Second Opinion for Ovarian Cyst

[nona52]

Dear Dr Goodman,

I am 52 just in menopause. 6/08 annual showed normal blood work, bone density, mammogram and 3 non-precancerous polyps removed during colonoscopy, no divurticulosis. I had occasional pain in lower pelvis like pinching (no previous history gyn. issues) so also had TV US which was normal (but found out later “left ovary not visualized-overlying bowel gas”).

For past 2 months having some general abdominal discomfort and pain in lower pelvis.

9/4/08 Abdominal CT scan w/wo contrast showed 3 left ovary cystic lesions: largest 2.1 cm, a 2 mm cyst within r liver, shotty subcentimeter bilateral inguinal lymph nodes, mild left lower thorax posterior pleural thickening.
9/8/08 CA-125 is 31
9/10/08 Multiplanar pelvic MRI (3.0 Tesla GE magnet w/wo gadolinium) showed a small 10mm dorsal fundal fibroid left uterus, 3 cystic areas of left ovary: two 20mm, one 14 mm, smaller one has a fluid/fluid level within it. Does not appear as subacute hemorrhage on T1-weighted fat-saturated series. No suspect enhancement left ovary but continued surveillance advised. No pelvic lymphadenopathy.

Could you tell me if you agree with waiting 3 months for follow-up by ultrasound? Or should I have laparoscopy and the ovary taken out for a better look?

The liver, lymph nodes and pleural thickening from the CT and the 14mm fluid/fluid ovarian cyst have me worried. I’m leery because my mom died of ovarian cancer at 61 and my aunt of breast cancer at 59. My brother just died last Sep of undiagnosed cancer at 50.

Thanks very much,

[Annekathryn Goodman, M.D.]

Dear Nona,

Thank you so much for all your detailed information.  I would suggest that you ask your doctor about the surgical removal of that ovary.

A small ovarian cyst, in general does not concern me. What is more important is the combination of your family history and your symptoms. Also you has a normal ultrasound 3 months ago. If you were premenopausal, I would agree with a repeat check after a few cycles as most cysts in the premenopause are related to the ovulation cycle.

Now the second issue is whether you would consider the prophylactic removal of the other ovary and tube given your family history?

Please ask your doctor about that. You could consider genetic screening for the BRCA 1/2 gene mutation however only 10% of women with breast and ovarian cancer have that gene mutation.
best wishes

[SEM1956]

BRCA1+, diagnosed with ovarian cancer stage 3 10-2005, six series of chemo, good CA125 for 2 yrs then 11-2007 diagnosed with breast cancer, stage 2; in the midst of obtaining a 2nd. opinion on whether to do chemo w/an aromatase, CA-125 rose from Jan. 2008 (14) and continued to rise to but stabilized in the 70's range, spiked-up to 102 one month then down again to 79, last blood work showed it rose again to 129.  Nothing shows on the PET/CT nor CT scans.  I see my oncologist next month & would like to know your opinion on the next step of chemo...and/or whether I should continue my herbals.  Seemingly it appeared to have good results however difficult it was to maintain proper/health eating.

[nona52]

Thank you so much for your response. That's what i was thinking, i have no problem having both ovaries/tube removed - hopefully i can get my doctors to agree.

Thanks for your time - you are a very special person to give your assistance to us all.

Best regards,