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Ovarian Cancer  (Expert Forum)
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Large Complex Ovarian Mass, elevated CA-125
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center Boston - MA
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MedHelp Member's Question

Large Complex Ovarian Mass, elevated CA-125

by SageQueen, Jul 05, 2006 12:00AM
I have been diagnosed with an ovarian cyst (10.9 cm x 11.5cm) on my left ovary. I'm being referred to a gynecology oncologist because the radiologist saw a tiny bit of surface tissue leading into the cavity and thought it could be non-benign. What does that mean? I'm awaiting my radiology report copy.



My CA-125 came back at 55.7. Could I really have cancer or could it be something else. I do not feel the cyst like I did before and my gyn. thought maybe it was leaking and going away. Is that good if that tissue is cancer?



How would that show up on an ultrasound if it was leaking at the time? Could your menstrual cycle elevate the CA-125 test because they took the blood 6 days before my next period is due.



I'm 35 years old and never had children but want to. My CBC was okay and pregnancy test was negative.



I see the specialist in 2 days. They got me in real fast. I believe I'm on the right track so far.



Any advice you have would be most appreciated. Thanks so much!



Dianne
Doctor's Answer

by Annekathryn Goodman, M.D., Jul 06, 2006 12:00AM
Dear Dianne,

Thank you for your comprehensive report. Most cysts are benign and only a minority of them contain some malignant change. The risk of malignancy increases as one grows older. The risk at age 35 is very low indeed.



A cyst is a descriptive word for a swelling or growth that is mainly fluid. (Think of a blister as an example of a cyst although we do not normally say "I stubbed my toe and have a cyst there."). Cysts can be simple which means that all one sees on the ultrasound is collection of fluid with a skin around it. A cyst can be complex which means that inside the swelling there is a nodule or an extra septation (think of it like a wall between two rooms that contain fluid.)



We are not good at predicting malginancy based on x-rays alone. So there are  some rules we follow about when to intervene surgically:

-if the cyst is increasing in size

-if the cyst is greater than 5 cm

-if a cyst less than 5cm  is "complex" and is not going away on serial scans (such as a scan every 6 weeks to 3 months for 2-3 times).

-if a tumor marker such as a CA 125 is elevated.



Now there are many benign reasons for an elevated CA 125:

-endoemtriosis

-fibroids

-inflammation

-varies with the menstrual cycle



If your cyst was leaking, a repeat ultrasound might show a smaller cyst and some free flowing surrounding fluid in the pelvic area.



It sounds like you are in good hands and that you are getting taken care of quickly. Let me know what happens. Best Wishes
Member Comments (7)

by SageQueen, Jul 12, 2006 12:00AM
Well I went to see the gyn/onc and he said he doubts this is cancer though the only way to know for sure is surgery. I told him that I couldn't feel it anymore so when he did his pelvic he couldn't feel it in front. Instead it was now behind my uterus but he didn't think it felt as big as what the original report said. So he ordered another u/s to see what size it is was. If it's shrinking he said we can wait and see but if it's the same size it's coming out. He said it's rare one over 10cm shrinks but nothing is impossible.



So today I had my second transvaginal u/s and it has shrunk by about half(7cm x 5cm I believe she said). The tech said there seems to be stuff inside. I could see it myself and it looked like fuzzy matter floating inside..not sure how to explain it. I asked her if there could be matter inside from shrinking and she said it was possible. Is this true? What else could it be?



I also have a cyst on my right ovary (2cm) and she said that one is a simple cyst and not to worry.



So I guess I wait to see what the gyn/onc thinks of the results. I'm thinking it will be a wait and see unless he sees something questionable on the scans.



The tech did ask if I had had a cat scan yet and I said no. She also asked if the dr. thought it was a hemorrhagic cyst and I told her he didn't use those words. So I am thinking they were thinking it was blood inside? Could this be the case?



I'm feeling more relieved knowing it's going down. I hope this is a good sign. My gyn/onc told me malignancy never shrinks it just grows. What is your opinion on this?



Thank you for any info you can give me.



Sincerely,

Dianne

by SageQueen, Jul 14, 2006 12:00AM
To: Dr. Goodman
The gyn/onc office just called and he said it has shrunk. It is now 7cm and he would like another u/s in 4 weeks. I asked her why they seemed concerned so she read through his note and all she could find was "thick walled vascular" She said he didn't put down that he was concerned.



What does "thick walled vascular" mean? Is this normal when a cyst is shrinking?



Thank you for your time,

Dianne

by kate121871, Jul 16, 2006 12:00AM
It sounds like they are doing a lot of work on your case.  But don't let doctors get stingy on testing.  Ask them to do MRIs and PET scans before they make you nuts worrying about cancer.  I recently went to the ER and my CT scan showed a complex 12 x 11 cm mass on my ovary with septations.  The scan also showed signs of spread: chain of enlarged lymph nodes and nodules in my omentum.  My CA-125 was 130.  I was admitted to the hospital to try to biopsy the lymph node and then start chemotherapy.  It turned out that a biopsy couldn't be done and I was put on a surgery schedule to remove the mass 11 days later. It turns out it was an endometriosis cyst.  But the doctors could have saved me a lot of grief if they had done the MRI and PET scans when I was first admitted.

by akg, Jul 16, 2006 12:00AM
Hi Dianne,



Hemorraghic means that there is some blood inside the ovarian cyst. This is a common kind of cyst that is usually related to ovulation. That is - in the normal menstrual cycle, when ovulation occurs, the egg breaks through the surface skin (epithelium) of the ovary and then floats into the fallopian tube which goes into the body of the uterus. When that breaking through the skin happens, it can hurt a little. Some women get a symptom of ovulation pain. And sometimes there can be some bleeding at that site on the ovary. That is called a hemorraghic cyst. It will get absorbed with time. Blood inside the ovary can also be from other conditions such as endometriosis which Kate had.

by SageQueen, Jul 17, 2006 12:00AM
To: Little Update
Thanks Kate and Dr. Goodman.



The Dr's office called with my next u/s appt. Aug. 7th and I asked her what kind of cyst. She said according to his notes he has "possible endometrioma".



Now I don't have much pain just twinges here and there. I just finished my period with no cramping just those twinges off and on. Could those twinges I feel be the cysts?



Thanks for all the help it's been such a relief!