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363281 tn?1590104173

Worried About Ovarian Cancer

Hello, my question will be lengthy, please bear with me. Here goes.

Back in January of 2015, I noticed a very tiny spot of brown discharge, only on paper and one time on my panties, well, being post-menopausal for approximately 3 years, I decided to investigate it. I called the local clinic here, (I live in New Zealand, but am an American citizen), they ran the usual test, you know, the pap smears, etc, all came back normal. So, I was referred for a TVultra sound. Here is what was discovered:
Findings:
Both transabdominal and transvaginal scans were performed.
Uterus: anteverted, normal size, longitudinal 65mm, AP 34 mm, Transverse 55 m. Volume 57 mL
Myometrium: Heterogeneous with 5 fibroids. Largest=subserosal and posterior, measuring 15mm. None has any significant submucosal involvement.
Cervix: normal
Endometrium: normal appearance, 4.9 mm. No focal abnormality or abnormal vascularity.
Pouch of Douglas: No free fluid.

Now, here is what scared me and still does:
Right Adnexa: 39mm mass containing low level echoes, reasonly homogeneous. There is an echogenic rim. No vascularity demonstrated within it. Right ovary is not separate from this.
Left ovary: Contains a 10mm follicle, volume 2.1 mL. No other adnexal abnormality.

Comments: Endometrial thickness approaching the upper limits of normal. Right Adnexal mass appears to be solid. We are unable to determine it to be a pedunculated fibroid.
Fibroid Uterus changes elsewhere.
Recommend review by gyn specialist for advice on management in view of the complex of changes.

So, I am then referred to the Christchurch women's hospital, there, they do another ultra sound, this time, it was scarier, here is what it says:
Endometrium noted to be around 7mm and poorly defined, the right adnexal lesion was joted to be persisten measuring 38x39x42mm, with a hetergenous echotexture but no internal vascularity and note has made that this did not move separately to the uterus. The right ovary was not identified separate from the mass but the left ovary was not identified either at this stage. A review of the imaging results was made at a multi-disciplinary meeting on March 25th with possible aetiologies being those of a pedunculated fibroid or a possible ovarian mass such as a fibroma with the noted endometrial thickness again commented upon and a plan for surgery is now suggested. Recommendation of a hysteroscopy, dilatation and curettage with a concurrent diagnostic laprascopy proceeding to a salpingo-oophorectomy or removal of pelvic mass with the option of a bilaterial salpingo-oophorectomy after a further pre-operative discussion in the Gyn Outpatient Clinic.

Ok, so I am concerned over the fact that the hospital ultra sound says that my uterus is poorly defined, the first ultra sound, done at a womens only ultra sound clinic, said it was clear. Also, the thickness, how can it be 4.9 one month and then 7 the next? Of course, that dang mass has me very worried.

I had a CA 125 done, it was 16.

I was planning on moving back to the states that June, so, I had originally canceled any further treatment as they had me on a 4 to 5 month wait list for the procedures, I figured it could not be too bad if they wanted to wait. Well, when I told them I was leaving, I got this letter informing me I could come in earlier, and have it all done in May, before I left. My husband, a kiwi, was all for it. You see, we do not pay a cent for any of this; it would cost us a good chunk of change back home.

I decided against the surgery anyway, never did return to the states however. So, about 2 years later, decided to re-open the case. The gyn said he consulted with the doctor in Christchurch, and since it had been almost 2 years, they wanted another ultra sound. So, off to the hospital here in Nelson I went. I had a very conscientious tech this time, she took a long time. At the end, she said it all looked good. Here are the readings for that one:

2 Responses
363281 tn?1590104173
Continued:
FINDINGS: Transabdominal and transvaginal scans performed. The uterus is midline and anterverted. Dimensions are 49x22x31 mm. (volume 17.5 mL) on TV scanning.
The uterus is reasonably well defined on today's exam and measures 3 mm in maximum thickness. No focal endometrial abnormality identified.
The adnexal lesion is again identified to the right of midline just above the level of the uterine fundus, this has a dimensions of 35 x 38x38 mm on today's scan. This remains avascular. There is a fine rim of increased echogenicity which is associated with a more prominent than usual amount of air defect that raises the possibility of peripheral calcification. The content of the cyst has low level heterogeneity. The posterior aspect is well seen. There is a small point of contact with the lateral aspect of the right ovary. Right ovary ovarian dimensions are 18 x 10 x17 mm (volume 1.6mL)
The left ovary is normal in appearance.
No free fluid seen.
CONCLUSION:
On this examination, the structure in the right corneal region is convincingly the right ovary and is not a small degenerating fibroid as was considered possible on the prior exams.
The right adnexal mass is unchanged. The right ovary is positioned between the mass and the uterus, but the fundus does approach the medial margin of the mass more superiorly. The sonographer felt that the mass was more related to the right ovary than the uterus on dynamic assessment. If clinically appropriate, an MRI may be useful to differentiate the aetiology of the ovarian mass, and/or exclude the possibility of a pedunculated fibroid. The endometrium appears unremarkable on the exam.

Attached to this was a letter from the referring gyn:
Dear Susan:
I have seen the report of your recent pelvic ultrasound. No abnormality was noted in the lining of your uterus and if you are not troubled with any bleeding, then it is not necessary to investigate with a hysteroscopy.
Likewise, the "Mass" to the right of your uterus is unchanged in size. It is still unclear if this is a small ovarian cyst attached to your right ovary, but given the fact that it is unchanged in size and your normal Ca-125 test in 2015, conservative management would be very reasonable unless you are troubled with discomfort.

