Would anyone ever suggest to not operate?

[melissam8484]

I have an ovarian mass (7.7 x 3.8 x 5.3 cm) and all my blood levels are normal (CA-125, APF, CEA, hCG, LDH - test for HE4 still outstanding).  An MRI showed the mass was homogeneous (not Multiloculated) with no fluid present and no evidence of metastasis.  I'm only 38, otherwise healthy, still menstruating, no family history of cancer, asymptomatic.  

Far as I can gather there is nothing pointing towards cancer other than the fact that there is a mass there.  They're going in laparoscopic and if possibly will only remove the mass but not the ovary.  But the mass is pretty well engulfing the ovary so they might need to take the ovary in order to get the mass out.  

I found a study that said having even one ovary removed increases your risk of, well - death.  As well as a number of things that cause death.  Of course, cancer increases your risk of death a lot more - and I'd very much like to know I didn't have cancer.  

I don't really have any options, right?  I pretty much need to let them go in and if they need to take the ovary to find out then they need to and that is that.  It is very very probably a completely unnecessary surgery, but on the off chance that there is some cancer there we have to go check, right?  Or would it be worth getting a second opinion?  

[Minnie6901]

A related discussion, scared to death was started.

[tin08]

A related discussion, adnexal mass meas 10.3cm was started.

[hopeshell]

Just to clarify...most recent message just above meant to be addressed to Shelly823

[hopeshell]

Hi there,

Sorry to hear about your worrisome scan.  Basically, any complex mass (meaning it has both cystic and solid parts) can be cancer.  Since you are post menopausal, your odds increase of it being a malignant tumor versus a benign.  However, don't despair, my neighbor was about your age and had a large complex mass and it was benign.    The CA-125 is a not a good measure of if a tumor is malignant or benign.  It measures a certain protein some tumors release but many tumors do not cause it to rise.  It is just one more screening tool because many ovarian cancers do cause it to rise.  The only way to know for sure if your mass is cancer, is to remove the mass.  This should only be done by a gynecologic oncologist.  Yours is large enough that it must come out and hopefully, you are being referred to a gyn/onc.  Do not just let your gyn do your surgery.  Here are some links for you to read:

http://oreilly.com/medical/news/ovarian_ten_things.html

http://www.wcn.org/findadoctor/

I know how truly terrible it is to be in the place you are in.  Just take a deep breath, make sure you push for a speedy surgery with a gyn/onc and know that you can face it no matter what.  I was 37 (two years ago) when I had a scan with a similar finding to yours.  My CA-125 was elevated though.  I had a gyn/onc do my surgery and frozen sections showed it was malignant so I had a complete staging surgery.  Thankfully, I was staged 1a.  I was so scared and know it is hard to wait but try to hang in there.  You really can't get definitive answers until the mass is removed and it is a good sign that your scan doesn't mention masses in other areas.  Let us know how it goes!

Shelly

[Shelly823]

After MRI, I was diagnosed as having a large right adnexal pelvic mass  that is highly suspicious for ovarian neoplasm.  Surrounding organs are normal. "The mass sis 7.5 cm AO x 6.7 cm transverse  6.4 cm craniocaudal dimension.  It demonstrates  hyperintensity on T1 weighted images on T2 weighted images and heterogeneousiso-tohyperintensity on T2 saturation images.  There is heterogeneous enhancement throughout the mass.  There is also an enhancing capsule of the mass."  "There is no free fluid identified in the pelvis.  There is no significant lymphadenopathy in the pelvis.  My CA 125 was 8.  Can someone please explain this to me.  I am very anxious for information about what i have.

[hopeshell]

Hi Melissa,

Hooray!  I am so happy to read your cyst was benign!  I hope you have a quick, speedy recovery.  That is wonderful news!  :)

Shelly

[shewrites]

Such good news!  What a relief for you!  I'm glad to know that you are cancer-free and healing nicely.  

I hope you'll keep posting here, especially to the "newbies" who are so scared.  Also, I think there is an ovarian cyst forum on Medhelp you can add to your interests and follow.  I get the impression that cysts can re-occur and, as you know, knowledge is power.  

