I have apatient who is 24 years old ,diagnosed recently to have ovarian cyst measuring 8x6 cm comlex in nature all tumor marker are high except CA19-9 is very high in thousands. what is the best treatment ?
Your question is not that clear. You have a patient? First part of your question: Keep in mind most ovarian cysts are benign. Since I am assuming that a sonogram showed a "complex cyst" warrants a very complete evaluation by a gyn-oncologist surgeon.
Second: "all tumor markers are high" it would have been helpfull if you posted which tumor markers were reported(CEA,CA125,LFT's). Third: Ca19-9 is not a test for determining if a patient needs to have an hysterectomy, it is a blood test that Dr's use as a guide to help differentiate between forms of gastric cancer like pancreatic and bile duct cancers. Elevated CA19-9 can also be from gallstones, cirrhosis, pancreatitis, and cholecystitis. Lastly: Elevated CA19-9 would not directly warrant a hysterectomy but if there is cancer that has spread from a primary spot then depending on cat scans and MRI's could then warrant further debulking surgeries
I hope this helped a little, good luck
hi kevin, thanks for your answer, yes by u/s and cat scan most likely the features of the cyst is infavour of dermoid cyst, her tumor marker (CEA,ca125,LFT) all were nomal level only CA19-9 was high, yes I know that it is high in the conditions you mentioned, but the patient has been counceled before by another gynacologist for hysterectomy and I counceled her for ovarian cystectomy +/- oopherectomy . when I went into litreture reveiw i fond that there is association between high CA19-9 and mucinoscyst adinocarcinoma ,thats why i am wondering if my plan of manegment is enough
Patients with gastric cancer can also present with signs or symptoms of distant metastatic disease. The most common metastatic distribution is to the liver, peritoneal surfaces, and nonregional or distant lymph nodes. Less commonly, ovaries, central nervous system, bone, pulmonary or soft tissue metastases occur.
I am not familar with prophylacticaly having a hysterectomy and or bilat oopherectomy. I would assume either on cat scan or mri there was suspicion of metastatic spread. If so I would think the next prudent move would be for an exploratory laparotomy for patholgy and washings.
Additionally her complex ovarian cyst of course will need to be removed intact and evaluated with a frozen section in the OR. If it is + for ovarian cancer then it will have to be disscused before surgery if she leaves the other ovary intact, assuming the remainig one is clean of any disease. But according to your post I would think she needs a diagnoses with what may be going on in her gastic area also. So potentially both can be addressed at surgery.
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