Second opinion please

[123nyc]

Thank you for your previous answer.    I have a follow up question and would appreciate your feedback.  Here is some additional information on me.  There is a question at the end!  

Age 32- No children but would like to have them in the near future.  Perfect health, active exercise regularly, regular periods, all normal, no surgeries, and pretty much no medical complaints!   During annual visit Dr noticed possible cysts.  Sent for a ultrasound the following week.
Results of transvaginal: The anteverted uterus measures approximately 10.cm long, 4.5cm thick and 6.1 cm wide.  The endometrial stripe measures approximately 13mm, with slight separation of the superior endometrium.  No discrete myoma is identified. There is a small amount of free pelvic fluid.  The right ovary measures approximately 3.5X 2.4X2.4 cm.  The left ovary measures approximately 3.2 X 2.3x2.6cm.  There is a 2 cm unilocular cyst on the right with internal echoes and two discrete mural nodularities measuring 5-8mm.   IMPRESSION: Aruate versus septate uterus.  Right ovarian cyst with mural nodularity.  Primary concerns include endometrioma (more likely) versus neoplasm.   CA 125 test- was told results are normal.

Family history of breast cancer (aunt, grandmother), younger sister dx with non Hodgkin’s lymphoma and PCOS.    The doctor would like to go in and remove the cyst.  She said while I am under they will do a biopsy and based upon the findings possibly remove right ovary in the same procedure.  Doesn’t this seem rather extreme?  I thought she would want to monitor the cysts for a couple of months. The cyst is rather small and I don’t have any pain.  I would prefer to have the cyst removed then discuss the findings with my doctor, not have everything decided while I am under anesthesia?  Is this type of cyst more alarming then she is telling me?  

Thanks again for your response~

[123nyc]

I wanted to give an update... I had a second opinion today with an OBGYN/ONC.  He was very surprised with my OBGYN wanting to do surgery without an MRI or a follow up sonogram.  He said you really need an MRI in order to see if the cysts and the things inside of it "light up" (he used medical terms but I can't recall them).  He said going in and removing the cysts without knowing what you are dealing with does not seem like a good plan to him.  So now I am scheduled for an MRI next week.  If it comes up clean we will do another sonogram and then go from there.  I am going to call and cancel my surgery with my primary OBGYN today.  I am so happy I did the second opinion; I thought I was over reacting but I feel so much better!

[bowlingchick]

My endometrioma was benign, the only reason for the hysterectomy was because of the endo.  It  was like a glue (it sticks to the surrounding organs) and causes havoc.

[saville]

In case, I did not emphasize it, it is highly unlikely your cyst is cancer.  I went into complete panic mode when they told me about possibility of cancer.  Most complex cysts (nodule or no nodule) are not malignant.  

[bowlingchick]

I just wanted to add, I had an endometrioma on my left ovary.  This cyst was wrapped up in the ovary ,so surgery was scheduled.  The plan was to remove the ovary and the cyst.  Since endometriomas are usually associated with endometreosis this was the case with me.  Once they opened me up, they could see that I had stage 4 endo.  So a total hysterectomy was in order.  Luckily I was finished with my family, I have 2 children and was 40 yrs. old at the time of my surgery. I know keeping the ovaries in most cases would benefit women in so many ways, but sometimes it's better to have them removed, it just can't be helped.  Try not to worry, I'm sure if your doctor feels there is no threat to you, she will do everything she can to save your ovary.  Please keep us posted and best of luck to you.

[123nyc]

Thanks so much for your comments.  The section about the cyst being embedded or spilling never even occured to me.  I have a second opinion with a Ocnc OBGYN next week at a great NYC hospital.   I was worried that since it is such a small cyst they would tell me to go with my primary obgyn and not waste their time.  I realize now that their is more too it then simply removing the cyst.  I am going to postpone my surgery with my primary obgyn and wait for the second doctor who seems to have a lot more experience.  There is way too much cancer in my immediate family for me to take this lightly.

I asked for an MRI since that is what my lab report suggested and my primary obgyn said it would not tell us anything more since it is a two demensial image.  She said "thats what all the lab reports recommend" and don't worry about it. I will see what the other doctor has to say.
I appreacate you taking the time to write!   Good luck to you as well.  Sounds like you have done a lot of research on this.

[saville]

Welcome to my world!  Except in my case, my physican actually wanted to perform a full hysterectomy even if the cysts were benign!  I also have no symptoms.  (I have a new physican who is not advocating for a hysterectomy, thank goodness).  

I am not a physician, but here goes....

It sounds like you have a complex cyst with nodular features that is causing your physician concern.   According to my physician, a MRI is very good at identifying endometriomas (which are NOT cancer).  In my case, I had two suspicious cysts, but the MRI narrowed it down to one suspicious cyst.  The MRI is very expensive, and your doctor may have to stamp her feet a little bit with the insurance company to get them to pay the cost.  That being said, I still have to have laproscopy for cyst removal.

In laproscopy, the physcian attempts to remove the cyst without harming the ovary.  Apparently, this is complicated by the fact that they can not allow the cyst contents to "spill" into the body, because if cancerous this may allow it to spread.  If they cannot safetly remove the cyst or it it is so embedded in the ovary they cannot be separated, they remove the ovary--even though statistically it is highly unlikely to be cancerous.  I have a problem with this, too!  (Of course, if you are one of the statistically unlucky and it is cancerous, you will praise the day your physician found it and removed it.)  Another highly unlikely scenario is they safely remove the cyst, biopsy it in the spot, and it is cancerous, in which case, your doctor will (at miniumum) remove the ovary.  They can't do anything without your pre-authorization so don't worry.

The "good" news:  According to my physician your horomone levels can be maintined with one ovary.  His analogy is as follows:  "Two ovaries is like a car with four wheels and a spare in the trunk.  One ovary is like four wheels and no spare in the trunk."    

My "insurance policy":   I attempted to locate a gynecologist with loads of laproscopy/surgery experience so as to minimize the risk of losing a ovary.  It is next to impossible to get any physician to comment on the skills of another phyiscian.  I found my physician by looking on-line to see who was teaching at the local gynecological laproscropy seminars!  

[123nyc]

I have asked my doctor to repeat the ultrasound and she said it was not necssary.  She said cysts c contained  contained two nodules which means they will not just go away.  I had the ultrasound done in early Sept and surgery is scheduled for the fist week in November.  I am having a hard time dealing with the fact that she dosen't even want to look again before she does the surgery.  

[Annekathryn Goodman, M.D.]

Hi There,
I think your doctor is being very careful. Her recommendations are perfectly reasonable. Another option is to repeat the ultrasound after a menstrual cycle to see if the cyst is still there.
take care