Cyst found in Ovary and High CA 125

[WorriedBF]

I want to thank you in advance for your advice. My fiance is East Indian and 28 yrs old. She has been having dull pain in her lower stomach for the last few months. The doctors at first were telling her she had IBS. A month ago she had unusual frequent urination and her GP gave her antibiotics for a Bladder Infection. The symptoms did seem to go away after completing the dose.

Just to be cautious, her GP did an Abdominal and Pelvic Ultrasound. This was done about 4 days before her period. They found a cyst in her right ovary. The cyst measured 26x33x19 mm. The report didn't say whether it was simple or complex. Also, there were a few small Nabothian cysts in her cervix and the bladder was distended.

The GP ordered a CA 125 because of my Fiance's family history. Her maternal aunt passed away from breast cancer in her late 40's. Another maternal aunt passed away in her late 40's due to some kind of stomach problem/mass. It isn't certain if it was due to OVCA since it was a long time ago in India. My fiance took the CA 125 blood test on what would have been the 5th day of her period. She stopped bleeding after the second day. I am not sure if this was related to her condition or just the stress of the whole situatiom. This usually does not happen to her. Her CA 125 results came elevated at 71 U/ml.

She and I are very worried. Her doctor refered her to a Gyncologist. Since she has an HMO, it is not until 3 weeks later. I understand the false positive implications of CA 125. However, one website that said for patients that have a pelvic mass and a CA 125 above 65 U/ml, 90% of the time there is maligancy. This fact seems contrary to what most sites say about CA 125, that one test is not conclusive. Can you please tell me honestly what are the chances of her having OVCA? Is her GP just being cautious or is there something to be worried about? What steps should we take next? I think it makes more sense for her to see a Gyno Oncologist and just skip the Gyno. The uncertainty and the wait due to the redtape are killing me.

[Annekathryn Goodman, M.D.]

Hi There,
Thank you for your complete information. Most cysts are functional and come and go. A CA 125 can fluctuate with the menstrual cycle. please see my previous recent comments on CA 125. It is a nonspecific test especially in very young woman.  However with a strong family history, it is a good idea to ask for a consultation with a genetic counselor. Our general rule is that we start screening family members about 10 years before the age of the family member who developed cancer. So for you fiance that would be mid 30's. Having said that it would be very reasonable to consider genetic testing. if she has BRCA1 or BRCA 2 gene mutations that is a reason consider the prophylactic removal of the ovaries. i would definitely recommend that by age 35 in someone where relatives are getting cancers in their 40's.

For right now, it sounds like she has a great GP who is careful and thorough.  A gyn oncologist can also give more perspective and help guide the next step ( probably repeating the CA 125 and the ultrasound)
best wishes

[WorriedBF]

Thank you for your kind words. It helps to hear the oppinion of other people with some background in this situation. I would appreciate more information from the doctor. When is the doctor going to post next?

[sistertwo]

I completely agree with you & think it would be wise for her to see a gyn/onc. If it's nothing, wonderful! If it is something more serious, then a gyn/onc will be the best physician to handle this type of situation. I wish the best to you & your fiance. Hang in there.