Could these ultrasound results be indicative of ovarian cancer?

[LexLexLex3]

30F. I recently had my annual pap and mentioned to my gyno that I've had a dull ache on my lower left abdomen for the past 6-12 months--can't really recall when it first began. He ordered a pelvic and transvaginal ultrasound, if needed. I ended up having both done.

The results:

Left ovary:
Multiple cysts. Largest cyst is 5.1 x 4.1 x 5.0 cm. Ovary size is 6.9 x 5.3 x 5.8 cm.

Right ovary:
Complex ovarian cyst with a questionable mural nodule ( nodule is 0.9 cm in size). The cyst size is 2.5 x 1.6 x 2.6 cm. Ovary size is 3.3 x 2.4 x 4.6 cm.

A normal, healthy ovary should be approximately 3.5 x 2.5 x 1.5 cm (for someone my age who isn't yet in menopause, according to a quick google search).

So, should I be concerned about the complex cyst? Does anyone know what a mural nodule is? Is it strange to have oversize ovaries? Could that affect fertility? FWIW, I temp daily and seem to ovulate (temp rise) and have regular if somewhat short cycles.

My biggest concern, after cancer, is retaining fertility. Following that, it's retaining both ovaries should surgery be necessary.

My gyno suggested that we wait and see regarding the larger (non-complex) cyst on the left that seems to be the cause of my pain. But as the pain has lasted for more than half a year, I don't assume it'll suddenly shrink. He has, however, referred me to a gyno oncologist regarding the complex cyst. I've an appointment in a few days but tend toward anxiety anyhow.

Should I be concerned??

[LexLexLex3]

Update:

I've been referred to a reproductive endocrinologist. The complex cyst with mural nodule on the right ovary has resolved on its own. The largest cyst on the left has grown a bit (5cm to 5.6cm) and is now identified as complex. The radiologist noted that it seemed likely to be either a hemorrhagic cyst or endometrioma.

The new doctor I've been seeing is suggesting surgical removal, though we did discuss potential damage to the ovary and how to avoid/minimize, and that I don't want to come out of surgery missing an ovary. At my last appointment, they took lots of blood and, among other things, are checking my AMH. If it's low, they may just put off surgery unless the cyst's growth rate increases and I further risk torsion.

At least for now, it seems likely benign.

[old_before_my_time]

Thanks for the update. Glad to hear the one cyst resolved. Hopefully, the other one will do the same. It seems that 7 or 8cm or thereabouts is the cut-off for monitoring and moving to surgery. It seems odd that your AMH result will determine whether or not to continue monitoring versus surgery. Why not just continue to monitor it regardless? Surgery has risks besides impaired fertility. But then surgery is quite profitable for all involved.  

[old_before_my_time]

Did you see the oncologist? What did you find out?

[LexLexLex3]

Thanks for your helpful words!

Yes, the gyno-onc is having me do another ultrasound but specified that it must be done while I'm on my period (tomorrow). The first was done on the day I ovulated, so hopefully this second one will show fewer/smaller cysts.

[old_before_my_time]

I'm sorry you're going through this. I know our minds tend to think the worst which doesn't do us any favors. But thankfully, the large majority of ovarian cysts, even complex ones, are benign. And imaging is not perfect so they cannot always tell the type of cyst. For example, hemorrhagic (blood filled) cysts that typically resolve on their own can appear solid (and concerning) on imaging. Multiple adjacent cysts can give the appearance of one big cyst with septations (making it appear complex). Endometriomas can't always be differentiated from other types of cysts, etc. But again, most ovarian cysts are benign and most go away on their own.

The cyst that appears to be complex is still very small so it seems monitoring would be the recommendation if you don't have a family history of ovarian cancer.

I think the explanation for your ovaries being enlarged is because of the cysts. The only thing I can say about a nodule is that a blood clot in a hemorrhagic cyst can appear as a nodule. I'm not sure of the implications of nodules and their various types, e.g. mural.  

You are right to want to keep your ovaries even if it weren't for fertility. All our female organs are essential our whole lives for good health. The ovaries of women with all their parts have been shown to produce hormones their whole lives protecting them from many chronic health problems. Overy.org talks about the negative effects of ovary removal. Removal of even one ovary has been shown to do more harm than good. Hysterectomy (uterus removal) is also damaging in a number of ways - hormonal / endocrine, sexual, anatomical (pelvic organ displacement), and skeletal (back, hips, figure changes).

If you do end up needing surgery, you will want to find a surgeon who has good cystectomy (cyst removal) skills to preserve your ovary or enough of it for normal function. According to this website by a doctor who does a lot of cystectomies, most cysts can be removed without removing the ovary - http://ovaryresearch.com/ovarian_cysts.htm.

Let us know what you find out from the oncologist. I wish you the best!