Complex Ovarian Cyst

Author Message
Barb Renee
Posted on Tuesday, December 04, 2001 – 5:21 pm

Dear Dr. del Junco: This may seem like an insignificant problem, but I am worried. I am 45 years old. I had my first period at the age of 10. Today my doctor called to say an ultra sound showed a 1.5 cm complex cyst on my right ovary. She suggested I go on the pill immediately (I haven’t taken the pill for over 20 years because of my reaction to it), and then have a follow up ultra sound in 6 weeks. How often is a complex cyst malignant? Since it is fairly small, if it is cancerous, would this be considered early? Would waiting six weeks make matters worse? I am very worried. There is no family history of cancer, but one of my sisters did have her uterus and ovaries removed due to cysts and fybroid tumors.

Dr. del Junco Jr. (Doctor)
Posted on Monday, December 10, 2001 – 11:45 am

Dear Barb Renee-
There is no way to determine percent of malignancy without knowing exact type of cyst. Your gyn has recommended very traditional and standard treatment for a nonspecified cyst found on radiographic image.
Waiting six weeks should not be a problem, especially with no history of ovarian malignancy in the family. I would recommend getting a CA 125 test done to enhance the diagnosis.

Posted on Thursday, January 24, 2002 – 1:01 pm

Dear Dr. Del Junco
I was diagnosed with one chocolate cyst on the left side. I have an appointment for a second opinion about how to proceed next (removal of both ovaries was the offer with first Gyn!!). Should I ask the 2nd Gyn to have me have this CA 125 test before I go to see him? (otherwise he might want me to have it done anyway, which would mean another 2-3 months for rescheduling an appointment!). How should I approach this new Gyn. and suggest him beforehand this blood test? Is this appropriate? (I am 38. There is no history of cancer of any type in the family, but one sister had (unfortunately)her uterus removed because of a grapefruit size fibroid-).
I read that a patient with a high CA 125 result and one ovarian cyst does not always has ovarian cancer. Would you treat patients who come to your clinic with this diagnosis? If so , How?
Or should the patient have cancer ruled out through surgery (laparoscopy or laparotomy?)before consulting with you?
I need your advice.

Dr. del Junco Jr. (Doctor)
Posted on Friday, January 25, 2002 – 8:45 am

Dear Elisabeth-
We always recommend patients have a CA 125 drawn prior to complete diagnosis, however this test does not prove conclusively the presence of cancer. Many women with endometriosis have elevated CA 125..we find this regularly in our practice. Once the endo is treated or the endometrioma is removed, the CA 125 returns to normal levels. Previous surgery is not necessary to come to our Institute. Many women have been scared with the threat of cancer and we have not yet seen one patient with an ovarian mass that was malignant. All our patients had benign endo that was treated and the ovary preserved. If you have no family history of ovarian cancer, percentages are on your side. Good Luck

Posted on Saturday, May 18, 2002 – 3:43 pm

Dear Dr. Del Junco:

I am 45 years old (had a hysterectomy at age 32 – du to endometriosis – and a left ovarectomy 8 months later – due to a grapefruit size complex ovarian cyst). For the past 2 months I have been experiencing severe right lower pain and have just been diagnosed with a complex ovarian cyst on my right ovary; this was found during an ER visit which they performed a vaginal ultrasound. I was given Percocet and sent home with advise to follow-up with my GP for another ultrasound in 6 weeks. I had a severe reaction to the Percocet and after 72 hours, the pain is still almost unbearable. From reading other patients questions to you, I am now concerned about cancer (even though no Dr. has mentioned this). Breast cancer runs in my family but I am not sure of ovarian cancer. As I also have quite a few immune issues, this new diagnosis has me concerned. Any advice you could give me would be greatly appreciated. Katherine

Dr. del Junco Jr. (Doctor)
Posted on Monday, May 20, 2002 – 4:38 pm

Dear Katherine-
Many women come to our practice with the fear of ovarian cancer. So far..I have not seen one patient with an ovarian malignancy….all have been benign cysts. I would recommend you get a CA 125 test drawn..however this can be falsely elevated with a history of endometriosis.
You should have the ovarian mass removed….have them check the pathology during surgery and if all is benign…do not remove your only remaining ovary. I recommend a laser removal to minimize damage to the ovary…but it is very important to keep it for natural hormone production. If you remove the ovary you will enter into immediate menopause and most women then require some type of hormone supplementation…this would not be recommended for a women with a history of familial breast cancer, as you have indicated.
Hope this has been helpful.

Dilek Newlon
Unregistered guest
Posted on Monday, May 09, 2005 – 10:03 pm

I’m a 45 year old female with no family history of ovarian cancer. Findings on my ultrasound that was performed on April 28 as follows: The left ovary measures 2.7 x 1.8 x 2.5 cm. It contains a 1.4 cm round echoic structure which is not clearly a simple cyst. The right ovary measures 2.7 x 2.2 x 2.6cm. This is unremarkable in its sonographic appearance and contains a simple appearing follicle. There is n free fluid.
Enlarged bulky uterus. this most likely represents a fibroid uterus. The endometrium is thickened and measures 1.8 cm. No focal masses are seen.

I’m very concerned with the findings on my left ovary. Does round echoic structure mean a solid mass on ovary? Radiologist recommends waiting 6 weeks and repeating the ultrasound. Even though it’s a fairly small cyst(1.4cm), I’m scared to death that this might be a malignant mass and 6 weeks is going to feel like an eternity. I’m going to ask my doctor for the CA 125 test, but could the condition of my uteres( enlarged uteres with fibroids and thickened lining) cause the test to be elevated? Is it okay to wait 6 weeks or should I get the cyst removed and tested right away? Thank you so much for your advice.

Dr. del Junco Jr. (Doctor)
Username: Doctor

Post Number: 43
Registered: 3-2004

Posted on Tuesday, May 10, 2005 – 1:03 pm

Dear Dilek-
Ovarian cancer is a very rare condition…based on the information you have given, we would also recommend waiting the 6 weeks for another exam by ultrasound. With no family history the chances of you having the disease are very small. CA 125s are helpful to assist with a diagnosis but can be falsely elevated with other conditions like endometriois and adenomyosis, which can produce an enlarged uterus. We have treated many women in our program with elevated tests and none have had cancer.
If you were my patient, I would advise the 6 week wait and a retest.
Good luck

Unregistered guest
Posted on Tuesday, July 26, 2005 – 2:36 am

Dear Dr Del Junco,
I am 42. My pelvic and vaginal US showed I have a complex mass within my right ovary measuring 2.0 x 1.3 cm in an otherwise normal sized ovary. The left ovary showed multiple physiologic cysts, normal sized as well. My uterus is normal too and the endo stripe is normal. I also have 2 endocervical polyps and the beginnings of a 8.0mm possible uterine fibroid. The right ovary mass contains cysts and solid septae as well as a rounded hyperechoic nodule within the wall of the cyst measuring 0.9 x 0.7 cm with no free fluid in the cul de sac. I am extremely freaked out by this and go to a gyno tomorrow for a follow up. What tests should I insist on and what is the routine way of handling these findings? There is no history of ovarian cancer in my family. I don’t want to take the wait and see approach. Id like to have it biopsied immediately. It frightens me. Thank you so much for your insights.

Dr. del Junco Jr. (Doctor)
Username: Doctor

Post Number: 55
Registered: 3-2004

Posted on Thursday, July 28, 2005 – 8:23 pm

Dear Dana-There is no need for further testing.
If you are concerned, you should have it removed, along with your cervical polyps. Your Doctor should not have to remove any organs, if all is benign.
Good luck