Solid mass in right ovary

[nhgirl2593]

I went in for an ultrasound 2 weeks ago due to tremendous pain in my lower right side.  My gyno told me I have a solid, 4x4cm complex cyst in my right ovary and that it has to come out.  She spent 45 minutes with my husband and I leading us to believe I most likely have ovarian cancer and that I need to see a gyno/oncologyst right away.  Saw the specialist a few days ago and after seeing the us pics he feels I should have laproscopic surgery to be absolutely positive it is not cancer.  I have been a total wreck for two weeks.  I go into these massive mood swings and cry uncontrollably.  Im extremely angry and scared.  The worst part for me is the not knowing with ovarian cancer.  I am 42 and have no uterus due to placenta accreta 13 years ago with my 3rd son.  I had 2 c-sections.  My biggest fear other than cancer right now is the possibility of having a lot of scar tissue and the Dr. then needing to cut me vertically to get at this cyst that MAY NOT be cancer and could very well go away on its own and do nothing.  I am not a shallow person but I take a lot of pride in how I look for my age.  Im 110lbs and work hard at my body.  The thought of being cut vertically and having my nice flat stomach look like a butt crack is a nightmare for me.  I may be cut and disfigured and it might not be cancer.  MIGHT NOT is the strong word here.  If its cancer than obviously I would want them to do whatever they could to get rid of it and cut me however they need to.  Its just very difficult for me to think of having that type of surgery on something that may not need it.  Please let me know if anyone else has gone through this or if your surgery started as laproscopic and turned into an all out cut.  Im so scared and really need support from someone who has been there.  
Kim

[OCFB]

I can completely understand your feelings regarding the "destruction" of your flat stomach; I felt the same way 8 years ago when my gyn/onc surgeon told me that my cut would be vertical.  I had always had a flat stomach and I cried my heart out when I saw the staples running from above my belly button down to my pubic bone.  I was a 1C and after 6 rounds of chemo, I am here to respond to you.  Whatever you decide to do as far as laparoscopic vs abdominal surgery, keep in mind that your health is most important.  I am 70 now, and everything that was once so well put together is slowly sliding south.   All the exercise in the world wouldn't have saved it, but I am cancer-free, and that, to me, is worth whatever additional years I might have had sporting a flat belly.  

[shewrites]

I believe the doctor who is on the ovarian cancer doctor's forum (see above) is from Massachusetts.  Perhaps she's the one for a second opinion.  

To keep things in perspective, I had a 14 cm mass removed.  I'm a 1A (one ovary, no spread), did chemo because my doctor is considered aggressive, and I've celebrated nine years since my surgery.  Chemo was not as bad as I'd imagined; the side effect I had was constipation.   I had a harder time with losing my hair than anything else.  If this is cancer, it's probably early and your gyn/onc will be able to take care of it.  

[kcd86]

Kim, a complex cyst needs to be removed and sent to pathology. Until it's removed and a pathologist looks at it, everything else will be guess work.
They would be able to tell if it was a simple fluid filled cyst on us which waiting another 6wks would be prudent but not for a complex cyst. I would be getting an MRI of the abd/pelvis as it will help define what the cyst is and also see if anything else is going on. I hear Mass General has a good GYN cancer center.

[nhgirl2593]

Thank you Kevin for such great information.  I was referred to a gyno/oncologist at Tufts in Boston because he specializes in laproscopic procedures for ovarian cancer.  He told me an MRI would only be helpful if I plan on holding off on surgery but if I wanted one he would be more than happy to set it up.  My CA 125 was a 3 but he also told me that he has had patients in the early stage of cancer have low scores and that it really means nothing.  He did say he thought he may be able to remove just the cyst depending on how it looks when he gets in there.  I definetely want a second opinion but have no idea where to go for it.  It would be someone in Boston but there are so many hospitals that its overwhelming trying to figure out who is the best and most knowledgeable.  So Im not sure if I ask for the MRI first or find a 2nd opinion and then have it.  I assume getting the MRI done now would be the smartest step.  I asked him if I could just wait 6 weeks and do another ultrasound to see if its shrinking but my sister thinks waiting is just prolonging something that really needs to get done to rule out any cancer.  Ive had 3 different opinions so far and that makes it harder.  My original gyno who brought me in with only having the preliminary us pics, the radiologist who simply said wait 6-8 weeks and have nother us and now the gyno/oncologist who says it really needs to come out.  Quite honestly I would just like to pretend this isnt happening to me and go on with my life but its not that easy:(

