Screening for ovarian cancer

[alleycoot]

I am in my mid 50s and have been followed with a large (18cm) fibroid for many years.  It is subserous, coming off the back and right side of the uterus.  My right ovary is not palpable on bi-manual exam due to the fibroid, but we have been able to monitor it on transvaginal ultrasound through the years.  This ovary has had a history of being enlarged with cysts that normally have subsided over several cycles . I have had a tubal ligation and have had three pregnancies.  The problem is the ovary can no longer be seen on transvaginal ultrasound because the fibroid has grown so large. I feel very vulnerable not being able to assess this ovary.  For many years I have experienced some of the ovarian cancer symptoms of bladder fullness and frequency, pelvic pressure, etc., due to the large fibroid so I don't think I would be able to detect cancer just on the physical symptoms since they already exist.  I am in the late stages of perimenopause and my gynecologist feels within a year I will be at menopause at which time the fibroid will probably shrink and hysterectomy can be avoided.  He does not seem concerned about not seeing or feeling the ovary.  What can I do to be proactive about ovarian cancer screening under these circumstances?  

[Sandymac]

I think that would be a good idea.. Another opinion never hurts.. Whatever the case, please stay in touch,

Take care,
Sandy

[alleycoot]

Thank you so much for your insight.  I think I will seek a second opinion.  I have been following with this physician for 15 years and perhaps a fresh "look" by someone else might be beneficial.  

[Laney8463]

Hi there,
I agree with everything Sandy has said. I too had a large fibroid. Actually I just found out from my doc post surgery (hysto/BSO/appy) that I had 12 fibroids, multiple cysts that had engulfed my ovaries, just an absolute mess down there. When I was trying to decide what to do with surgery, initially I was going to have just my ovaries removed, then figured with these fibroids, why not take it all out and start fresh. My doc said, although many fibroids shrink after menopause, this is not always the case. So mine just kept getting bigger and bigger and I decided, if im going in for surgery, Im only doing this once so I had the hysterectomy at the same time. I don't want to go through this again, the waiting and "what ifs" are the worst for me... So on the 15th of this month I had  robotic surgery.
I know it's hard to decide what to do, but like my doc said, you will probably get sick and tired of all the repeat TVUS, and do something... well that is just what happened. I was playing this "watchful waiting" for a year and had enough.
Good luck and let us know what you decide
God Bless
Laney

[Sandymac]

I can only speak from my own experience. I'm post menopausal and when I had the TVUS last year due to pain on one ovary. a small cyst was found in addition to 2 fibroids and some fluid in the uterus. I was told also that I could monitor the cyst for a few months, but my Dr. did want to check on the fibroids since, after menopause they really aren't usually "there".. So , in my case menopause didn't do a thing to the fibroids. Now, they were small and she actually just left them. But usually it is a concern in patients our age ... and I have 15 years on you and that many years since onset of menopause... The Dr. suspected the fibroids may have been larger at one time . ..The ovary and tube were removed during that procedure (laparoscopy)  

There is always the CA-125 blood test but that probably wouldn't be that reliable as you have the fibroids, and aren't menopausal yet.  That test is used primarily in women already dx. with OvCA to monitor how well the treatment may be working. I was given the test since I am way past menopause and the test holds a little more weight.. But in younger women, there are so many things that can throw the results off, that it isn't really to be used for screening purposes only ..

Isn't the fibroid causing any pain since it is large? I do agree that those symptoms are probably from the fibroid but I'm not a Dr. .

The real problem that exists is that there really is no absolute screening for OVCA. That's what makes it so difficult. Even with the CA-125, there are those women with high numbers and do not have cancer..Other patients have really low numbers and have OVCA.. Most symptoms can be attributed to other things ; bloating, urinary frequency, digestive problems.. all those can be due to many other things. The only way that cancer can be ruled out  for sure. is by surgical procedures and path results..I wish I had better answers for you, Hopefully with the onset of menopause , the fibroids will shrink,enough to be able  to view the ovaries better.

In any case, stay in touch and good luck.
Sandy