Interpreting Results of U/S

[SuzyQ67Cqy]

Age: 40 No kids or pregnancy; 8+ yrs on pill in 20's.
Symptoms: Non-specific  
Meds: .137mg Synthroid for 12+years; Metformin for 2yrs

Basis for U/S:  Screening, family history.
Mom was diagnosed Jun-07 after radical & severe bloating. Surgery re-classed as peritoneal, did not start in ovaries.
Passed away Feb-07.  During period determined both her mom (54) and her mom's mom (60's) passed of ovarian.

First U/S Technician had problems - unable to see right ovary, left not clear but definite shadow/mass.  I do not have
a copy of this report.

Referred to Gyn.  Internal revealed no palpable cysts / masses.  Felt was "normal" cysts since absorbed by body.
Sent for second U/S.

U/S report was as follows:
Uterus is normal in size, no focal abnormality noted, no abnormal vascularity seen.
There is a complex mass in the left adnexa.  It is inhomogeneous and most likely to be arising from the left ovary.  It measures 5.8x4.3x6.2 cm.  The right ovary was identified today and also appears bulky measuring 3.8x4.8x4.7 cm.  It is inhomogeneous with at least one complex cyst measuring 2 cm.  There is minimal vascularity in the ovaries.  There is no evidence of free pelvic fluid.
IMPRESSION:  Bilateral ovarian masses, larger on the left.  Neoplastic disease can not be excluded.

Blood tests done around time of second U/S:
Creatinine - 55, CEA - 1.5, CA125 - 63.5
I have not had these tests previously so change is not know.
I have an MRI scheduled in one weeks time.

Question:
1)  Can you clarify what the report and tests really mean?
2)  Family history - how much does this increase my risk of malignancy?  Coupled with a high CA125?
3)  Does my risk level warrant planning of full hysterectomy at first go vs. lap to remove left ovary and a "let's take a look" attitude?
4)  Is a consult /referral to a gynecological oncologist warranted at this point, prior to surgery?
5)  What will the MRI be able to clarify, rule out, or add to my current diagnosis?

Thanks for your thoughts.

[Annekathryn Goodman, M.D.]

Dear Suzy,

You have three family members who have passed away from ovarian or peritoneal cancer. They were in their 50's. This strongly suggests that you may be at risk for ovarian/peritoneal cancer.
About 10% of women who experience this cancer have a gene mutation BRCA1 or BRCA 2. For those women who have this gene mutation, they also have a very high risk of breast cancer.

You should consider getting tested.

Even if your test for BRCA 1/2 are negative, I would strongly encourage you to see a gynecologic oncologist for a discussion of risk and a consideration of the prophylactic removal of the ovaries and fallopian tubes.

Now in addition to your family history, you have developed ovarian cysts. These could be benign, they could be related to endometriosis (that would go with the mildly elevated CA 125 and the bilateral cysts) or they could be malignant. It is not possible to say more.

The next step is at least a laparoscopy to look and evaluate.

The decision about what kind of surgery to have (laparoscopy versus full hysterectomy) will depend on the finding, your symptoms and physical exam, and your current goals (are you trying to get pregnant etc?)
best wishes

[JC145]

As one who has Ovarian Cancer, the only way to tell is a biopsy .. it rules cancer in or out.  Dr. Goodman did give the proper sequence of events.  Find a Gyn/Oncologist.  They have the most experience dealing with Ovarian issues/masses.  Then the MD will suggest either a laparoscopy to "see" what is there or full surgery and hysterectomy (which is what I had).  Once the tumor(s) are biopsied, you will have your diagnosis.  Hopefully and prayerfully, everything will be benign.  I am the only one in my entire family (aunts/cousins, etc) that has OVCA, so I didn't get the BRCA test.  It tells you if you are carrying the gene and the cancer was inherited .. as opposed to just being.  Hope this helps.  Judy C

[Jenny58]

I have been waiting watching this discussion for awhile as I am in a similar undiagnosed state, but these questions by Suzy appeared to have been missed by Dr Goodman.

I don't know if posting something here will help point out the omission, but I am hoping...

I would like to post my own circumstances sometime soon, but it is hard to get a posting as it always says to try later so I would like to see the good Dr's opinion on this posting.

Thank you.

[SuzyQ67Cqy]

Addendum to post:

First U/S March 10, 2008

"The uterus is retroverted.  The endometrial echo appears normal measuring 4mm.  The right ovary is not definitely defined.  There is a complex mass in the cul-de-sac and extending into the left adnexa.  The overall size is approx 5.4x4.5x4.0 cm.  The cystic components contain debris and thick septations.  The appearance suggests an ovarian neoplasm possibly associated with a hydrosalpinx.  MRI may be helpful for further evaluation.  Prompt gynecologic consultation is appropriate."

My MRI is tomorrow morning, June 20/08