complex ovarian cysts

[rpeds]

Am am 46 yrs old with a complex ovarian cyst.  U/s in Jan was 2.2 X 1.5 X 2.0  cm with some diffuse internal echos, c/w hemorrhagic follicular cyst.  No solid components or color flow.  No free fluid.  It has been aching intermittently and is bothersome.  Repeat in 6 weeks was unchanged.  Repeat in 8 more weeks (April)  was 2.8cm X1.6 cm X 1.8 cm and conglomerate with low-level echos within the cysts and similar configuration to previous exam -- read as stable but lack of resolution so cystic tumor should be considered.  

GYN said reports are not worrisome, but given age and complexity, recommended a laparoscopy and said if it looked benign, she'd remove fluid and dissect the wall (she felt then removal of the ovary would be overkill), but if worrisome, would remove the ovary.  She also just ordered a CA125 knowing all the limitations.

My question(s):  Is it safe to remove the fluid and dissect, knowing that some will get into the peritoneum?  Is there a better approach?  Am I better off having a gyn/onc do the lap?  She said the malignant potential was 'low' (single digits).  Is that accurate?  And if it were malignant, likely early due to size etc.  Is that true?  (I was trying hard not to get anxious but the recent information is tipping me over the edge and wondering if I should have had the lap in February.)  Any words of wisdom?  Thanks.

[Annekathryn Goodman, M.D.]

hi there,
it sounds like you have had excellent care. If your CA 125 is normal, it makes sense for your regular doctor to do the surgery. My personal leaning would be to suggest removing the whole ovary at age 46 but you should check in with your doctor about that.
best wishes

[rpeds]

For what it's worth, I forgot to add that my sister had breast cancer at age 48 (genetics were all negative), paternal aunt with breast cancer, and maternal uncle with colon cancer at age 60ish.

Another question -- I spoke with a second GYN who said she also agrees with leaving the ovary if it looks benign, and that if it looks suspicious, she closes up and reschedules the laparotomy with a gyn/onc.  Is there a reason you wouldn't remove the ovary at the time of the initial surgery?

Also, do you agree with leaving the ovary if it looks benign on visualization during the lap?