Ovarian mass

[jennygirl1]

My daughter had a transvaginal ultrasound about two weeks ago as a follow-up to one in September as a result of a palpable enlargement of her left ovary during an exam.  The latest ultrasound stated it was a heterogeneous entity of the left ovary which contains internal echo's and vascular supply, and is unlikely to represent a cyst.  The heterogeneous mass measures 2.2 x 1.8 x 1.6 cm, in addition to a 1.2 cm endometrial thickening.

Her doctor did not suggest any kind of follow-up.  However, if the radiologist said it is not a cyst, what is it?  Should she get a second opinion?

Thanks very much

[jennygirl1]

Working in the medical field, I agree with your conclusions.  I think my daughter should also seek a second opinion.  It is mother's intuition I guess.  Thanks for reaffirming my feelings.  jennygirl1

[hopeshell]

I can see how you would be left with many questions.  I would not be comfortable with no follow-up without an explanation.   From the report notes you mentioned it sounds like it is a complex cyst which technically is a tumor and not a cyst.   Most complex cysts are also benign even though they have a solid component to them.  This is *possibly* what the radiologist meant by it not being a cyst.  It is hard to know since the reports can vary quite a bit between radiologists.   Did she get a copy of her report?  How old is your daughter?  

I am guessing off of the information you posted so it is important that your daughter talks with her doctor who knows her full situation.  Did she see a gynecologist or a primary care doctor?  I think she needs a second opinion either way since this doctor plans no follow-up.  I think she should request a CT or MRI which will be able to give her a better picture of what is going on.  Her mass is small which is a good sign.  But, malignant masses do often have a vascular supply.  Usually, doctors choose to watch and wait on cysts that are under 5cm.  If they grow, then they are treated.  Most go away on their own in time.  But, her symptoms and the appearance of the mass may lead a doctor to remove it rather than watching and waiting.

Since it does have a vascular supply, a more detailed scan is definitely needed.  Then, they may want to give her a CA-125 blood test just to check the number.  It is not a reliable test for diagnosing ovarian cancer.  You can get a low number with advanced cancer and a high number with benign conditions.  But, it is one more piece of the puzzle that may affect treatment.  It is also a valuable tool for follow-up later if cancer is found during surgery.  Timely treatment is the key with ovarian cancer.  

I was diagnosed three years ago with Stage 1a ovarian cancer.  My doctor found it because my ovary felt enlarged on exam.  I was lucky because it was caught so early.  I have not had a recurrence.  So, I am true believer in not waiting on anything that has any "chance" of malignancy.  If further testing reveals she has signs worrisome for cancer, she should ask to have a consult with a gynecologic oncologist prior to her surgery.  Her overall prognosis will be much better if a gyn/onc is involved.  

That said, it is very unlikley that it is malignant.  Ovarian cancer is still pretty rare.  Other benign conditions and tumors could cause the same finding.   Ovarian cancer can be cured when caught early.

Other than it being a complex cyst of which there are many.....the only other thing that crossed my mind while reading your post is if she could have an ectopic pregnancy?  The mass should show up in her tube and not on the ovary which makes me think this is less likely.  But, ectopic pregnancies can't be seen on ultrasound until they are more than two months along.  This is just a stab in the dark.  If she has a lot of pain and you think this is a possibility, then it is important she gets care right away.  It seems unlikely her doctor would not have ruled this out already.

Good luck on finding answers.  I hope your daughter decides to get a second opinion.  

Shelly