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Cancer: Cervical & Ovarian Message Board

Cancer: Cervical & Ovarian Board Index

Hello Mantra,

I am in the province of Québec and in Montréal there are a number of private radiology clinics who will do the ultrasound, bloodtesting or whatever you need. I do not live in Montréal but outside and even here we have a private radiology clinic. All you need is a referral sheet from your doctor and you can book an appointment for an ultrasound, mammogram or whatever within a week. I preferred going this route rather than waiting months to get an ultrasound on the public healthcare system. The name of the doctor in Montréal that I went to who does a day a week of internal ultrasounds is Dr. Deborah R. Cohen and her clinic is on Côte-des-Neiges in the downtown area. I am not sure if they take out of province patients but you could always try to phone them and find out (sorry but I don't have a number for the clinic).

Another option for you might be to try a gynecologist in Buffalo, New York as this is probably closer and you will have even less of a problem getting an appointment. I am sure that they can give you a fee for an ultrasound and consultation and you can just drive in and have it done. Here in Quebec doctors have a choice of working completely in or completely out of the system and there are more and more doctors who are starting to work outside of the system as more and more people prefer to pay for the convenience (and safety ?) of being able to consult whenever they need to.

You say you had a biopsy in a doctor's office ?! Taking a biopsy of an ovarian cyst is impossible to do in a doctor's office. It requires at least a laparoscopic surgery under general anaesthesia. Perhaps the doctor did an endometrial biopsy which tests the lining of the uterus (or a pap smear which is a biopsy of the cervical surface). This type of biopsy would do nothing about the ovarian cyst and would only look at cells contained in the uterus (or cervix). You are absolutely correct about women living longer if they keep their ovaries until at least age 65 and I think that this was a very wise decision so don't regret it. Ovaries continue to provide the body with small amounts of estrogen and hormones even after menopause. I was not happy to part with one of my ovaries, believe me, and I tried to hang on longer. If my cyst had not started to grow or change, I would also have remained without having it removed. This is not a bad decision but a prudent one.

You may want to continue to go for CA-125 testing in the interval between now and when you see a doctor. If the levels remain the same then this should be reassuring. Perhaps it is different in Ontario but here in Québec technicians do not do pelvic ultrasounds, radiologists do (technicians do perform routine mammograms however). You may want to find someplace that has only radiologists performing the sonogram because an ultrasound of the pelvis and abdomen is not that clearcut and I personally would prefer to have the doctor specialist performing this scan. The doppler may or may not give more information and the jury is still out on whether this is helpful or not (the theory being that the doppler can spot angiogenesis or blood flow to a cancerous tumour). It doesn't hurt though so it would be prudent to have it done.

Don't put too much stock in what that report says. It is "weirdly" worded in my opinion and hopefully the technician did not screw up your ultrasound and cause you unnecessary anxiety. Definitely try to get another ultrasound done, preferably an internal one as this will see the cyst from a different vantage point and you will be closer to it.

By the way, I am very sorry to tell you but you will not know if an ovarian cyst is malignant or benign with 100% certainty until it is taken out completely and biopsied. A radiologist and gynecologist can look at the cyst and tell you what it looks like (ie. offer you strong reassurance) but to be one hundred percent sure you have to go through the laparoscopy. This was my problem all along. If there was a way to know whether the cyst was benign or malignant without having to have surgery, believe me I would have found it.

If you have any questions that I can help with, feel free to come back and ask. During my 2 years of looking at my cyst, I did a heck of a lot of reading on cysts so if I can offer you any helpful information based on what I have read or what I have experienced, I would be happy to provide. There are a number of medical studies available on the internet that can perhaps offer you reassurance. Stick to scholarly articles or web-sites of gynecologists and forget about the rest as these others are inaccurate at best.

I hope your mammogram went well.

Take care and best regards,

Again, thanks for all the info. When I got home from work today, there was a message from my GP telling me I have an appointment with the gyno next Tuesday. She said the office told her they are squeezing me in and that I should be prepared to have a very long wait. I'll just bring a good book and plan on spending the day! He is the gyno that I went to when my cyst did not go away after menopause. He is the one who did the biopsy in the office (you're right . . . after you mentioned it I do remember he took some fluid from my uterus). So here's where the anxiety comes in. Are they squeezing me in because I was a past patient? Are they squeezing me in because he's afraid he may have made the wrong decision in telling me not to have my ovary removed? Is he squeezing me in because the report is telling him time is not on my side and I need to have surgery ASAP?!

I know for sure I want my ovary removed .. . regardless if it is cancer or not. Is it possible I can bypass the biopsy step if I just tell him to book the surgery and they can biopsy it after my ovary is removed? Or do they need to know in advance is it is cancereous and if so, send me to a gyno who specializes in cancer?

I also asked my GP to book that Doppler assessment that the technician neglected to do. I'm thinking that the Gyno is going to want this so I might as well speed up the process by having it done. I don't know if I will get an appointment before next Tuesday and even if I did, I doubt the results would be back in time for my appointment.

