Bilateral ovarian cysts

[saville]

I am a 46 year old, healthy woman.  I skipped a period this spring, but am largely asymptomatic.   I had an ultrasound last week which revealed bilateral, complex ovarian cysts.  They are large, 6 cm and 4 cm.  I have been advised there is a 75% chance they are endrometrias, and a 25% chance they are ovarian cancer.  In either event, I have been advised I have to have a laprostomy for a complete hysterectomy.

My questions:
1. Are these odds correct?
2.  Do I have to have a hysterectomy if they are endrometrias?
3.  Can the surgery be performed by laprocopy, instead of laprastomy?
4.   Would a CA-125 test be helpful?
5.  I am scheduled for a MRI on Monday.  How will this help?

Thank you, s

[Annekathryn Goodman, M.D.]

Dear Saville,
Thank you for all the excellent information.

Most cysts are benign.
Endometriomas are common.

Ovarian cancer is not common. Overall, women have a 1 in 80 lifetime risk of ovarian cancer which is one tenth the risk of breast cancer.

Now that statistic is a lifetime risk. That is - when your take all 80 to 90 years old ladies and look back over their lives. The risk is much lower, the younger you are. So at age 20 the risk of ovarian cancer is very, very small. At age 40 to 50 the risk is probably 1 in 1000. By age 80 , it is 1 in 80.

Now I am sort of guessing at these numbers. Statistics are general estimates. Each individual is unique.  The chance of a cyst being cancer for an individual will depend on lots of factors including:

what does it look like - solid/cystic, size (anything under 5 cm is considered small), does it have internal nodules
Also - what else is going on - is there free fluid, how much, what about masses in other areas of the abdomen
-Symptoms - bloating, abdominal distension, changes in the bowels
-and associated risk factors:
              -age (the older one is , especially post menopausal , the higher the risk)
              -family history of premenopausal breast and ovarian cancer
              -personal history of other cancers such as  breast and colon


Based on what you have told me, you are low risk.
but having said that, follow-up is good. A CA 125 maybe interesting but remember it is elevated in endometriosis.
The findings on MRI will not be affected by your period.
And finally, the decision to operate to remove the cysts will be between you and your doctor based in your exam, xrays, and personal preference

best wishes

[saville]

My MRI  is tomorrow--the day before my period.  isn't this going to make them appear even bigger than normal!  Should I reschedule it?

I really, really, really appreciate you.  I am a nervous wreck.

[saville]

My horomone levels are good.  No menopause, or peri-menopause.  No history of ovarian cancer.  My mother was diagnosed with breast cancer at 60.  No other cancers in family.  I have never had surgery (except laproscopy for fertility issues) and have enjoyed excellent health.   I just had a mammogram, and it was fine.  

[saville]

I keep thinking of things to add:  I have never had children due to infertility problems, probably related to age.  I had a laproscopy 10 years ago to fix a twisted a fallopian tube.  They ended up just just cutting it.  It was also noted I had significant scarring due to a old, resolved PID.   I have had painful periods since I was 13, but manageable with with advil.

[saville]

Note:  I am not a small woman.  I am 5'10' and 190 pounds.