complex, septated, left ovarian cyst: ultrasound results

[amyd1970]

hello dr(s) and community members,

had an mri about 2 weeks ago for VERY severe lower back pain (at night) - among other symptoms, and results
hello fellow members and/or dr(s):

came back with recommendations for a followup pelvic ultrasound due to incidental bilateral ovarian cysts findings.

my ultrasound (pelvic AND transvaginal) results came back this week:

BILATERAL OVARIAN CYSTS found
uterus measures:  9.2 x 3.8 x 4.9 cm
endometrial stripe:  echogenic, measuring 1.0 cm
right ovary measures:  4.9 x 1.9 x 3.1 cm
left ovary measures:  6.9 x 4.0 x 5.1 cm
left ovarian cyst:  complex, containing septation, measuring - 6.1 x 4.0 x 5.1 cm
normal appearance of right ovary w/ small follicles (< 4.5 cm) identified
comparison is made to prior ultrasound (10/22/08) same complex left ovarian lesion was present at that time - only smaller
cystic neoplasm needs to be excluded.

so i now have an appointment with a cancer center here in town for friday to find out when i will be having surgery for the cysts.  i believe they will be removing the cysts on both sides, and doing a biopsy on the complex one found on the left ovary.

some questions i have:
what questions should i ask at the appointment?  
should i be concerned at all about the endometrial stripe findings?  
do i need to request that a GYN/ONC be present during the surgery?  
will they be able to tell DURING the surgery if malignancy is present, or will i have to wait?  if so, how long is the typical wait time?  
are there others with similar results who can share their experiences?

i'm a little nervous, but i'm also hopeful that perhaps these cysts are the cause of my back pain that is causing me such turmoil at night.  (please see my post:  http://www.medhelp.org/posts/Back--Neck/How-can-severe-back-pain-be-worse-at-night-or-when-Im-resting/show/1033887)  maybe when they are removed, i will get some relief!

thank you so much for your replies.
amy

ps:  i also posted this in the ovarian cancer forum, as i was not sure where it would fit best.  i apologize for the duplication.

[amyd1970]

thank you so very much, once again!

[MarieMichele]

As for the surgeon, the absolutely best option is for the gyn/onc to do the surgery.  They have the skills, the hands, and the eyes best trained for this sort of thing (even when all is benign!)  Your regular gyn could attend/assist, but your best outcome is at stake.  The gyn/onc is the person to provide it.

Questions to ask would include:
1.  What type of surgery:  laparoscopic (small incisions) or laparotomy (open surgery).  Laparoscopic surgery = about 1/3 the hospital stay and recovery period compared to laparotomy.  Surgeons have compelling reasons for or against the different surgical options.  Listen to them.
2.  If laparotomy, vertical or horizontal incision? Again, there are different reasons for going with one or the other.
3.  Remove just the cyst(s) or is it likely the ovary associated with the complex cyst might be removed?
4.  Be very candid about all your concerns, your medical history, your sensitivity or allergic reactions to medications (include foods if you are allergic to things like shellfish).
5.  Make a list of your questions.  It's so very easy to get caught up in the moment and forget some of them.
6.  Let them know if you are easily made nauseous (thinking about anesthesia now).  A good anesthesiologist has medications or patches that could be used to reduce this.
7.  Ask about the endometrial stripe....I have no idea what that is or if it's anything of concern.  Maybe it's something that can also be addressed during surgery?

A gyn/onc knows what to look for in surgery and they do tests during surgery for cancer, a "wash" of the internal parts, and a general inspection/exploratory of the surrounding areas.  If problems are found, more areas might be subject to surgery, repair or cleanup.  The final pathology of the removed cyst(s) will determine if any cancer was present that was not seen during surgery.  

You will likely wake up with a report as to "yes" or "no" whether they found cancer during surgery (remember, the "no' is the more likely answer!)  How soon the final pathology report will arrive varies greatly.  I had mine before discharge 3 days later.  Others have waited as long as several weeks.