Complex Cyst Update/Questions

[LLM41]

If you don't mind answering a few more questions before my gyn. app't. on Thursday I'd be so grateful!  It seems that I get more info. from here than I do w/ my Dr.  Thank God for all of you!  Here's what I know so far:  I am 41, 3 children, no family history of breast/ovarian cancer.  I have a complex cyst (w/ a solid component) we've been watching since early Aug.  It has gone from 5 cm. to 4.7 cm (via TVU) and a CT scan from last week that shows the same complex cyst measuring 4.2 cm and a uterine fibroid.  No other remarkable findings noted.  I've had 2 CA-125's drawn (Aug. it was at 16 & Sept. was at 10).  The cyst does not cause me any pain (except for the occasional twinge) but I do get bloated/gassy frequently (mostly at night).  My Dr. wants to perform a laparotomy to remove my left ovary/tube and have a total hysterectomy.  She will have a gyn/onc. on call during the surgery and will do a frozen section of the cyst to check for malignancy.  If all of that comes up benign - she will leave in my right ovary so I can enter menopause on my own.  My questions are as follows:  Would a TVU & a CT scan have different measurements of the same cyst?  I was hopeful that the cyst was getting smaller.  Getting smaller would reduce the risk that it was malignant I would think?  (I'm not sure what the "margin of error" was on measurements).  It seems that most people on here have this done laparascopically - I want to ask her why the "big" surgery.  She doesn't appear to anxious about this (hasn't scheduled me for a surgery date - hence Thursday's app't) but she's mentioning a big surgery (not laparoscopy), a gyn/oncologist, etc.  I think all I heard for the rest of that app't. was oncology, total hysterectomy, etc. and I blanked all the rest out.  I believe her thoughts on the hysterectomy was because I had significant bleeding issues in Aug. (needed a D&C) that seems to be resolved now.  So I'm wondering if I can just have the ovary/F.tube removed and call it a day?  Please-any thoughts on this?  BTW - I happened to read JennyRose's post about her anxiety on this issue & I can only say DITTO on all of it.  Too much googling, sleepless nights & worry!  Marie Michele - any news on the job front?  Thanks Ladies!

[outdoorsgirl]

Hi, I had laparoscopic surgery to remove my ovary and fallopian tube due to a cyst. Mine was thought to be a simple cyst, but it turns out it was a 6cm serous cystadenoma which is benign, but not really classified as a cyst. I think my doctor told me that he removed everything intact without reducing anything. He made the incision a little larger down near my pubic bone to do so. I just wanted the cyst removed leaving the ovary. He recommended removing the ovary in case the cyst was malignant, but agreed to just take the cyst if possible. He ended up removing the ovary due to some changes on the ovary itself. Reports came back all benign. Point is, I think they can remove ovary whole through laparoscopic procedure, thus preventing spillage if cyst is contained by ovary. I will check on this at my next post-op appt. I was not awake at the last one. I think though every case is different and what may be right for one person is not necessarily the way to go for another person.

[MarieMichele]

I don't know if TVUS and CT would show the same cyst at a different size.  Maybe they captured it at different angles.  These things are not perfectly ball sized.  Picture a water balloon that you have squished on one end for an example, since cysts get squished by being in tight quarters next to other body parts.  It could be 4.7 cm from one side and 4.2 cm from another.

As for why the doctor wants laparotomy, it is probably for the same reason my own doctor preferred it.  To remove the cyst intact without having to reduce it in size and risk spilling anything from the cyst into the body. Many doctors can contain/reduce a cyst and remove it via keyhole surgery, but I have read stories of enough accidental spills that I can see a surgeon getting nervous enough not to risk it.  IF (and I mean "IF") there is any cancer, they want to contain it and give you the best result possible. An accidental spill can mean all the difference between needing followup chemo or no follow up at all.

Of course, it could be getting smaller, too (possibly liquid aspects of it) but they are probably worried enough about the solid component not to let down their guard entirely.  

The hysterectomy portion would not be necessary if it were not for the fibroid and uterine bleeding issues.  It sounds like they are not taking chances with that either.

I can understand them wanting to leave at least one ovary if everything tests benign so you don't get an early menopause.  That also leaves open the possibility that the remaining ovary could develop a cyst in the future.  There's no right answer on this point.  It comes down to personal preference and what is best for the patient's present health status.

As for my job hunt....I had a great first interview with an employer that impressed me above and beyond all others I have met in recent months.  I am hoping that by tomorrow or later this week they will call me for a second interview.  I could see myself working there and for a very worthy cause as well.  Been doing a lot of praying on this one.

You doctor can best explain the rationale for one type of surgery over another.  Have a list of questions so you don't blank out this time.  I know how easy it is to let a piece of news competely knock you for a loop to the point you are left speechless.  Then the appointment is over and all the questions arise after you are home!