Recent dx of septated ovarian cyst

After years of left ovarian pain, I was finally dx yesterday (after a trans vaginal ultrasound) with a 3.1 x 2.4 x 3.0 cm septated cyst, with some free-flowing fluid in the pelvis.  The NP suggested waiting for 6-8 weeks to monitor it, then proceeding accordingly.  In the meantime, I have to wait to get a gyn appt. for a CA-125.  But, my GP is on vacation until Tuesday.  I don't like having something foreign growing within me.  Especially, not knowing the risk or status of it (beningn or other).  I am trying to remain peaceful, yet I am very concerned.  There is a smaller cyst on the rt ovary, but that one doesn't hurt.  I have been in pain for the past week and a half, with lower back pain, headach, shoulder/chest pain and some shortness of breath.  I am also having some GI problems (constipation)...  Is this common?

[kcd86]

I am sorry you have to go threw this, it is very stressfull to have this hanging over your head.  Keep in mind most cysts are benign!!  Since this has been ongoing for you and your trans-vaginal (TV) shows septated cyst with some fluid in your pelvis, warrants a very through work up to rule out any other potential issues.
My wife was recently Dx with granulosa Cell cancer( GCT) Jan 2010 and I know what it is like to not know the next step will be. Here is an overview.
Tests like sonograms, Cat scans and MRI's along with blood tests like CA125, Inhibin A&B, MIS and CEA are just used as a guides for the Dr's to help assist in making a diagnoses(Dx).
A transvaginal ultrasound (TV) is the most valuable diagnostic study in the evaluation of an adnexal or pelvic mass/suspicious cysts.  Cysts, hemorrhagic cysts, endometriomas, and dermoids have a high predictive diagnosis via TV ultrasound. The NP is having you wait because if it is a simple cyst then in about 4-6 weeks it should resolve or become smaller, assuming that it is a simple cyst.The fluid in the pelvis could be from a ruptured cyst but since the cyst is septated I would want to have a cat scan or MRI.(read further)
The blood test CA-125 is a test used by Dr's as a guide to determine if you have the most common form of ovarian cancer, approximately 80% of all ovarian cancers are epitheal ovarian cancer which is cancer of the cells on the surface of your ovary. Please keep in mind that CA-125 can be elevated if your menstruating and some other cuases of inflamation (inflammation)..
There are other types of ovarian cancer that are hormone driven and depending which form a person has there will be excess symptoms of that specific hormone. This is the type my wife was Dx with granulosa cell ca. These group type are called sex cord -stromal tumors. These type of tumors have specific markes that the Dr's use just like ca-125 to aide in their dx of epitheal ovarian ca. They are Inhibin A&B and MIS. Please keep in mind if and only if you have a dx of these form of tumors there is a missconception that these tumors are always benign, which is completely false> They are just slow growing tumors as opposed to epitheal.
Unfortunately with any type of suspected ovarian mass/tumor/ suspicious cyst(s) surgery will be the only way for the Dr's too make a definitive Dx. It is NOT recommended to biopsy any ovarian mass/tumor/suspicious cyst as it can rupture and seed the pelvis with cancer cells if that what it turns out to be.  Please make sure you have your blood drawn for the following blood tests,Inhibin A&B, CA125 and CEA so at the very least you have baseline blood work.
Since there is some suspicion based on your TV-sonogram I would immediately find a good GYN/Oncologist surgeon. I am not suggesting what you have is cancer but studies have shown that treatment of ovarian cancer by nongynecologic oncologists and by low volume surgeons is associated with suboptimal surgical management. I would reccomend going to a large tiertiary hopsital where they see large volumes of patients.  This is not to make you worry even more but to make sure that the Dr who treats you has vast experience with diagnosing and treating various types of GYN / Onc issues if that is what it turns out to be. If the Dr wants to remove the cyst/mass via laprascopic procedure PLEASE make sure they have much experience with removing these INTACT! All too often I read posts from patients who say their Dr thought it was a cyst and removed it haphazardly causing a rupture and seeding of the pelvis with cancer cells, only to be found on pathology post removal.
Next: From experience I would be asking for an MRI of the abdomen/pelvis ,MRI's are very precise when read by a Radiologist that specializes in GYN/ONC, My wife went to a radiology practice that does all types of MRI's and the Radiologist read her MRI as a fibroid. I then took her to Sloan Kettering in NYC to see a GYN/ONC surgeon Dr Carol Brown who had the MRI repeated by a GYN/ONC Radiologist who called her DX to the tee which was confirmed after surgery.
The best advice you see all over these posts is you have to be your own advocate, be aggresive (aggressive) and stay on top of your phycicians. Get copies of all your tests/results. Post with any other questions you have this site has some very knowledgeable people on it. I wish you all the best
Kevin
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