One of the things that is concerning me is that I'm starting to have pain on the left side of my back . . sort of where the kidney is.

In Ontario, only technicians do the ultrasound but the radiologist reads it. At least the Gyno I'm going to on Tuesday does his own ultrasound in his office so as you said, it will be a lot better. I have no idea if he performs surgery but I guess I'll know more on Tuesday.

I had a pap smear come back as precancerous about 25 years ago. I had surgery and in all honesty, I was kind of glad the internet didn't exist. I didn't spend endless hours researching. Of course, back then I was young and foolish/ignorant and it never occured to me that anything could or would go wrong. Now of course I'm constantly searching for info and am also very panicked about having a general. Being awake wouldn't thrill me either but perhaps "twilight sedation" would be an option.

I'm trying to keep busy and am also trying to just go with the flow and thinking that worry is just a waste of time since whatever happens, happens. I can't change what already is and worrying myself sick isn't going to change one single thing. Of course, I'm thinking that way at 6:26 PM June 29th, 2009 and at 6:30 PM I may be back to worrying. Right now I'm just going to worry about dinner and taking the dogs for a long walk. Easier said than done!

I thought I'd pick up where the story left off. You might remember I was heading off for a mammogram that morning. A few days later the hospital called and asked me to come in yesterday for a few more pictures because something showed up that they needed to see from a different angle. The technician said they are microcalcifications that weren't there last year. She took two more views and told me to wait until she shows them to the radiologist. Ten minutes later she came back and I was told I needed to have a biopsy and they booked me for a stereotactic biopsy to be done on Thursday morning and the results should be back in a few days. I'm not overly concerned but of course will feel better once the results are in. The only problem I have with any type of biopsy is that a false negative result could happen. I have had other microcalcifications looked at on an ultrasound but she said the biopsy is the route to go and not an ultrasound.

Today was my appointment with the gyno. As thought, he did his own pap smear and another ultrasound. He said his equipment shows the cyst to be fluid filled and at 2.7 cm (not 3 cm with a solid component and a 4mm echo. as shown in the ultrasound done at the hospital). Regardless he said even if the other test is correct, nothing is overly concerning him. However, even though he really can't see the solid component as described in the report, it does need to be followed up. He said the C125 test is very good at 9.9 however, it really doesn't give a lot of comfort given that it really isn't a tool used for screening. He told me to dress and meet back in his office.

In his office, he started out by saying that over the years I've seen him, the cyst is growing slowly . . . started out as 1.5 cm and has now grown to 2.7 cm. Still very small, but nevertheless, it is growing. He understands my desire to have surgery but he says he really needs more info before he can recommend it. He is booking me for an MRI because a solid tumour shows up much better on an MRI than it does on an ultrasound. I told him I am booked for the doppler part of the test on July 14 at the hospital that did the original ultrasound. He said that he turned on the doppler during the ultrasound he did in his office and really didn't see anything but for my own comfort level, I might as well go ahead and get the test done.

He said he would best describe my situation as orange. He said up until this year, he would describe it as green. Meaning, everything was normal with the cyst and he had no concerns. The fact is, is it is growing and by continuing to do so, it will without question get to the point where surgery is required and that is why he describes my situation as orange. He said red would be someone who has no choice and surgery must be done. He is hesitant to do the surgery and kept referring to my tubal as a bit of a problem and he also mentioned the possibility of perforating the bowel. I'm not sure if the two were related or whether they were two separate, unrelated issues. What he wants to do is see what the MRI shows. Then he will have all the information he needs to make his recommendation to me. However, he completely agrees that at some point this is going to need to come out and that doing it sooner than later is better for me both emotionally and physically. He says that if the MRI doesn't show anything concerning, his recommendation will be to wait. However, he says he is not the one having to live with a cyst growing on an ovary that one day could become cancerous. So even if he feels surgery is premature, my desires will come first regardless. But he also said I need to understand how our medical system work and that booking surgery for a patient who could wait for it, means someone who is in real need of surgery has to wait . . something that is frowned upon by the hospital. That said, the surgery will happen but it may not happen as quickly as I like. He left it by saying, let's get the MRI done and your breast biopsy results and then sit down and talk about it without having all these unaswered questions. He thinks the MRI will be in a few weeks.

I'm feeling a lot less anxious but also know that regardless of what the MRI shows, this ovary is going to be removed one way or the other .. . . even if I have to tie a string around it, attach one end to the door knob and have the tooth fairy hold on to the other end. :) If the MRI shows nothing of concern, I am going to take a deep breath, try to get a second opinion and take my time making sure my decision is well thought out and that I have the best surgeon do the surgery. Without the worry of cancer, I will have time to properly do my homework and make the best decision for me. I also won't have to worry about finding a gyno/oncologist and worrying about the time involved in waiting to see one. I also asked if he does this surgery laposcopically (sp) and he said "oh yes, for many years."

That's it for now.

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