Solid mass in ovary

[ellehcim]

I have been living in what seems to be a nightmare since last Thursday when I had an ultrasound for pain I started having in my lower right side.  The ultrasound tech started my panic when she left the room "to go get something" after she asked me when my appt was to have the Dr go over the results.  She then made me wait after the scan, back in the ob/gyn waiting room.  This has never happened and Ive had probably 30 of these in my life.  20 minutes I sat there panicking watching her run around only to come tell me she was confused because my appt was not with my actual Dr. but a different one and she had to change the report.  An hour later I get a call from a nurse saying my actual Dr. who had no appts until July wants to see me first thing in the morning.  No one would tell me what was wrong and in fact told me it was a mix up with dr.s and nothing to worry about.  My husband and i go in the next morning and my actual Dr. tells me she only has my preliminary us report and it shows a solid mass on in my right ovary and its 4x4cm.  She tells me it has to come out, she is sending me to the city to be seen by a gyno oncologist and I wont know if I have cancer or how much of my insides will be removed if it is cancer until I wake up.  Unless i prefer they wake me up to tell me how bad it is and then remove what they have to.  I was told this on a Friday and needless to say my weekend was just horrible.  The Dr.s office keeps messing up names, dates, people calling me for appts I dont need and I dont know what to do.  My final report now states that I have a complex cystic structure with solid components in it.  4.20x 3.34x 4.17cm.  Now the radiologist recommended follow up in 6-8 weeks!  This after my gyno tells me I might have cancer and I have to have surgery right away.  The specialist she referred me too is leaving the practice july 13.  Someone actually called me to tell me to find one on my own!  My PCP is helping me now and Ive had about 6 phone calls with apologies.  Its ridiculous to deal with that kind of incompetance along with the unknown of this mass.  Needless to say, I have a million questions but most of all want to know what is a solid mass with internal blood products?  Should my gyno have got me so worked up without even getting the final report?  Also, I had my uterus removed due to placent accreta 13 years ago, so I have no period but do still ovulate.  The last 2 months have been pretty bad as far as pain and thats why I called.  I am 42 and do not know if there is a history of cancer because neither of my grandmothers went to the Dr.
Thanks
K

[kcd86]

I would wait on the 2nd opinon until you have the disk of the MRI in hand then bring that to the 2nd opinion. The MRI will be much more precise than the us. As for the Dr's I belive that since you are going to reputable medical centers that see a large volume of gyn/onc patients you will be ok. FYI, Memorial Sloan Kettering in NYC has a 2nd opinion service also. My wife was operated on by Dr Carol Brown(gyn/onc) at Sloan who was very good.

[JulieRF]

My heart goes out to you in a major way. I am also 42 and have been told I have a 4cm complex cyst with a 3cm solid component to it.

I have a history of cysts and had a complex one last year. The doctor ordered a CA 125 which was in normal range and when we rechecked it two weeks later it was gone. I was so happy.

Unfortunately, I'm going through this a second time so soon. It's a nightmare and I cry constantly. I am like a zombie just waiting for the phone to ring with my current CA 125 results.

I see similarities in our stories...when I called my gyn. yesterday, I told her I could bring the CD with the ultrasound images over to the office and they told me they only needed the radiologist's report. A seemingly lame report in my opinion...measurements, etc. Doppler blood flow to the ovary, torsion not likely, Yada yada yada.

My gyn says she isn't worried in the least and sent me for the blood test (CA 125) and started me on progesterone because I'm also two weeks late for my period. This, she feels, is further evidence that my hormones are out of whack and the likely cause of this current cyst...not cancer.

I am not feeling as confident. I think the ultrasound pics look scary...an ill defined circle with clear fluid (no debris) and a solid mass that looks terrifying. I also have some serious bloating going on which I didn't have last time. That in fact is what made me think I might have a cyst...my jeans were getting tighter. Scary.

I can't even speak about this without falling apart and everytime I look at my children my heart aches.

Anyway, I am going to keep you in my thoughts and prayers. I hope you get a positive outcome and inner peace while you wait to find out for sure what is going on. Please update when you can. I posted over on the ovarian cyst community too.

[ellehcim]

Kevin, How do I find out if the surgeon I have is what you are suggesting I look for in a Dr.?  I cannot find any reviews on him anywhere on the internet or the hospital site.  He actually called me yesterday and left a message asking if I had made a decision on the surgery and that if I had any questions or needed anything to please dont hesitate to call him.  I found that shocking since most Dr.s dont generally call like that.  I did make an appt for a 2nd opinion and am waiting to have an MRI scheduled.  The other strange thing though is that the secretary at Mass Gen (my 2nd opinion Dr) told me I didnt need to bring the US pics and that the Dr would either agree with the radiologists report or not, that he did not need to see the US.  My 1st Dr. wanted to actually see the US himself and once he did he called me immediately and said he really wants it to come out.  He was on the fence prior to seeing those pics.  So Im scared now and feeling like I should just stop confusing myself more and stick with the first guy and just get it over with.  If you or anyone know anything about either of these Dr.s I would love to read some reviews.  1st gyno/oncol is Dr Michael Kelly at Tufts in Boston and the 2nd opinion Dr is Dr. Schorge at Mass General.  Dr. Schorge is the Chief gyn/oncologist there.  Thanks

[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 !!  
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).
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 causes 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. **********
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Since there is some suspicion  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(specializes in cancer only) to see a GYN/ONC surgeon 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

[shewrites]

I'm sorry that you're going through this.  

First, you need to know that far more cysts/masses are benign than malignant.  Second, you need to know that 4 cm cyst is small -- and therefore most probably manageable if it is malignant.

I'm nine years out from cancer diagnosis of a 14 cm mass on my ovary.  I was stage 1A (one ovary affected, no spread).   I did chemo (although most women who are 1A seem not to have chemo) and I've been clear ever since.  After the surgery, my gyn/onc  promised to cure me, and I like to say that I'm holding him to it.  

Please be sure that a gyn/onc does your surgery.  They have more training and they get better results for their patients.   If the gyn/onc wants to watch it, that might be ok -- but I'm not sure I'd take that recommendation from a radiologist, gynecologist or primary care doc.  If you have a gyn/onc, you don't need to have them wake you up and then put you under again.

The only way to get a firm diagnosis is by having a pathologist review the tissue during and after surgery.  You don't officially have cancer until the pathologist reports back -- even though a  gyn/onc can probably make a good guess beforehand.  

Try not to worry too much.  (Good luck with that.)  Keep in touch for information and support;  the women on this forum have a wealth of knowledge to share.  God bless