Multiple complex cysts

[denise534]

I am 37 yrs old never had children and  have been diagnoised on ultasound with two small (2.8 cm and 1cm)complex cysts on my right ovary and one 1cm complex cyst on my left ovary.  I have not had a period in over one year and am in some pain with other various symptoms.  My GYN took blood yesterday for four tumor markers but I do not know results yet. If the marker test results are negative, she wants to do laproscopic surgery and take biopsies of these cysts to identify them.  I talked today to a Gynocological Oncologyst who said these biopsies are tricky because if you open that ovary and there is cancer, it can spread if  the GYN is not trained to deal with removing these types of cysts and/or ovaries.  These experts suggest a second opinion because they would know how to handle the situation if it is cancer. My questions are : 1) has anyone ever heard that when a cyst is biopsed (and the ovary left in place for future treatment by an GYN Oncologyst) but the cyst tests possitive for cancer, it  could spread throughout the blood stream? 2) How long is it safe to do nothing with multiple complex cancers? 3) What other ways can you diagnose the complex cysts if you did not biopsy it? 4) What other options do you have to treat these complex cysts other than surgery?

[denise534]

Thank you so much for you comments.  I am convinced to use a GYN  Oncologist.  Found the one that I will use.  I will keep you updated.

[denise534]

Thank you so very much for all of the info.  I changed my HMO network so that I could use a peticular GYN Oncologyst  that has a very good reputation.   This process will take 15 to 45 days and I keep my same PCP.  This will be a 2nd opinion and by that time I  will have the results of the tumor marker tests.This specialist will handle the case.  I feel so much better and will keep you updated.

[Jane39]

I know this must be a difficult time for you.  What alot of us gals are going to tell you~~~Is you truly only have one try to get this right.  Since this is a complex cyst (solid and liquid components), don't take the chance, have a gyn/oncologist do this surgery.  They know what they are doing and what they are looking for.  More than likely these cyst are benign, but don't take the chance.  The only way to see what type of cyst these are and "if" they are malignant is to do surgery, period.  The CA 125 is a guideline, however, don't put all your eggs in one basket with those results.  I had a 28 cm tumor and my first original ca125 was 30, so you never know.  That gyn/oncologist you spoke to is 100% correct, follow his advice, go get your second oppinion from a specialist.  Good Luck and please keep us updated.  Jane

[kcd86]

I am sorry you have to go threw this it is very stressfull to have this hanging over your head. Keep in mind most cysts are benign!!  Since your transvaginal sonogram(TV) showed  complex cysts on your ovary warrants a very thourough work up to rule out any other potential issues.
My wife was recently Dx with granulosa Cell cancer( GCT) Jan 2010 and I know what it feels like to not know what the next step is. Here is a quick overview.

Tests like sonograms, Cat scans and MRI's along with blood tests like CA125, Inhibin A&B, MIS and CEA are just used as a guides for the Dr's to help assist in making a diagnoses(Dx). A transvaginal ultrasound (TV) is the most valuable diagnostic study in the evaluation of an adnexal or pelvic mass/suspicious cysts.  
An MRI is usually the next test that should be given as they are more precise when read by the right radiologist.
The blood test CA-125 is a test used by Dr's as a guide to determine if you have the most common form of ovarian cancer, approximately 80% of all ovarian cancers are epitheal ovarian cancer which is cancer of the cells on the surface of your ovary. Please keep in mind that CA-125 can be elevated if your menstruating and some other cuases of inflamation..
There are other types of ovarian cancer that are hormone driven and depending which form a person has there will be excess symptoms of that specific hormone. This is the type my wife was Dx with granulosa cell ca. These group type are called sex cord -stromal tumors. These type of tumors have specific markes that the Dr's use just like ca-125 to aide in their dx of epitheal ovarian ca. They are Inhibin A&B and MIS. Please keep in mind if and only if you have a dx of these form of tumors there is a missconception that these tumors are always benign, which is completely false> They are just slow growing tumors as opposed to epitheal.
Unfortunately with any type of suspected ovarian mass/tumor/ suspicious cyst(s) surgery will be the only way for the Dr's too make a definitive Dx.
It is NOT recommended to biopsy any ovarian mass/tumor/suspicious cyst as it can rupture and seed the pelvis with cancer cells if that what it turns out to be.  Please make sure you have your blood drawn for the following blood tests,Inhibin A&B, CA125 and CEA so at the very least you have baseline blood work.
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Since there is some suspicion based on your TV-sonogram I would immediately find a good GYN/Oncologist surgeon. I am not suggesting what you have is cancer but studies have shown that treatment of ovarian cancer by nongynecologic oncologists and by low volume surgeons is associated with suboptimal surgical management. I would reccomend going to a large tiertiary hopsital where they see large volumes of patients.  This is not to make you worry even more but to make sure that the Dr who treats you has vast experience with diagnosing and treating various types of GYN / Onc issues if that is what it turns out to be. If the Dr wants to remove the cyst/mass via laprascopic procedure PLEASE make sure they have much experience with removing these INTACT! All too often I read posts from patients who say their Dr thought it was a cyst and removed it haphazardly causing a rupture and seeding of the pelvis with cancer cells, only to be found on pathology post removal.
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Next: From experience I would be asking for an MRI of the abdomen/pelvis ,MRI's are very precise when read by a Radiologist that specializes in GYN/ONC, My wife went to a radiology practice that does all types of MRI's and the Radiologist read her MRI as a fibroid. I then took her to Sloan Kettering in NYC to see a GYN/ONC surgeon Dr Carol Brown who had the MRI repeated by a GYN/ONC Radiologist who called her DX to the tee which was confirmed after surgery.
The best advice you see all over these posts is you have to be your own advocate, be aggresive and stay on top of your phycicians. Get copies of all your tests/results as you are entitled to them. Post with any other questions you have this site has some very knowledgeable people on it. I wish you all the best.
Kevin