Large ovarian cyst and elevated CA 19-9

My wife was diagnosed with a 20 cm mass that seems to be forming from her left ovary. The original diagnosis was mucous cyst adenoma  and she did an ultrasound and MRI. This morning we found out that her ca19-9 came in at 289 and the doctor ordered a ct. What could cause this elevation. She is healthy, energetic and besides the discomfort for the mass has no other symptoms. Could the size of the mass cause these results? Is pancreatic cancer a possibility?

[Annekathryn Goodman, M.D.]

Hi There
While CA 19-9 is used to follow pancreatic cancer , it can be elevated in mucinous tumors and in dermoid cysts which are benign tumors of the egg cell (also called mature teratoma)
She needs to have that mass removed.
I would suggest a consultation with a gynecologic oncologist.
please let us know what happens
take care

[Juan0773]

Thank you for the information. She is having surgery tomorrow and I will let you know what happens.

[Juan0773]

My wife is currently in recovery after a 35+cm borderline mucinous tumor was removed. The tumor had encompassed the left ovary, so Dr. Sharon Lewin also removed her left ovary and tubes and her appendix. Her right ovary, tube and cervix looked healthy and nothing else was present. The biopsy was performed and the results of the complete section will be back in 5 days. The doctor is very optimistic that we will receive positive results. Although I am still quite worried. I have a picture of the tumor if anyone would like to see it.

[carolyn663]

I am hoping that your wife's biopsy came back with good results. The medical language is so confusing. Do you know what her Stage, Grade and Cell types were?

I am also recouperating from a similar surgery, they removed both my ovaries, tubes as well as the appendix, but they also removed my omentum & did a peritoneal wash.  All was clear of cancer except the ovarian cyst that they called an adenocarcinoma that came from mucinous borderline cystadenoma-it seems that the cancer was confined to the right ovary.  I don't know exactly what this means yet as I have not been given  my Stage, Grade and Cell Type.

I am also trying to understand exactly what this diagnosis means as I have been given 3 options by my gyn/onc
1) Do nothing - meaning followup appointment every 3 months for bloodwork & ultrasound
2) Do 6 monthly rounds of chemo (just in case they missed finding the originating or lingering
     cancer cells somewhere else)
3) Do a 2nd surgery to remove lymph nodes and do multiple biopsies-the Dr's least favorite option as she says this is a much more invasive surgery than was just done and can have many complications.

[Annekathryn Goodman, M.D.]

Hi There
a bordeline tumor is usually cured by complete removal

for Carolyn - I would recommend getting a second opinion on the pathology from a high volume place like Mayo Clinic, Johns Hopkins, Mass General, or MD Anderson.

The decision on what to do next is very much related to the pathology.

if you had a tiny spot of invasive cancer inside a big borderline tumor, you may be fine but it depends on:
the grade of the cancer - if grade 2 or 3 more risk of recurrence
and whether there was rupture of the tumor during surgery
and whether the invasive cancer was involving the surface of the ovarian tumor

are you being seen by a gyn oncologist? if not, you should get a second opinion from someone in that subspecialty

best wishes