Surgery for dermoid / endometrioma?

[oidara]

I have to decide whether to go ahead with a laporoscopy to remove two cysts from my left ovary. They are 2cm and 3cm each and have not changed or grown since they were first found 3 years ago. They are either endometriomas or dermoids. I am very nervous about surgery which is why I have avoided it until now, but recently the anxiety of not knowing if they are malignant has made me consider surgery. If I thought I could just leave them in indefinitely, then I probably would. But my doc said even if they are benign, they could mask other changes in the ovary in the future, which makes me think they have to come out sooner or later. I just don't know what to do. Is the surgery very risky? Will I cause myself more problems with adhesions from the surgery? Should I just leave them alone or is there still a chance they could be cancer even though they didn't grow in 3 years. I am 34 with 2 children.

[N_chai]

I had a ovrian cyst rupture last Monday. One last later the same cyst grew by almost 1 cm. Doctor asked me to consider a Lap surgery since it us growing. But the cancer marker is fine.

I had severe rapid pain during the rupture, but ut settle down after injection but my urine had red blood cell and lots of white blood cells.

Last week, my lower abdomen wad sore so as lower back pelvis. Especially if walked or sat for too long. The soreness was much better this week after I started the anti biotics. But u had low grade fever on Monday afternoon.

I booked the Lap surgery in this Friday but I am still not very sure should I go for it????

[oidara]

Thanks again for your input, everyone. I really appreciated it.

I went ahead and had my lap yesterday. I was quite nervous beforehand, but I had a few sessions of acupuncture and listened to some hypnosis recordings which helped, I think.

The cysts turned out to be old endometriomas, so they didn't really need to be removed, but at least now I have the peace of mind that they were nothing sinister.

I am a little sore today, but I'm not taking any painkillers (breastfeeding) and managing okay. To anyone else who is reading this and is as scared as I was, I sympathize! But it's really not so bad. You just have to put your trust in the team working on you and believe you will make it through okay.

[hopeshell]

Thank you so much for the well wishes.  I will be keeping you in thoughts and prayer for your sugery on the 4th.  It isn't too much longer to wait!  I pray all turns out benign and will be looking forward to hearing an update.  

Take care,

Shelly

[Lindita8]

I too had a softball sized dermoid removed and a pedunculated fibroid via laporatomy.  If you have any information on how to prevent these by lifestyle changes and help prevent hormonal imbalance that caused the cysts and dermoids I would be more than interested to learn how to do this!

Thanks.

[oidara]

Thanks a lot for your input too, Kim. You made a lot of interesting points there. I will certainly be following your advice on the massage and exercises. I really appreciate you taking the time to help me. Thank you!

[kimmery]

hi oidara,

i had surgery for a dermoid in march of 2008. it was softball sized and was causing me a lot of pain. personally, i agree with Shelly and think that dermoids need to be removed. a very small percentage of them become malignant but they do continue to grow (albeit slowly) over the years and can cause ovarian torsion and other unhappy symptoms, including pain and pressing on other organs.

i had laporoscopy and while it took longer for me to heal than expected i am now doing so much better. i've made a lot of lifestyle changes (to deal with the hormonal imbalance that caused the cysts and dermoids) and am now finally medication free during my periods. for years i had been debilitated by horrendous menstrual and pelvic pain.

after my surgey (i think about 4 weeks later) i started to see my massage therapist to have her massage my belly and break down scar tissue that was starting to form at the incision sites. my thought was that it would help deter adhesions from forming, and i have to say, 1 1/2 yrs later that i feel immensely better than i did before my surgery. now, this wasn't always the case (in the first year 9 months or so i felt quite delicate and not quite 'right' in my pelvis, but at least it wasn't the pain i had before) but i can honestly say that it is now worth it all.

i also saw on another page that there are self-massage exercises you can do to help break down surgical adhesions. in the health pages for ovarian cysts (i think it was) she described lying down atop a ball and extremely slowly rolling in a v-shape from ovary to uterus (pelvic bone) to the other ovary to break down the scar tissue.

anyway i hope this helps and if you have any questions on dermoids, let me know. i'm a big nerd and do tooooonnnnnnnnes of research when it comes to my health. ;)

good luck with your decision!
kim

[oidara]

Hi Shelly,

I just wanted to say thank you so much for taking the time to write such a lengthy and considered response to me. I have been pondering it for the last day or two, and what you said really struck a chord with me. I have decided to go ahead with the surgery on 4th October, and I'm looking forward to putting this whole episode behind me.

I'm sorry that you have had a tough time over the past few years, and I send you lots of well wishes.

Many thanks.

[hopeshell]

This is a tough decision.  Personally, I would have them removed.  Dermoids can cause infection if they rupture.  I doubt they are malignant since they haven't grown in three years.  Ovarian cancer usually grows rather quickly.  But, I believe that chronic inflammation is a risk for malignancy and so it is best to remove them since they haven't resolved in this long period of time.    I don't think adhesions will be an issue.  Have you had a MRI and a CA-125?  I would want to make sure that you don't have changes that are suspicious before entering surgery without a gynecologic oncologist.  Usually, gyn/oncs only get involved when cysts are 5cm or larger.  

I was diagnosed with ovarian cancer at the age of 37 three years ago.  I know for a fact that I had a cyst on the same ovary that had the malignancy four years earlier when I delivered my son.   I assumed it would resolve and did not pay much attention to it.  I don't even know for sure that it was the same cyst that became malignant.   But, looking back, I wonder if the cyst transformed in the four years after his birth.  I never had follow-up.  I have read so much about how cancer in other areas of the body occur during periods of inflammation.  Esophageal cancer is common when you have acid reflux.  Throat cancer is aggravated by cigarette smoking and alcohol.  Liver cancer is brought on by medications and alcohol.  Stomach cancer is brought on by certain foods that cause inflammation.  The list goes on and on.  I have wondered if long standing cysts and hormonal imbalance can cause this type of change to the ovary.

But, I am not a doctor.  These are only my thoughts and don't substitute for a doctor's opinion.  And, surgery does carry many risks.  It leaves you with a scar and if you lose your ovaries then you have a lack of hormones which brings other health problems.  I chose not to take hormones to reduce cancer recurrence risk and I have suffered many extra health issues due to lack of hormones.  I probably will never be the same as I was prior to my surgery! :(  It is truly a decision that only you can make.  You may want to get a second opinion just to help with this decision.  Like I mentioned, I would be inclined to have them removed in order to remove the risk.  It sounds like your doctor feels the same.  Good luck on making your decision.  Please keep us posted on how you are doing!

Shelly