OBGYN refuses to remove my 5cm cyst laproscopically...?

Hello,
I was hoping to get some input here. When I went in for menorrhagia and related symptoms, an intravaginal ultrasound shows I have a 5-6cm cyst with an enlarged right ovary. As treatment, they want to remove them; but the OBGYN refuses to do it laproscopically. He wants to do a full open vertical incision (not even transverse=bikini,) surgery! What the heck? The only reason he really gives for this is that he doesn't do them if he suspects cancer. A. everyone I spoke to on his staff told me he does them and nothing else indicates cancer (blood test, D & C, PAP.) B. isn't suspicion of cancer the main reason for such a removal? Yet it seems most on here have had theirs done laproscopically.
I do not wish to have such an invasive archaic surgery, with so much down time (not an option.) The Dr. ended the last visit, not wanting to deal with me, by saying "you obviously don't think it is cancer, so we will just keep an eye on it." Of course, this has not resolved my ongoing issues and leaves possible cancer looming.
The other problem is that he is the only horse in town, so to speak. He's specialty is Oncology and if it were cancer he is in a hospital where they would know immediately and could proceed appropriately.
Could I please be advise if this is common for a Dr. to choose and why, along with advise on how I should proceed.

Thank you!

[GYNsymptoms]

No, I don't believe that is common at all!  I had a 6 cm complex cyst that was dealt with laparoscopically.  We actually watched it and it shrunk every month but I was still having pain so my gyn went in to check things out.  Is he a gyn oncologist?  If so, you could go to a regular gyn who probably wouldn't only focus on cancer, cancer, cancer.  Was one of the blood tests a CA-125 and do you know the results? Wow, I'm sorry you are going through this!  Be your own advocate!  

[Delphinid]

Thank you for your response! Okay, now I don't feel so unreasonable. I have had repeated ultrasounds and it isn't shrinking. Yes, he is a GYN Oncologist. I am going to call my original OBGYN today, it is just they aren't as equipped if say it is cancer (doing this all just once makes the most sense to me.) Yes, I had the CA-125 which they said came back within normal range (he told me those aren't very conclusive.) That is why I am here, trying to be my own advocate, I am just not getting very far! I appreciate your input :)

[BethesdaGirl]

Why would this doc be so insistent on it being cancer and wanting to do a vertical incision?  That doesn't make any sense to me.  I had a 6cm complex cyst removed laparoscopically (along with the ovary) and the recovery was a piece of cake.  Surgeons can start a surgery as a lap and then if they see that it is cancer, they can convert to a full incision surgery. I would definitely get another opinion and I wouldn't care how far I had to travel to get it.  This guy sounds like a hack!  I wouldn't trust him.  Make sure you find a GYN that does a lot of laparoscopic surgeries. Please keep us updated.  Let us know how it goes.   GOOD LUCK TO YOU!

[sassyfras1985]

Hi there, the only reason I would think this to be his only option is if he truly suspects it is cancerous. When removing a simple cyst or something believed to be benign they go in and drain the fluid from the cyst and then remove the excess tissue to send for testing just in case. This can all be done laproscopicaly. However if something is believed to have a risk of being malignant it is better to open up enough to remove the cyst/tumor as a whole as not to let any fluid spill onto surrounding tissue. If fluid from inside a malignant growth erupts the surrounding areas could end up causing more tissue to be affected by the cancer. A ca-125 is pointless unless you are menopausal. Younger women have to many shifts in hormones for them to be accurate. More people have false positives than false negatives but I had a borderline Tumor with super low ca-125.

[GYNsymptoms]

My CA-125 result was 12.  I asked my doctor before I had it drawn about research I heard with it not being very accurate.  She said they are pretty accurate if they are low it's the higher ones that may or may not be cancer/ are inconclusive.

[Delphinid]

Yep, that is my thinking, but he wasn't interested. He was my second opinion, and none are in my city so he was a short travel. Have an appt. with my original GYN next week. Glad yours worked out. THANKS!  

[Delphinid]

That was the only rationalization he gave (possible cancer,) yet when I asked him if he really felt this was cancer, he didn't relay a strong impression (if he REALLY thinks it is, he probably shouldn't have said "lets just watch it.") As I said, nothing else has red flags it as being cancer (though, I realize the only conclusive way to know is through biopsy.) I know they don't want anything to spread if it is cancer, though I am not confident full open surgery saves you from that possibility, and with laparoscopy they can bag as they go to prevent spread as well. It is also my understanding, that cysts much of the time are not treated and most go away on their own. Mine is not, and with those cases, what prompts treatment is risk of cancer; therefore, laparoscopic shouldn't/wouldn't even be on the table for cyst/ovary removal...? How many on here have had cyct/ovary removal, where the main reason was to screen for cancer, and had it done  laparoscopically?
I do appreciate your response; I am just trying to get this all straight in my head, and be more informed as I proceed with this .

