10cm adnexal mass, what to do.

[juliesmom]

I have a surgical dx of endo, almost 6 years ago and one more lap since to remove another 5g of it.  Went to gyn last Tuesday for annual pap and he found a 10cm mass on the left ovary, confirmed by ultrasound.  CA125 results were 43.1 and he suggests that I have ovary removed.  There is family hx of ovarian cancer, maternal grandmother died with it due to untimely dx and poor healthcare.  After my last lap, Aug 06, I had a horrible time with the anesthesia and just basically felt awful, swore that if he had to go in again he was taking it all out with him, but now I'm not so sure I'm ready for that.  I'm 34 and my husband and I have been trying to have our 2nd child for about 3 years with no luck...I'm lost.  I have an appt w/ the gyn tomorrow to discuss what I should do and want to know if there are specific questions that I should ask or new methods of finding out exactly what this mass is.  US report says most likely hemorragic cyst but can't rule out cystic ovarian neoplasm.  I'm scared and confused.

[juliesmom]

Since I had a lap done last August my doc doesn't think its an endometrioma.  He says that endo tissue doesn't grow that fast.  I'm still going to try to find some other kind of treatment or therapy for this...I'm not symptomatic, other than some abdominal tenderness when palpated, so I think it's reasonable to just wait a bit and see.  I hope he agrees.

[Casey06]

With your history of endo it could be an endometrioma (endo inside ovary) and unfortunately the best treatment is surgery, but your doctor or possibly a gyn/onc could offer another treatment.

It is almost impossible to do a needle biopsy, because it is difficult to accurately locate the ovaries inside the pelvis.

A large cyst like this should be evaluated by a gyn/onc.

I am sorry you are having these troubles. I hope you get relief soon.

[nyc lady]

I know that it is easy for me to say, but, try to relax....your grandmother having OvCa really does not increase your risk all that much....it is an increased risk when first line relatives (mother, father, sister) have breast, ovarian or colon and even then the increased risk is less then 10 percent.  This is basically a random disease.  

We are all afraid of the unknown...no one blames you for your fears.  

Usually they do remove cysts over 5 or 6 cms as they can begin to twist and cause trouble.  I don't think that waiting until your next cycle to do another sono is such a bad idea....if it is a folicle cyst, it could shrink. Did they say what kind of cyst it was?

I don't blame you for not wanting to rush into surgery....again, I do suggest a GYN/ONC just because you have had other surgeries and they have more training in gynocological issues, their practice isn't based around obstrestrics (sp?).

Pam

[juliesmom]

Thanks, I'm just terrified of being put to sleep yet again and this time not having any idea of just exactly what I might be missing when all is said and done.  The US report suggested waiting 6-8 weeks or at least one menstrual cycle and repeating to see if there are any changes, would you do that or go ahead and schedule the lap?  Since I watched my Granny die from ovarian cancer I have a hard time waiting around and hoping that this thing will shrink or at the very least not grow any larger.  Honestly, the CA-125 results don't worry me much, it's more the family history that's concerning me.  My GYN is wonderful, after suffering with endo for about 8 years and being told that it was just cramps by my PC I went to a friend who is a midwife and asked her honestly who the best GYN in town was and when she gave me his name I trusted her.  The 4 other docs I've asked to look at my labs and US have all said that they trust him and would trust him with their wives, he's a good doctor, proactive yet conservative.  Maybe I'm just afraid of what he'll find once he gets in there, then again, my last lap was just over a year ago and this wasn't there at that time, certainly he'd have found it.  Who could miss something the size of a baseball???  I'll post again after I talk to him tomorrow.  I've got lots of questions to ask him before I schedule another surgery.

[nyc lady]

I do not know if they can do a needle biopsy of an ovarian cyst.....I believe that it is done laproscopically.  But, I could be wrong.  

[juliesmom]

So, can they biopsy this thing w/o putting me to sleep?  No one, and believe me I work in a hospital and have asked several doctor friends, has even brought up maybe a needle biopsy.

[nyc lady]

Being pre-menopausal, a CA125 of 43.1 doesn't mean much.  

With all of  your issues, have you thought of going to a GYN/ONC????  No not because I think that you have cancer, but, because they are the experts in gynocological issues, they have 3 years additional training and often treat benign conditions such as endo.  If there is a slight chance that cancer is suspected then you want the surgery to be performed by a GYN/ONC.  Studies prove that women have a better survival rate when operated on by a GYN/ONC.  

The report will always read, can't rule out cancer, etc....that is normal because they can't tell by the report if it is cancer or not, the only to know is from a biopsy.

Good luck.