[kcd86]

Kim,
In addition to my last post, my wife's gyn/onc initially went in with the scope took out the mass and when pathology came back positive then she mad the same incision as her previous c-sections to remove her ovaries,uterous and lymph nodes. It will depend on what the gyn/onc finds when she gets in there on which way she has to make anincision or extent of disease. Did they do an MRI of the abd/pelvis to see if there is any other disease?

[kcd86]

I am sorry you have to go threw this it is very stressfull to have this hanging over your head. Keep in mind most cysts are benign !!  
My wife was recently Dx with granulosa Cell cancer( GCT) Jan 2010 and I know what it feels like to not know what the next step is. Here is a quick overview.

Tests like sonograms, Cat scans and MRI's along with blood tests like CA125, Inhibin A&B, MIS and CEA are just used as a guides for the Dr's to help assist in making a diagnoses(Dx).
The blood test CA-125 is a test used by Dr's as a guide to determine if you have the most common form of ovarian cancer, approximately 80% of all ovarian cancers are epitheal ovarian cancer which is cancer of the cells on the surface of your ovary. Please keep in mind that CA-125 can be elevated if your menstruating and some other causes of inflamation..
There are other types of ovarian cancer that are hormone driven and depending which form a person has there will be excess symptoms of that specific hormone. This is the type my wife was Dx with granulosa cell ca. These group type are called sex cord -stromal tumors. These type of tumors have specific markes that the Dr's use just like ca-125 to aide in their dx of epitheal ovarian ca. They are Inhibin A&B and MIS. Please keep in mind if and only if you have a dx of these form of tumors there is a missconception that these tumors are always benign, which is completely false> They are just slow growing tumors as opposed to epitheal.
Since your us is describing the cyst as complex unfortunately with any type of suspected ovarian mass/tumor/ suspicious cyst(s) surgery will be the only way for the Dr's too make a definitive Dx.
*****It is NOT recommended to biopsy any ovarian mass/tumor/suspicious cyst as it can rupture and seed the pelvis with cancer cells if that what it turns out to be. **********
.
******************************************************************************************************
Since there is some suspicion  I would immediately find a good GYN/Oncologist surgeon. I am not suggesting what you have is cancer but studies have shown that treatment of ovarian cancer by nongynecologic oncologists and by low volume surgeons is associated with suboptimal surgical management. I would reccomend going to a large tiertiary hopsital where they see large volumes of patients.  This is not to make you worry even more but to make sure that the Dr who treats you has vast experience with diagnosing and treating various types of GYN / Onc issues if that is what it turns out to be. If the Dr wants to remove the cyst/mass via laprascopic procedure #####PLEASE make sure they have much experience with removing these INTACT! All too often I read posts from patients who say their Dr thought it was a cyst and removed it haphazardly causing a rupture and seeding of the pelvis with cancer cells, only to be found on pathology post removal. ######
****************************************************************************************************
Next: From experience I would be asking for an MRI of the abdomen/pelvis ,MRI's are very precise when read by a **Radiologist that specializes in GYN/ONC**, My wife went to a radiology practice that does all types of MRI's and the Radiologist read her MRI as a fibroid. I then took her to Sloan Kettering in NYC(specializes in cancer only) to see a GYN/ONC surgeon who had the MRI repeated by a GYN/ONC Radiologist who called her DX to the tee which was confirmed after surgery.
The best advice you see all over these posts is you have to be your own advocate, be aggresive and stay on top of your phycicians. Get copies of all your tests/results as you are entitled to them. Post with any other questions you have this site has some very knowledgeable people on it. I wish you all the best.
Kevin