬有類似經歷的女性那樣，我百感交集。我告訴自己要保持冷靜、堅強，我也沒有理由認爲自己不能活下來，親眼看着子女一天天長大，看到孫子孫女來到人世。

I called my husband in France, who was on a plane within hours. The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is peaceful.

我給身在法國的丈夫打了電話。幾個小時後，他就跳上了回家的飛機。生命中遭遇這樣的時刻，美好的一面就在於，一切變得如此明瞭。你知道了活着的意義，知道什麼才最重要。雖然極端，但卻帶來了平靜。

That same day I went to see the surgeon, who had treated my mother. I last saw her the day my mother passed away, and she teared up when she saw me: “You look just like her.” I broke down. But we smiled at each other and agreed we were there to deal with any problem, so “let’s get on with it.”

當天，我就去拜訪了外科醫生。她曾治療過我的母親。上一次見她，是母親去世的那天。見到我，她眼中含有淚光：“你跟她長得真像。”我崩潰了。但我們對彼此笑了笑，決定兩人都準備好了要去應對任何問題，所以“我們這就開始吧。”

Nothing in the examination or ultrasound was concerning. I was relieved that if it was cancer, it was most likely in the early stages. If it was somewhere else in my body, I would know in five days. I passed those five days in a haze, attending my children’s soccer game, and working to stay calm and focused.

查體和超聲波檢查都沒有顯示出需要擔心的跡象。就算是癌症，也極有可能還停留在早期，這讓我鬆了一口氣。五天之後我才能知道，是不是身體的其它部位有問題。那五天我過得昏昏沉沉，參加了孩子們的足球賽，忙着工作來保持冷靜和專注。

The day of the results came. The PET/CT scan looked clear, and the tumor test was negative. I was full of happiness, although the radioactive tracer meant I couldn’t hug my children. There was still a chance of early stage cancer, but that was minor compared with a full-blown tumor. To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it.

出結果的那天來臨了。PET/CT掃描看起來沒問題，腫瘤測試的結果也呈陰性。儘管因爲體內有放射性示蹤劑，我不能把孩子們攬在懷中，但我滿心歡喜。雖說還是存在早期癌症的可能性，但與來勢兇猛的腫瘤相比，這算不上什麼。讓我釋然的是，自己仍舊可以決定去切除卵巢和輸卵管，而我的決定就是去做手術。

I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery. I have spoken to many doctors, surgeons and naturopaths. There are other options. Some women take birth control pills or rely on alternative medicines combined with frequent checks. There is more than one way to deal with any health issue. The most important thing is to learn about the options and choose what is right for you personally.

之所以這樣抉擇，並不僅僅是因爲我身上攜帶BRCA1基因突變。我也想讓其她女性明白這一點。BRCA基因突變檢查結果呈陽性，並不意味着你馬上要去動刀。我和很多大夫、外科醫生和自然療法專家聊過，的確有其他的選擇。有些女性會吃避孕藥，或者依靠替代療法並結合頻繁的檢查。對付健康難題的辦法不止一個。最重要的是，你要了解各種應對的辦法，從中選擇對你個人來說最正確的那種。

In my case, the Eastern and Western doctors I met agreed that surgery to remove my tubes and ovaries was the best option, because on top of the BRCA gene, three women in my family have died from cancer. My doctors indicated I should have preventive surgery about a decade before the earliest onset of cancer in my female relatives. My mother’s ovarian cancer was diagnosed when she was 49. I’m 39.

拿本人的例子來說，我看過的東西方醫學的大夫都認爲，手術摘除卵巢和輸卵管是我最好的選擇，因爲除了BRCA基因突變，我的家人中，還有三名女性被癌症奪去了性命。醫生們表示，在我的女性親屬患上癌症的最早年齡提早十年左右的那個時候，我就應該做預防性手術。我母親確診得了卵巢癌是在49歲，而我今年39。

Last week, I had the procedure: a laparoscopic bilateral salpingo-oophorectomy. There was a small benign tumor on one ovary, but no signs of cancer in any of the tissues.

上個星期，我做了腹腔鏡下雙側輸卵管卵巢切除術。一側卵巢上有一個小的良性腫瘤，但所有組織中沒有發現癌症跡象。

I have a little clear patch that contains bio-identical estrogen. A progesterone IUD was inserted in my uterus. It will help me maintain a hormonal balance, but more important it will help prevent uterine cancer. I chose to keep my uterus because cancer in that location is not part of my family history.

我的身上有一個小的透明貼片，裏面含有生物同質性雌激素，子宮內則放置了一個黃體酮節育器。這將有助於維持我的激素平衡，但更重要的是有助於預防子宮癌。我選擇了保留子宮，因爲這個部位的癌症並不存在於我的家族病史中。

It is not possible to remove all risk, and the fact is I remain prone to cancer. I will look for natural ways to strengthen my immune system. I feel feminine, and grounded in the choices I am making for myself and my family. I know my children will never have to say, “Mom died of ovarian cancer.”

排除所有的風險是不可能的，實情是，我還是會易於罹患癌症。我會尋求自然的方式來增強自己的免疫系統。爲自己和家庭，我覺得做出了一個女人的、明智的決定。我知道，孩子們以後決不用說出“媽媽死於卵巢癌”這種話了。

Regardless of the hormone replacements I’m taking, I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared.

儘管使用着激素替代藥物，但我現在停經了。我不能再生育小孩，身體也將出現一些變化。然而，無論將來有何風雨，我內心坦然。這並不是因爲我很堅強，而是因爲這就是我生命的一部分。沒有什麼可怕的。

I feel deeply for women for whom this moment comes very early in life, before they have had their children. Their situation is far harder than mine. I inquired and found out that there are options for women to remove their fallopian tubes but keep their ovaries, and so retain the ability to bear children and not go into menopause. I hope they can be aware of that.

對於那些生命中早早遭遇這一難題，卻還沒來得及生兒育女的女性，我懷有深切的同情。她們的處境比我要艱難得多。經過諮詢，我發現有切除輸卵管但保留卵巢的可能性。這樣就依然能懷上孩子，也不會停經。我希望她們可以瞭解到這一點。

It is not easy to make these decisions. But it is possible to take control and tackle head-on any health issue. You can seek advice, learn about the options and make choices that are right for you. Knowledge is power.

做出這些選擇並非易事。不過，任何健康問題，我們都有可能加以掌控，正面迎擊。你可以諮詢建議，瞭解不同的應對辦法，做出對你來說正確的選擇。知識就是力量。