Trust gyn or see gyn oncologist?

[justus4]

I'm 45 , no period since March, pain in lower left abdomen...GP ordered tv u/s showed complext cyst on left ovary 2 cm...referred me to gyn. Gyn didn't think a 2 cm cyst would cause pain but does order a CA125, which was normal and orders repeat tv u/s 6 weeks out and adds for them to r/o a hernia...they don't call me with results, so I called today.  Receptionist says u/s shows the complex cyst has gotten larger but that "it's not abnormal".  I don't know what that means.  I have been spotting off and on now for a couple weeks.  I have a very bad family history of breast cancer, including sister diagnosed at 37, so I was under the impression that increased my risk of ovarian cancer.  I read that complex cysts that increase in size are normally removed surgically, but she isn't even asking me to come in for an appt or another u/s or anything.  I'm not sure whether to chill out and trust her or go see a gyn oncologist...any suggestions would be welcome...I don't want to get sick, because I was being polite to a doctor!

[justus4]

thank you, Nerdymom and Hopeshell...I am usually not an alarmist, but I'm going to be more demanding on this...it's not like we have a lot of margin for error!  thanks again!

[Nerdymom]

Justus4...

I'm no expert but been reading a lot since I found out I have complex cysts.  I also have a family history of breast cancer and ovarian.

Here are the reasons you should see a gyn-onc in my opinion:

1) cysts are complex  (size is generally not an indicator of malignant vs benign... even the most tiny tumors can be cancerous)

2) family history of breast cancer (your sister getting it at such a young age might point to a hereditary component... did she get checked for the BRCA 1 or 2 mutation?  Who else in your family has had it?

3) changes in your period

4) cyst getting larger


The presence of complex cysts along plus your family history would warrant a gyn-onc referral in my opinion.  Call your gyn today and ask for a referral.  Get your CA125 levels asap too.

Keep us updated!

[hopeshell]

I am bit concerned that given your symptoms, he is not following up.  I think you should seek a second opinion by another gynecologist and push for a transvaginal ultrasound again at that time to check on the size of your cyst.  Also, call your doctors office and ask for a copy of the old report.  The receptionist saying it grew is just too vague.  You need to know the size change.  You know your body and keep pressing for answers.  If you are having pain, loss of your period and also have a complex cyst...you shouldn't just be ignoring it as your gyn seems to be doing but not having you scheduled for follow up.  

Usually, a gyn/onc will only see referrals who meet certain criteria for cancer.  Since there are so many cysts out there, they try to limit the ones they see based on a referral from the gyn and certain criteria related to the tumor. They are pretty much the one to get involved when surgical intervention is required.  The general rule for that is over 5cm and complex.  The CA-125 results are really not a great indicator of if your tumor is malignant or not.  That said, if your 2cm complex mass is growing quickly and not resolving, I think you need to have a gyn who will consult a gyn/onc for an opinion on your treatment.  

Most cysts resolve, but with your symptoms, family history, and the fact that you have been told it grew...I think you need to follow up ASAP with another gyn.