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Ovarian Cancer Ruled Out?

Hello Dr. Goodman,
I am having extreme anxiety over the results of the ca 125 blood test. My story all began with a miscarriage in July of 07, I went to  the ER during a vacation for nausea. It was so bad I could barely lift my head. The diagnosis was a pregnancy that was short lived, as before I had a chance to leave I started bleeding. The ER doctor ordered a transvaginal ultrasound and a fetus could not be detected, but I did have to simple ovarian cysts. I then was released and was told to see my doctor when I returned home to California. Upon returing home I went to Gyn and he thought that I had an etopic pregnancy and did emergency laproscopic surgery. He found a right ovarian cyst and drained it. The fluid was sent pathology and came back non-malignant. I had had slight pelvic cramping in the months previous to this with rather large blood clotting during menstration. My Gyn thought everything was fine and that was that. A month or so later I went to my family doctor for abdominal pain and symptoms of acid reflux. She sent me for a transvaginal ultrasound and a small complex cyst was discovered on my left ovary. Again my Gyn was informed and thought all was well. Well, I went for a second opinion in November. This doctor decided to do another transvaginal to recheck the cyst and he also decieded to run a CA 125 blood test. The ultrasound was normal, but the blood test came back elevated at 52.8. This doctor thought everything was fine and wanted to redo the blood test in Feb. 08. In the mean time he said it was fine for me to go on my extended vacation (which would be six months). I went to Maine to see my family. In Maine I contacted another Gyn and she decided to do another transvaginal ultrasound and ca 125 blood test. The ultrasound was normal, but the blood test was elevated at 41. She too said everything was fine and that the elevation not worrisome. I was put on depo and did not have the pelvic pain during that three months. Although the pelvic pain had subsided, I spoke to my new Gyn about laporoscopy to evaluate the pelvis, due to the ca 125. Prior to surgery she checked the level again and it was at 47. I had a lap on 4/29 and the only thing that was seen was a small patch of endometriosis in the cul de sac, which she burned during the procedure. She seems to think that this was the reason for the elevation of the ca 125. All was great for a month. Then the pelvic pain began again. I realize that during this time I am not on depo and this could be the reason for the return of the pain. Since November of 07 my menstrual cycle has been a bit off. I contributed this to the stress over the ca 125 being elevated and then the withdrawal from depo. I have had very irregular periods since coming off depo. For example, on day 15 of my mentrual cycle I started spotting. At first the spotting was red, but quickly turned to thick brown discharge. I went back to my gyn today due to pelvic pain that I have had on two separate occasions. Both being 15 days after I had a bleed. She seems to think that since the depo stopped the pain previously and the pain is happening on the 15 day that it ovulation pain. Does this sound right even though I normally did not have this pain prior to the miscarriage. Considering the numerous transvagianl ultrasounds, an abdominal and pelvic cat scan with contrast, a negative lap, and serial ca 125 blood tests without a significant increase in elevation, do you think that it is safe to assume that the pelvic pain is from ovulation? And in your opionion would the small amount of endometriosis found during the lap cause the elevation in the ca 125 blood test? Could endo still be causing pain? Your opinion is greatly appreciated. I am so stressed out and do not know where to turn.
Thank you in advance for your time.
3 Responses
242604 tn?1328124825
Hey there Corky,

Thank you for your complete information (except your age which is always helpful to know).
You have had the delux super evaluation and wonderful, wonderful care.
several ultrasounds and two laparoscopies which show - no sign of cancer
and endometriosis.
You have a diagnosis and a reason for the elevation of your CA 125 and for your pain.

For women with ovarian cancer, what is seen is an increase of the CA 125 on serial checks. That is
40 then 65 then 100 then 300 then 1000 etc.

Your values have all been around the same and I would guess that that is where you live.

You ask an excellent question which is why did all this start after your miscarriage. I am not sure of the answer .
It brings up the bigger question of when does endometriosis start and when do symptoms first develop?

But with the careful follow up that you are receiving, I trust you will be watched and treated appropriately
best wishes
Avatar universal
Thank you for your helpful response. By the way my age is 37, does my age change anything as far as your opinion? So the small patch of endo found in the cul de sac is indeed enough to cause pelvic pain and raise the ca 125 level? I am gathering from your post that i can rest easy that I have no worries of ovarian disease. Again thank you for your help.

Avatar universal
Also, can endometriosis be diagnosed just with a visual. The operative report stated that: there was a 1.5 cm patch of endo in the right cul-de-sac. This patch was burned during the procedure, so there was not a specimen sent to pathology. I am still having pelvic pain that is right sided and within the last month or so I have had some episodes of intense pain in the right side of my lower back and hip area. Can this be endo related even though only the one patch was seen. My last lap was on 4/29 could something have developed since then to cause the increase in pelvic/back/hip pain. Cysts? Does this sound worrisome?
Thank you again
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