[melissam8484]

Hey Becky -

Here is an articles on the study:
http://abcnews.go.com/Health/Story?id=2430839&page=1

And another about dementia:
http://www.sciencedaily.com/releases/2007/08/070829162824.htm

Obviously if anything is malignant it needs to come out, but there does seem to be risk involved in removing healthy ovaries before age 45 or so *if* no HRT is done.  Basically it is looking like (from initial research) that when it's natural for your body to get hormones (pre-menopause age) it's good for you to get hormones.  Taking hormones *after* menopausal age seems to cause some problems.  It makes sense - to give your body what it would naturally be getting.  

Hope that helps!  I had a benign tumor removed and they took pieces of each ovary for a biopsy but were able to leave most of both ovaries in.  If they had taken them I would have started HRT ASAP since I'm only 38 - and probably continued it until 50 or so.  

[Nerdymom]

I am confused about this 'risk of death' issue.  Does having your ovaries removed (in the absence of malignancy) increase your immediate risk of death?  LIke during the surgery and recovery?  Or are you talking long-term life expectancy?

I am seeing a gyn-onc this Friday to discuss my gyn's desire to remove bilateral cysts (gyn thinks they are dermoids).  I am curious if I do lose an ovary in this process, what is this increased risk of death??

Thanks,
Becky

[Plonanon]

I had a mass that was 9 cm., and I was told that at that size, it had to come out. They didn't know from the ultrasound whether it was benign or malignant. I discussed with my surgeon various scenarios, and we agreed that if it was malignant or borderline malignant he would take everything out. If not, he would take out only the affected ovary. I was nearly 43 at the time. In the end it was malignant, so I had a TAH-BSO.

It is true that bilateral oophorectomy for non-malignant causes apparently does increase the risk of death, though I am not sure that I have read that about unilateral oophorectomy. If your surgeon is willing to try to leave in the ovary if the mass is not malignant, then I think that is the best that you can do.

Good luck.

[hopeshell]

Hi Melissa,

It sounds like you are on the right path with your docs, etc.  I will be praying for you to have a benign outcome.  That is great that it is cystic which is another factor in your favor.  Please post and let us know how it goes.  :)

Shelly

[melissam8484]

Thanks so much Shelly...

That's what I was assuming, but it's good to hear it from somebody with experience who isn't a doctor - and you had a smaller mass at 37 that ended up malignant!  So I'm not in the clear till they go in.  The MRI says the mass is homogeneous, which I believe means it's likely blood or fluid filled (not solid) and they might be able to get it out laproscopically (pop and drain).  

I do have a gyecological oncologist - I've met with him and he seems pretty level headed.  He's also experienced and we agreed that he would be as conservative as possible (if the mass is benign he will do his best to leave me with both ovaries) but of course if there's cancer he will take out anything he thinks is appropriate to remove and do a complete staging.  He and my GYN will be doing the surgery together.  

If I do end up with fewer ovaries or a stage one cancer I will definitely be seeking you out to ask about your experiences!  I just looked at your profile and I'm glad that things are working out well so far on the cancer front  :-)  I'm sorry about the problems with hormones.  

But thank you for your sane perspective on the surgery.  I want to do what is needed and you are an obvious illustration that even with no risk factors I will need to have surgery to be sure.  

Best wishes - and thank you,

Melissa

[hopeshell]

Hi there,

Unfortunately, I don't think you have a choice but to get that mass out.  It is probably benign as most are.  Is it complex?  Even if it is just cystic it is too large to leave.  Any complex mass (meaning there are solid parts in it) can be cancer.  Cystic masses that are large can also rupture and cause infection and a multitude of problems depending on their consistency.  Yes, it stinks to have a hysterectomy or even one ovary removed, but it is better than letting cancer spread.  Try to think of it as one of those things you can't change and get it out.

It is important to have a gyn/onc consult before your surgery and to have one on board in case it is caner and needs to be removed.  Here are a couple of links that explain more and can help you locate one in your area.  

http://www.wcn.org/findadoctor

http://oreilly.com/medical/news/ovarian_ten_things.html

I was 37 and my mass that was 6cm and complex turned out to be malignant.  I didn't fit any of the risk factors.  It is better to be safe than sorry.  But, if during surgery they find your mass is benign I highly recommend avoiding the hysterectomy and leaving the other ovary.  I have had lots of problems as a result of no hormones.  Best wishes.

Shelly