Borderline ovarian mass and cervix neoplasia?

Hello, I'm after a bit of advice. I had a ovarian mass/cyst removed 4 weeks ago. I had no idea that is was there as the symptoms of it were confused with pregnancy ones (I miscarried at 22 weeks gestation 3 days before the surgery). The cyst had burst and I was told it was the size of a large melon plus there was an extra 2 litres of fluid/pus drained out of me, they removed the ovary with the mass and alot of biopsies were taken. I had a laparotomy done and was told nothing else looked abnormal internally and a CT scan the day before showed no signs of anything spread. The lab work showed it was a mucinous ovarian cyst of borderline malignancy, all other biopsies were clear I believe.

I'm seeing my consultant on Thursday but on the phone he suggested a hysterectomy and removal of the other ovary would be the safest option because I also have the added problem of having been re-occurring high grade neoplasia in the glandular cells of my cervix. This has been treated twice by cone biopsy in 2005 and by loop diathermy in 2009. I have 2 children but we did want another baby (hence why I was just recently pregnant). I think I could cope with not having another but I'm really afraid of losing the other ovary and needing HRT etc. Do you think it would be reasonable to keep the other ovary and be closely monitored? I'm hoping they will do another smear (PAP) and colposcopy on Thursday as whether this is clear or not will help me make up by mind.

I also wanted to ask what follow will I need if I don't go for the full hysterectomy?

What am at extra risk of considering the cyst had burst?

Is there any link between the two types of abnormal cells?

Thanks for any help.

Claire

[Annekathryn Goodman, M.D.]

HI There,

Borderline ovarian tumors are slow growing malignancies.There may be a higher risk of recurrence since the tumor ruptured.Unfortunately this is more true for the mucinous subtype than for the more common serous subtype.

because the tumor is slow growing, if you want to try to get pregnant again, it may be safe to wait until after delivery to have a repeat surgery.

I actually think it is safer to go on hormone replacement therapy than to leave in an abnormal ovary.

The data on hormone replacement therapy is pretty clear than estrogen alone (which you can safely take if the uterus is removed) does not seem to increase the risk of breast cancer.The Women's Health Initiative study (WHI) showed that there was an increased risk of breast cancer for women who take estrogen plus progesterone in their 60's for more than 5 years. However for women who take estrogen by itself, there was actually a  reduction in breast cancer risk.

There is not a link between glandular dysplasia on the cervical and ovarian cancer. However, glandular dysplasia of the cervix that has required 2 prior procedures puts you at high risk for the development of cervical cancer. That is another strong indication for a hysterectomy.

That must be alot to have to process especially in the setting of losing a pregnancy. I am so sorry for your loss
take care