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Cancer: Cervical & Ovarian Message Board


Cancer: Cervical & Ovarian Board Index


Kali,

Hello, I am a fellow cyster sister who was in a somewhat similiar position (though not exactly). In 2007 I started to have irregular menstrual bleeding which freaked the heck out of me. After an endometrial biopsy which was somewhat inconclusive (a lot of blood in the sample but the few cells present were normal) I began to have abdominal pain (which turned out to be ovulation pain .. I had just gone off the pill after 20 years so was unfamiliar with this). I was sent for an ultrasound which uncovered an 8 cm simple ovarian cyst on my left ovary. No cause for worry, I was told, we watch it and it will go away with time. Well, it did not go away and it began to develop solid components. When it got to around 9 cms, my doctor recommended removal and I had surgery to get rid of it.

During the 18 months that I watched my cyst, I read everything that I could get my hands on about ovarian cysts and some of the things you mention that are contributing to your anxiety do not concur at all with my sources so perhaps my mentioning these might help.

Ovarian cancer is not common at any age, but when it does occur, it is women 60 years of age and over who are most at risk. This means that if you are premenopausal (which you are since you are pregnant), it is highly unlikely for you to have ovarian cancer. Of course highly unlikely does not mean impossible but it does mean highly unlikely.

Ovarian cysts, EVEN COMPLEX ONES, are extremely common. I am not sure where you read that complex cysts are rare. They are not. Yes the most common cysts are simple ovarian cysts, which are usually just ovarian follicles, but not all simple cysts are ovarian follicles (mine wasn't) that go away with time. I had an abnormal simple ovarian cyst which is not your run of the mill cyst that comes and goes with the cycle. Some simple cysts persist and get larger (like mine did). Also, when cysts get very large, even simple ones, all bets are off and they must be removed ... this leads me to the next point ...

Size matters. Cysts that are 5 cms or less in diametre are extremely common and most often not worrisome. Simple cysts that are less than 5 cms are usually just follicles or corpus luteal cysts. Complex cysts that are less than 5 cms can be follicles or corpus luteal cysts that have bled into themselves or that have persisted for a long period of time. You are right in saying that usually complex cysts are removed in order to be on the safe side but 90% of complex cysts are benign (don't know where you saw the 20% malignant figure).

Also, I would not worry too much about the cyst becoming gigantic and rupturing or twisting your ovary. This is not a common occurence and your cyst is rather small. I walked around with an 8 cm cyst for a year and a half and this cyst was much heavier. Usually they become concerned around the 10 cm mark as this is starting to get large and the risks that you mention become more worrisome. A cyst rupturing is extremely painful but the risks of dying from this event are very very small if not practically non existent (I have spoken to a number of very good doctors, including gynecological oncologists who have told me so). A cyst twisting your ovary, on the other hand, is an emergency situation that requires immediate surgery or your ovary will die from a lack of bloodflow. This is also incredibly painful as you can imagine.

Having said all of this, these cysts cause a tremendous amount of anxiety because when one has something that risks even 1% being malignant, we worry. There are some things which you can do to control your situation which may help.

1. You may want to inquire about the CA-125 test. This tests for a cancer antigen that is normally present in great numbers when ovarian cancer is present (a reading of 35 or less is normal). However, this test is notoriously unreliable and may show a high reading when there is no ovarian cancer. It also misses some stage I ovarian cancers (ie. a false negative). Ask your doctor about this test and see if it is right for you.

2. You can ask for more frequent ultrasounds in order to "keep an eye" on the cyst. Then if you see that it is growing at a fast rate, you can react quickly in order to control the situation. You may find that the cyst will start to regress and then go away completely and this would be wonderful news indeed.

Talk to your doctor about these two things as they may help to keep things under control while you are waiting for your baby to develop. They will also help keep your anxiety under control as this is also not good for the baby. If you can keep an eye on the cyst and know exactly what you are dealing with, it will help immensely. Also, talk to your radiologist as these folks are very good at knowing what is and what isn't cancer. They are not 100% accurate but believe it or not, they have a higher accuracy rating than the CA-125 test.

I was faced with waiting on an ovarian cyst and the way I kept my wits is to use both the CA-125 and the ultrasounds as reassurance that it was extremely unlikely that I had cancer. As time went on and my cyst was still there and barely growing, I became more and more certain that the cyst was benign (ovarian cancer usually moves quickly).

Be very careful about internet reading and watch your sources. Use scholarly journals or board certified gynecologists' web-sites. There is a lot of panic generating stuff on the internet so tread very carefully. If you type "headache" on the internet, you will get all sorts of things like brain tumours and brain cancer when most of the time a headache is just a headache.

Hang in there and try to relax. If you are still very anxious, talk to your doctor about the things that I mentioned and perhaps explain that you are very anxious about this situation. They are definitely used to it because we are all anxious about ovarian cancer. Oh and by the way, ovarian cancer can be cured just as endometrial cancer can be cured. The thing about ovarian cancer is that when it is discovered it is often at stage III or IV so it has progressed unchecked for a while. When ovarian cancer is discovered early, it has an over 90% cure rate just like endometrial cancer. The thing that will help is when they finally release an ovarian cancer screening test. They are working seriously on this and hopefully we will have something very soon.

Take good care of yourself and let us know how you are doing.

Best Regards,

Estria





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