[BethesdaGirl]

My GYN was pretty confident that my 6cm cyst was an endometrioma based on the ultrasound.  And since it wasn't going away (we had been watching it for months) she said it should be removed.  Just to be 100% sure, I got a second opinion and the second GYN also thought it was an endometrioma and also felt I should have it removed even though I had no symptoms whatsoever...no pain at all.  I guess once a cyst gets to be a certain size, they feel it should come out.  Of course, they did say that they couldn't be 100% sure what it was until they got in there, but both of them were pretty confident it was an endometrioma.  Since it wasn't bothering me at all, the only reason I had the surgery (aside from the fact that they both recommended it) was to make 100% sure the stupid thing was benign...which it was. Both doctors recommended a lap procedure.

What did your ultrasound show?  Did the doctor or ultrasound tech provide you with any information on what they saw on the ultrasound?

Also, if you don't mind me asking, how old are you?

[Delphinid]

You know, the doctors have mentioned that as being the most likely diagnosis for what is going on with me as well. So, they recommend and did lap removal for you, again making me not understand my GYN's stand. What was basically relayed from my ultrasounds is that I have a cyst on my right ovary that is also enlarged, with prodding, he finally gave me a size of about 5-6cm, the endometrioma was brought up adding they can't be sure it isn't cancer with out the removal biopsy. Probably, very similar to your experience only my GYN refuses to do it lap. Glad yours was benign!
I am 42 and have never had children.

Thank you!

[Delphinid]

Forgot...if you don't mind me asking, did you have any symptoms? What prompted the ultrasound? I know you said no pain, but were you having issues with your period, weight gain, adult acne...things seeming hormone related?  Did the lap go fine, and have you had any issues since the removal?  

[BethesdaGirl]

Hey Delphinid - It's kind of a long story.  In my teens, 20s and early 30s, I always had horrific cramps each month (along with nausea, vomiting, etc).  We long suspected I had endometriosis (which can cause endometriomas) but I was reluctant to have surgery just to see if that was what was going on. I was scared to have surgery. I got by using pain medication each month. I finally went on the pill when I was 36 to help with the pain and it helped tremendously, but the pill gave me migraines.  I put up with the migraines for 10 years because the migraines were better than the monthly menstrual cramps/sickness.  But, one day, I got so fed up with the migraines, I decided to stop taking the birth control and see what would happen.  And what do you know?  The horrific cramps DIDN'T return when I stopped taking the pill. I was elated. I was in heaven. No migraines, no cramps.  Life was GREAT!  I was 46 years old.

Time comes for my annual GYN visit and the doc asks me about my cycle and how it's going.  I say everything is great, no pain, etc.  But, I mention that I'm spotting and also mention that that's the way I've always been when I haven't been on the pill. That spotting is completely normal FOR ME. I always spotted for a few days after my period ended before I went on the pill and was spotting again now that I was off the pill.  She didn't seem convinced that that was ok and asked if I minded getting an ultrasound; so I did.  Of course, the ultrasound showed a cyst on my right ovary...5 to 6cm.  We repeated the ultrasound the next month, still there.  We repeated it two mores times because I didn't want to have surgery, and it was still there, but hadn't grown at all.  It never bothered me.  No pain, no acne, no weight gain (I'm super thin and have been underweight all my life), no nothing...no symptoms whatsoever. After the fourth ultrasound, she told me "you really need to get it taken out".  All along she suspected it was an endometrioma.

Got a second opinion mostly because my GYN was no longer doing hospital procedures. She had changed her practice to only do in-office procedures so I needed someone to do the surgery.  I researched and found a wonderful GYN, saw her, and got her opinion. She agreed with first doc that I should have the surgery and also felt that it was most likely just an endometrioma.  Was scared to death because I had never had surgery before. Came to this forum to read about experiences others had had with the surgery and that helped a lot.

The surgery turned out to be a piece of cake. When she got in there, she saw the endometrioma, of course, and also found another smaller endometrioma hiding behind the one we had seen on the ultrasound. She removed them both, and also had to remove my right ovary and right fallopian tube.  The endometriomas had destroyed the ovary. She found endometriosis, of course and adhesions and she was somewhat surprised that they weren't causing me any pain.  She said my left fallopian tube was also "messed up" but decided to leave it alone since it wasn't causing me any issues. I think she took care of some of the endo and adhesions, but she was reluctant to do "too much" since I wasn't having any pain issues.  We wanted to be conservative with the surgery. I was in recovery a long time because the general anesthesia made me so sick (nausea/vomiting).  

