Do I have ovarian cancer?

I'm 24 years old. A couple of years ago I had back pain that became severe when I lay flat. I had a CT scan which revealed a large ovarian cyst. My Gyn did a battery of tests and said I had PCOS. Since then I have had three very severe attacks of abdominal pain, mostly on my right side. I was put on birth control and my gyn later said my cyst was gone. But after my second pain attack she put me on a different kind of birth control. A vaginal ultrasound revealed no cysts in mid-May. But about 3 weeks ago I had a very severe pain attack on my right side. I went to the ER and a CT scan revealed nothing except a cyst on my right ovary. My gyn said it was gone just a couple weeks before that. A few days later I had yet another attack and my regular doctor was pretty sure it was appendicitis because I had all the symptoms. He admitted me to the hospital but another CT scan showed no problem with my appendix and nothing on my ovaries. But I did have a slight bladder infection. It also showed fluid in my abdomen. I went back to my gyn last week and she did an ultrasound, which showed nothing on my ovaries and nothing wrong with liver, kidneys, or uterus, but it did show several pockets of fluid. She did a pelvic exam and tested for VD and she did a blood test for CA-125 which came back elevated (above 200). So now she wants to schedule me for surgery to rule out ovarian cancer. She says she doesn't think it is because of no masses, nothing on the scans, and my age. She thinks it might be endometriosis. But my Internet research doesn't indicate that endometriosis causes fluid pockets (ascites). So I'm still very much afraid it's ovarian cancer. What do you think? And also, shouldn't my gyn do a paracentesis prior to deciding on surgery? Thanks.

[J.M. Keyes, MD]

Hi there,
I'm sorry to hear you have been having such a time with this and have had no resolution.  It sounds to me like the fluid in your abdomen may be from ruptured ovarian cysts, although it is impossible to tell for sure because I have no access to you (ie examination) or your tests.  I think it is smart to have the surgery (likely laparoscopy) if you have an elevated CA-125, but I agree that it is unlikely that you have ovarian cancer.  
Having a paracentesis would be unnecessary since you should have the surgery anyway, and that will answer any questions paracentesis would.  Also, you may not have enough fluid to be able to extract some through a paracentesis.
If it were me, I would go through with the laparscopy (endometriosis is likely I think).  I would be very surprised if you had ovarian cancer, so try not to lose too much sleep over that in the meantime (easier said than done I know).
Best of luck.  I hope you get some answers and are feeling better soon.
JMK MD

[wilstar]

Thank you for your response. It, along with my gyn's speculation, makes me feel a little better, but I was hoping to avoid surgery if possible. I'm freaked at the anesthesia. I am only 24 and feel like an old woman. I have complex migraine with auras and am on Topomax (topamax), which conflicts with my birth control pills. I have PCOS. And now I have all these things going on inside me (abdominal pain, nausea, bloating, elevated ca-125, ascites). I'm tired and scared.

[sarajefferson]

I agree with the earlier post.  A laprascopy is the only definete way to tell if it is ovarian cancer but the ultrasound is pretty accurate!  I am a nurse and schedule gyn surgeries we recently had a pt with a ca125 of 300 and it was endometriosis.  Very unlikely this is cancer.  Good Luck

[Justnoww23]

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