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Wait and see, or surgery ASAP for complex ovarian cyst?
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Wait and see, or surgery ASAP for complex ovarian cyst?

I have a complex cyst in my right ovary, about 5cm x 3cm.  It isn't causing me any pain, but my cycle has been more weird than usual the past 4 months or so.  It has always been short, but it's gotten down to 20-21 days, usually with bleeding for 5 days, but one cycle I bled for 2 weeks, which finally caused me to schedule my overdue annual ob appt.  When I described my cycle to my ob, he had me schedule an U/S, which I had today.  They did a transverse U/S, and the tech was very good to answer all the questions I asked (she showed me a functional cyst I have, which they could not care less about, and the complex cyst, with a septation and some bumpy solid parts. My uterus looked fine). Then I went in to talk with the dr, and he said he really didn't think it was cancer (I know those odds are very low) but also that it wasn't the type to typically go away on its own.  He said he would call my gyn onc and one of them would get back to me to schedule an appt. So, my ob office called this afternoon saying they were faxing my records to the gyn onc, and to call today to make an appt, and if they couldn't get me in in the next week to ask to be put on a cancellation list. (This freaked me out a bit but I will remain calm!!). I called and got an appt for tues.

I'm 34 and have very little history of cancer in the family, but a lot of my aunts have had various ovarian cysts, mostly dermoid.  When I was 31 and pregnant with my 4th child, they found a large cyst (9cm) in my left ovary during my 8 wk ultrasound.  I had follow up US's to monitor it, and when it didn't change, they ended up removing it at 19 weeks (I also had the option to wait until delivery and have a c-sec and remove it then).  (My baby was fine...it's amazing what they can do!)  Anyway, they took the left ovary and tube, non laparoscopically. The cyst was a LMP mucinous cystadenoma.  They also said it wasn't something I was at increased risk of getting again...no need for any further treatment or monitoring.  So I wonder why I've gotten what seems like the same thing again in my other ovary?

I've never been on the pill, but I've had 4 babies and breasted each for a year, so my ovaries have had quite a bit of 'rest' in the past 10 years... ;-)

Obviously if it were cancer, I would want it removed yesterday.  But if it's not likely to be cancer, what is the downside to not removing it immediately?  The last time I went through it, it was the worst recovery of anything I've ever had...my mom came and stayed with us for 3 weeks and people brought us meals, and I don't know how I would have managed without that help!  Waaaay harder than childbirth recovery.  If there's no imminent danger, I'd like to plan e surgery for a "convenient" time when I have a spare month (if there is such a thing for a mother of 4)... Maybe this time since I'm not pregnant, they can do the surgery laparoscopically. Although it sounds like the recovery is not much easier for that anyway.

Thankfully I trust my doctors and will most likely follow whatever they recommend.  We live in an area that people travel to from around the country/world to see our doctors.  My gyn onc did a great job with my last surgery and protecting my baby.  A plastic surgeon closed me up so that my top-to-bottom scar is so small now that I would actually consider wearing a bikini again if not for the 4-baby-damage. ;-)  Just curious what other people would do in my shoes now and if there's anything I should ask when I meet with the gyn onc next week.  Thanks.
6 Comments Post a Comment
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4349241_tn?1358290877
Hi jbesmom,
So sorry you have a recurrence of a complex cyst!

I am 36 years, and 7 weeks post op for removal of a 14cm Stage IIB LMP tumor. I too was not able to have laparoscopic surgery - had vertical laparotomy. I had my right ovary, tube, omentum, 30 lymph nodes and some pelvic tissue samples removed. I am also fortunate to have a wonderful gyn/onc who I feel very confident with. Pre-op, my CA125 was 105. Last week, my CA125 was 8! Yay! It was reassuring. My onc is also taking my slides to a tumor review board meeting at the end of this month, where additional pathologists and oncologist will review. I won't hear anything from it, unless for some reason others disagree or have other concerns.
I too do not have fam history of ovarian, breast or colorectal cancers. I have no biological children, but was on birth control pills for many years.

I agree the recovery, especially the first few days, was the most miserable I've ever experienced. Having your abdomen sliced open vertically has such an impact. At week 7, I still am limited when an muscles are involved. I am tender yet internally, and I feel strain when I reach too far, list too much, etc.

As much as I never want to experience that again, if I were in your situation, I would opt for surgery. I have talked with several woman over the past several weeks who have had recurring LMP tumors, and some who later developed aggressive ovarian or other cancers. Not trying to come off negative, but a couple women were pretty quick to warn me to mot take this lightly and be very aware of my body going forward. I know some doctors seem to dismiss LMP as cancer, or as a concern. My gyn/onc has stressed the seriousness of it while also reiterating it is a very slow growing form of cancer with excellent prognosis when all suspect cells are surgically removed. He told me, it was his opinion, had I been 10 years older, it is likely I would have an aggressive later stage ovarian cancer.

So, anyway, if it was me, I would definitely have it removed, especially since there is no way to diagnose with certainly without surgery. I still have my left ovary, and recurrence is definitely a concern of mine. I know there will be some anxiety during my 3 month gyn/onc visits.

Best wishes to you!! Let us know how everything goes.
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Avatar_n_tn
Thanks!  I didn't think I would have a hard time with this, this time around, since last time I had the pregnancy complication and this time it would be 'no big deal' in comparison.  But I'm still thinking about it all the time, and my main concern this time is if they have to remove the ovary, it's my last one and I'll have to do HRT for probably 15 years!  If I do, it is what it is and I'll deal with it, but I hardly ever take medication for anything (even childbirth, lol) unless I'm really sick, so of course that idea is not exactly appealing.

Also, my gyn office called me today to make sure I had made the appt with the gyn onc.  So either they are just really on the ball following up with me, or my dr is really concerned and wants me to see the specialist ASAP.  

I've never had the ca125 test...I wonder if they'll do that this time or if the US alone is enough to warrant surgery, then they'll just test the tissue.

Well, I might as well get some sleep and stop thinking about it.  I'll update when I have my appt...
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Avatar_n_tn
Well, I'm very happy. Had my appt today, and the dr is going to do a robotic laparoscopy, and only going to take the ovary if it is LMP. I was prepared for/expecting a laparotomy with complete hysterectomy, so that was great news.  I'm supposed to have it done in the next 2 weeks...will post afterwards how it goes. :-)
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3185070_tn?1344704177
I had a robotic lap to remove my uterus. Your recovery should be MUCH easier with that!
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Avatar_n_tn
My surgery is scheduled for Monday.  They're also removing my appendix, since I guess there is some correlation between ovaries and appendices for mucinous cysts.  I've started having some dull pain in the general area of my right ovary...I went ahead and scheduled another ultrasound with my primary gyn, mainly to see if there's been any change since it was found. (It's only been 2 weeks, but my husband thought it was a good idea.)

It's crazy how having something "wrong" creates havoc on your mind.  I had bad gas pains earlier, and start thinking there must be something else wrong.  Other stuff I'm currently blaming on this cyst: my broken-out face, bloating and 5-lb weight gain, and irritability/feeling 'hormonal'.  I'm going to be disappointed if that all doesn't go away with the cyst! :-)
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4349241_tn?1358290877
Send best wished for your surgery Monday! Keep us posted how it goes, and if you do find the symptoms disappear!!

I can so relate on the mental havoc - I am way to conscious of everything, now. 9 weeks post-op, and wheels are still turning. I noticed some digestive problems starting to re-appear, so am now trying to analyze what's going on there :P

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