Went home the same day and never had a lot of pain.  Took the anti-inflammatory med she gave me (toradol) for 24 hours, more of a "just in case" than anything else.  I wanted to stay "ahead" of any severe pain that might decide to come along...but it didn't. After 24 hours I switched to Advil and took that for the next 24 hours or so.  I was afraid of the gas pain that everyone talks about with lap surgery, but I didn't really experience that.  My belly was flat as a board when I came out of surgery and I didn't have any major gas issues. I felt a little pressure mid chest on day 2 or 3 and got nervous (because I thought I was having heart issues) but then realized that it was probably just a small amount of trapped gas. DUH!  Day 4 or 5, I felt a little ache in my shoulders, but honestly it was NOTHING.  Have had worse shoulder pain the day after a good aerobics workout. No big deal.  The incisions didn't give me a problem.  I had 3...one in belly button that wasn't visible and two tiny ones on either side close to my hip bone. They are no longer visible. Went back to work in one week.  Could have probably gone back earlier, but I was a bit tired the days following the surgery. I took it completely easy...rested all the time, napped, and took slow, small walks around the apartment the first few days.

It has been 1 year since the surgery and everything is great.  Don't have any hormonal issues since I still have one ovary. The surgery was so much easier than I expected. My surgeon is very talented, a great all-around doc.  I was so fortunate to have picked a wonderful surgeon. The lap is so easy compared to a full incision surgery.  Oh yeah, and I still spot right after my period so the endometriomas weren't causing the spotting.  The endometriosis that I have is probably causing it (I'm guessing).  

I really hope you find a good doc to help you and one willing to at least start the surgery as a lap to see what's going on.  And, of course, I hope and pray that your cyst is completely benign. Wish you lived in the Washington/Baltimore area where we have so many good docs to choose from.  Please keep us informed and let me know if you have any other questions.

[jbesmom]

I had to have a vertical laparotomy a few years ago, but my cyst was 8-9 cm, and I was 19 wks pregnant. I was also told they couldn't risk the cyst leaking by doing a laparoscopy. It ended up being a LMP mucinous cystadenoma. My doc is a leading gyn onc in Dallas.  I'm seeing him again because I have another cyst now on my remaining ovary. This one is smaller, 3x5 cm, but is complex again and causing me slight pain as well as some hormone issues I think (or maybe I'm just getting crazy).  This time he said they normally wouldn't do anything for a cyst under 6 cm, but with my history we're going to go ahead and have it removed. He's doing it laparoscopically this time, using a "divinci robot" and if it's LMP again, he'll probably take the ovary, if it's benign, he'll try to leave it so I don't have to do HRT. He's also taking my appendix, as there is apparently some connection with mucinous cysts and appendices....  Oh, I am 34 with 4 children.

Bottom line, there are reasons for a laparotomy but your dr should be able to answer all of your questions to the point where you feel comfortable.

[Delphinid]

Update: Thank you everyone for your input! I went back to my previous OBGYN and we are making plans to remove it by laparoscopy. Cross-fingers! I will keep you posted.  

[BethesdaGirl]

Excellent news Delphinid.  Glad to hear it.  Please do let us know how it goes and what they find. Good luck to you!

[Delphinid]

Next update: I need your ladies help again. I did what I said and got the mass removed by laparoscopy through my original OBGYN and her colleague. They planned to be conservative and when all looked good they chose to only remove the cyst not ovary etc...
However, pathology came back today showing the mass as "borderline"...I was advised they usually recommend a full hysterectomy with that, but I can also choose to watch closely (hard for my to justify such a surgery for a maybe, frustrating.)
I am wonder what others take and or experiences are concerning borderline masses.

[BethesdaGirl]

Hello again Delphinid, First, I'm happy that they were able to remove the cyst laparoscopically and I hope you are recovering well.

As far as your "borderline" diagnosis goes, it's hard to know what to do. I think if it were me, I would seek a second opinion from an independent GYN; not someone recommended by your current docs.  Also, instead of a hysterectomy, can they just remove that one ovary?  I would ask that question.  And, lastly I would post your latest question on the forum independent of this current/original thread so that others might see it and respond.  You might get other suggestions that way (since many members sort the questions by original post date).  Since this original post is kinda old, other forum participants might not see it.

Keep us posted on what you decide to do. Best of luck to you.

[BethesdaGirl]

Another question: How are they going to "watch closely"?  What do they mean by that?