Surgery necessary for benign ovarian cysts?

[Carla68]

6 months ago I had ultrasound looking for a missing IUD. They didn't find the IUD, but found masses on both ovaries. In the right ovary there was a complex solid and cystic mass of 4.5 x 3.3 cm and an ill-defined hypoechoic mass-like area of 3.3 x 2.6 cm. In the left ovary there was a well-defined fluid cystic mass of 4.4 x 2.9 cm.

I delayed followup due to moving, so it has been 6 months. All three masses are still present, but have not grown. The one on the left ovary is the same size and the two on the right ovary are smaller than they were. The doctor says she doesn't think they are cancer, but she says I need to have surgery to remove them right away.

I don't really get the urgency - they haven't caused any symptoms or problems. If not for the IUD I would never have had ultrasound and would never have known about the cysts.

1. What may happen if I leave them alone? They haven't caused any problems for 6 months, and possibly for years, so what's the likelihood they would cause problems in the future? They haven't grown in 6 months, so what's the likelihood that they will begin to grow?

2. The doctor ordered tests to try to rule out cancer, which of course would be a huge concern. She ordered HcG, CA-125, AFP, and Inhibin A. What kind of results can they reveal if the values are elevated?  She also ordered a CT scan of my pelvis.

3. The doctor suspects they were caused by endometriosis. That surprised me, because I have never had any symptoms of endometriosis - I never have any abdominal pain, not even menstrual cramps. Does that theory seem likely?

[serene64]

A related discussion, urgent? was started.

[akg]

great! keep us posted.

[Carla68]

I'm 37, very little cancer in family history - grandmother had breast cancer at age 80, and one aunt had breast cancer. The blood tests have come back negative. Haven't had the CT yet.

[Annekathryn Goodman, M.D.]

Hi Carla,

I agree with your doctor that you should have more of an evaluation. The blood tests that she has ordered will be abnormal ( elevated values) in some malignancies. The Ca 125 can also be elevated in the setting of endometriosis or inflammation or fibroids. (And yes, sometimes a person will have no symptoms from endometriosis, very curious!)

If you have normal blood tests, have no symptoms ( pain, change in bowel or bladder, bloating, weight loss), and the masses are unchanging then close follow up is reasonable.

I would suggest your doctor consider also getting a CT scan of the abdomen and pelvis just once. Sometimes, the masses of the ovaries are only the tip of the iceberg and there are other things going on in the abdomen as well.

Also, how old are you? Is there any history of cancer in your family?

[Carla68]

I should add I am 37 years old.