OK, fast forward to now, 2018. My husband has been diagnosed with a very nasty bowel cancer, since then, I also have been noticing "period-like cramps in my lower pelvic area, they actually start around where the pubic hair is. I have been having this pain for the last month or so, and it seems to be getting worse, especially when my husband is undergoing radiation treatment. He was examined by his doctor last week, and we got the sad news that it has hardly shrunk, now, my pain is really acting up. I am wondering if this pain is due to that damn mass or from stress over my husband. I had no pain prior to his cancer diagnosis.

I have informed my GP, he has sent in a referral to a GP to discuss the matter, but sadly, they have me on a wait list, I can't get in until September 25!!!! He is trying to set up another ultra sound, but so far, I have not received an appointment date. He said if it is still unchanged, then they will keep the September date, but if it has changed, then they will probably move the date up. I would rather an MRI when they do it, but I guess since it has been over 2 years since the last U.S. they want another U.S instead. I am so scared, and the more scared I get, the more I hurt. I did see my chiropractor, he said my muscles in my hip area are very tight, and that is causing the pain, I have been doing some exercises I that area, it seems to help a wee bit, but still, I am worried sick.

I am 61, have no family history of ovarian cancer, and when I had my periods, they were always normal; I never had any "female issues". I have always been prone to ovarian cysts however, as I shared, I have not had a period in close to 3 years.

Thanks for reading this, any input will be appreciated. I am at my wits end.
Avatar universal
I'm sorry you're going through this and your husband's been diagnosed with cancer. :( Stress can certainly manifest itself with physical symptoms but it's hard to know if that's part of what's going on.

The odds are very much in your favor that this isn't ovarian cancer since 1) it's rare, and 2) the "mass" had not grown. But if I understood correctly, it's been 2 years since your last u/s in which case another u/s (or maybe an MRI) would make sense.

Ovarian cysts are common even after menopause and are almost always benign as discussed here - http://ovaryresearch.com/ovarian_cysts.htm. Unfortunately, ovaries are removed unnecessarily far too often for ovarian cysts or "just because" they are "in there" (doing pelvic surgery). Surgeons with good cystectomy skills can almost always remove the cyst(s) and save the ovary or at least most of it for normal hormone production.

Medical studies have shown that removal of any part of the "reproductive" system does more harm than good if there is not confirmed cancer. The effects are life-shattering since ovaries produce hormones a woman's whole life. Hormones are the "essence" of life not only for all organs and tissues but for who we are as individuals. That's why so many women report turning into someone they don't recognize after these surgeries. Hysterectomy has additional adverse effects since the uterus is critical for normal bladder and bowel function, sexual function, pelvic skeletal integrity as well as normal ovarian function.  

I hope this helps! Let us know what more you find out.
3 Comments
Thank you so much for your comment, yes it helps.

I got a letter yesterday with my ultra sound appointment, it will be the 19th of this month. I admit, I am very scared. I think because of my husband's cancer, I am more scared as well. Before we found out he had it, I was not worried and had no pain as I have shared before.

I agree, I don't think most hysterectomy's are needed, I am sure not going to have one unless it is the absolute only thing to do.

I will let you all know how it goes.
I just got my results back from the ultra-sound, it looks good, the only thing that worries me a tiny bit is the part that says there is a TRACE amount of fluid in the fundus of the uterus, other than that, the wall is thin and I don't have any post menopausal bleeding, the "mass" is still there but maybe a wee bit smaller. Anyway, here is a copy of the report.

FINDINGS: Transabdominal and transvaginal scanning performed.
The uterus is anteverted and normal in size, measuring 49 mm length x
23 mm AP x 42 mm TR. The endometrium is well defined and normal in
thickness at 4 mm. There is a trace of fluid in the fundal aspect of
the endometrium. In the right adnexa closely abutting the right side
of the uterus with possible claw sign is a well-circumscribed rounded
solid mass measuring 34 mm x 32 mm x 35 mm with rim calcification,
stable or slightly decreased compared with previously (35 mm x 38 mm
x 38 mm 27/5/2016). As previously there is no internal flow with
colour Doppler. The right ovary is not identified separate to the
mass.
The left ovary is not identified. No other adnexal mass. No free
fluid.
IMPRESSION: Stable or slightly decreased right adnexal mass with thin
rim calcification compared to 27/5/2016. The differential includes a
pedunculated fibroid or a right ovarian mass. As previously noted,
MRI may provide further information.
Dr Chris Davison, FRANZCR, NZMC# 30051
Radiologist NMDHB, Nelson Hospital
cd/ps 19/07/2018 5:09 p.m.
Sonographer: BG
Recommendations made in this report do not necessarily indicate
availability via publicly funded clinical pathways. Please refer to
HealthPathways for further information.
Ordered by:ROBERT HAYES
Lab Test Results Interpreted by:CHRIS DAVISON
Laboratory:wrauhrad
Observation date:19-Jul-2018




It's good the mass has shrunk a little - would seem to mean it's nothing concerning. I wouldn't think a little fluid in the uterus would be a cause for concern. What has your doctor said?
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