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Ovarian Cancer (Expert Forum)
Hetereogeous fluid filled pelvic mass on CT
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
This forum is for questions and support regarding ovarian cancer issues, such as: Biopsy, Chemotherapy, Clinical Trials, Genetics, Hysterectomy,Immunotherapy, Ovarian Cancer Types, Radiation Therapy, Risk Factors, Screening, Staging, Surgery.
Hetereogeous fluid filled pelvic mass on CT
by ebt, Sep 19, 2006 12:00AM
Hi,
Could you please run through the various conditions this CT result could indicate? I'm getting conflicting direction from the staff at my clinic. Two intake nurses said this could be urgent and I should probably be evaluated by an oncologist, and soon, and but the nurse who scheduled me said "I haven't seen your tests, but I've seen this before and there is no problem with waiting for an appt."
I assumed the mass was just a subserosal, pedunculated myoma I was diagnosed with 6 years ago. At that time it was 5x3x3cm. that diagnosis was on the basis of a Transvag US. However, the mass on CT now is 7x7x7 and showed heterogeous contrast with many fluid filled areas. The contrast become more homogenous on the delayed scans. Report said it was unclear if it was a uterine myoma or an ovarian mass. There is no free fluid or air in the abdomen.
I had a full feeling for the last year, and had a tender area that only hurt when I poked it, but finally developed enough constant low back pain and bloating to call the DR a month ago. I have also had nightsweats, occasional fevers with no apparent cause, and some irregular bleeding. I am 46. I am high risk for Ovarian Cancer due to history of infertility, Clomid and Family history.
But isn't it likely this is just the fibroid beginning to degrade? I just would like to know the range of things I could be facing and which additional diagnostics would be appropriate. Thanks!!
Could you please run through the various conditions this CT result could indicate? I'm getting conflicting direction from the staff at my clinic. Two intake nurses said this could be urgent and I should probably be evaluated by an oncologist, and soon, and but the nurse who scheduled me said "I haven't seen your tests, but I've seen this before and there is no problem with waiting for an appt."
I assumed the mass was just a subserosal, pedunculated myoma I was diagnosed with 6 years ago. At that time it was 5x3x3cm. that diagnosis was on the basis of a Transvag US. However, the mass on CT now is 7x7x7 and showed heterogeous contrast with many fluid filled areas. The contrast become more homogenous on the delayed scans. Report said it was unclear if it was a uterine myoma or an ovarian mass. There is no free fluid or air in the abdomen.
I had a full feeling for the last year, and had a tender area that only hurt when I poked it, but finally developed enough constant low back pain and bloating to call the DR a month ago. I have also had nightsweats, occasional fevers with no apparent cause, and some irregular bleeding. I am 46. I am high risk for Ovarian Cancer due to history of infertility, Clomid and Family history.
But isn't it likely this is just the fibroid beginning to degrade? I just would like to know the range of things I could be facing and which additional diagnostics would be appropriate. Thanks!!
Doctor's Answer
by Annekathryn Goodman, M.D., Sep 19, 2006 12:00AM
, Sep 19, 2006 12:00AM
Hi There,
I think you are right on. This sounds very much like a degenerating fibroid. It sounds like you have thought through the possibilities well. I would suggest a pelvic MRI as the best way to distinguish between a degenerating fibroids and an ovarian mass.
Finally if you have pain, a growing fibroid, and a family history of ovarian cancer, you should consider the option of surgery to remove the uterus, tubes , and ovaries. We do not know of any way to protect women at high risk form ovarian cancer except to remove the ovaries. Also we do not have a screening test for ovarian cancer.
best wishes to you
I think you are right on. This sounds very much like a degenerating fibroid. It sounds like you have thought through the possibilities well. I would suggest a pelvic MRI as the best way to distinguish between a degenerating fibroids and an ovarian mass.
Finally if you have pain, a growing fibroid, and a family history of ovarian cancer, you should consider the option of surgery to remove the uterus, tubes , and ovaries. We do not know of any way to protect women at high risk form ovarian cancer except to remove the ovaries. Also we do not have a screening test for ovarian cancer.
best wishes to you
Thank you for your response. I was waiting for my f/u with my Dr. before I wrote back, and it has taken this long. Dr. says I probably should consider surgery to treat what we assume is the myoma due to its size, but she said it is up to me and my tolerance for living with the symptoms. She is recommending just taking the myoma.
She still wants the endometrial biopsy, because of the endometrial cells on the pap, but said she could do that while I'm out for the laparotomy. Yay!
She ran a CA125 and it is 50. I was on day 4 of my period, so Dr. said that was not too concerning. Good!
So my two questions: Do you concur I can wait as long as I want to schedule all this? And Two, since I will probably need surgery anyway, and we do not know for sure it is the fibroid and not an ovarian mass, and with the abnormal pap, and a borderline CA, should I just consider having the surgery done by a Gyn/Onc to avoid having to go back if something comes back on the pathology?
Thanks again, I echo everyone's gratitude for how graciously you handle this difficult forum!
I would recommend repeating the CA 125 in a few weeks to make sure it is not going up. I agree that a fibroid can give a value of 50. That is very common.
It is hard to say whether you should have your regular gyn or a gyn onc do your surgery. You could see if you can get a second opinion with a gyn onc who can examine you and directly look at the films. That might help sort that question out.
best wishes to you.