ovarian cyst - concern - surgey suggested - but questions

[ca_concerned]

I have had an ultrasound and MRI that indicate an ovarian cyst (6cm, 4cm) in my left ovary.  OB/GYN suggests oopherectomy and testing cysts during thsi surgery to determine if more would need to be done.

MRI shows septations and Ultrasound mentioned something about possibly internal papillary projections.  MRI offers no definitive answer...just  possibility cyst could be a hemmoragic cyst, an endometrioma, or cystic neoplasm.  Can benign cysts have characteristics mentioned above or is this more likely malignant?  Also, what are the considerations if this cyst tests as borderline during surgery and what does borderline mean?   Also, if possible I would like to preserve my fertility.  Waiting for consult with Gyn. Oncologist who would either do surgery or be on-call.  In interim, interested in what advice or thoughts you may have.

[ca_concerned]

Thank you so much for your suggestions and input.

[Annekathryn Goodman, M.D.]

Hi There
that is excellent information!

You do not have any risk factors for ovarian cancer (infertility, family history, other personal cancers).
I am sorry about your Dad! Melanoma is not related to ovarian malignancies.

The single most important  intervention to protect against ovarian cancer ( aside of surgically removing ovaries) is the birth control pill. Big population studies show a 50% reduction in ovarian cancer among women who have taken the pill.

It is possible that you have had a benign ovarian tumor for some time. Your symptoms suggest that.  But ultimately, unless those cysts are gone next time an ultrasound is done, it is very reasonable to evaluate the ovary by laparoscopy and remove the cysts and possibly the whole ovary.

Even though you are low risk and have a normal CA 125, there is still a risk (small) that you have a malignant tumor. Ask your doctor what he/she thinks about a gyn onc consultation. They are in the best position to assess because they have seen your scan

Borderline is a type of malignant ovarian tumor. It is slow growing and usually cured by surgical removal.  If you are actively trying to get pregnant, you should include a fertility doctor in your decision making.  It might even be important to have that doctor present at your surgery as they trained to do fertility preserving surgeries.

If you are not actively trying to get pregnant, you should consider when you are planning on trying.  AT age 40 and beyond, fertility drops quickly. It might be reasonable to understand how well your eggs are doing right now and not wait on that.

best wishes

[ca_concerned]

I am 40, have taken pill-based birth control since approx age 16, had change in menstrual bleeding (heaviest I can ever remember) followed by breakthrough bleeding that concerned me as unusual.  Scheduled appt. with doctor and upon exam I explained my concern and that I had always had some discomfort on left side when sexually active like someone bumping into something (although this symptom has been at least 6-8 years).  I had always chalked this feeling up to just me (unaware of cyst), but in hindsight this might explain what I had been experiencing if the cyst has been there the whole time.  I have never been diagnosed with any cancer, endometriosis, never pregnant, and there is no history of ovarian cancer in my family (although my dad passed away in Dec. from melanoma).  The only surgery I have had is emergency appendectomy when I was age 11 or 12 years.  The only scans I have had of my pelvis were in the last month (ultrasound then MRI).  Blood test for CA-125 tested in normal range, but ultrsound and MRI indicate complex cyst and cannot rule out cystic neoplasm.  The recommendation I have received is to remove my left ovary and test cells at surgery with frozen section to determine if cyst is benign, malignant, or borderline?  Does this help.  

[Annekathryn Goodman, M.D.]

Hi There
The meaning of cysts in the ovaries depend on context.
it is helpful to know the following to understand what risks a person has for a cyst being malignant:

-age
medical history
menstrual history
previous surgery
personal history of cancer
personal history of endometriosis, pregnancy,
use of birth control pills
family history

and then it is important to know what is the time course of the cysts -how many scans have you had. most cysts resolve after a menstrual cycle or two

and finally what are your symptoms?
pain, bloating , GI symptoms, changes in bleeding pattern

thank you