5 cm Complex Cyst and Severe Abdominal Pain

[AustenGirl1975]

I was in the ER for severe abdominal pain that made me double over every time I ate.  I've lost several pounds in the last month from subsisting on as little food as possible to avoid the pain.  The ER doc ordered a CT and subsequent US, which showed a 5-cm complex cyst with multiple septa on my left ovary.  I am 40 and had my right ovary removed when I was 22 and a partial hysterectomy at 26. A CT scan 1 year ago was completely clear, so this cyst has developed in 12 months or less.  I began experiencing menopausal symptoms within the last 6 months and was prescribed estrogen 2 months ago. My mother was diagnosed with Stage 4 ovarian cancer 18 months ago.  She and my sister are BRCA1+, but I am negative. I have no personal history of cancer.

From your experience, is it likely that I'll need surgery soon?  Are there any alarming indicators in my description that might point to it being malignant?  I'm seeing the doctor soon, but too worried to sleep.

[old_before_my_time]

I am sorry to hear this. I hope you do not have cancer and your surgery goes well. Keep us posted. My CT scan showed cysts on my kidneys and liver but I was not told to follow up on those.

[AustenGirl1975]

Thank you so much for your response. My gynecologist worried me by telling me that all of my symptoms point to ovarian cancer, but he is delaying surgery for a few weeks because my CA-125 was only 11.5. However, I know that test can be unreliable, so I'm calling him tomorrow to request surgery sooner. I'm in so much physical discomfort and have no energy. I've lost 25 pounds in less than two months, mostly because I experience severe abdominal pain after eating. I'm also being treated by a GI specialist and am having a colonoscopy. The CT scan that found the cyst also showed lung nodules, so I'm in the care of a pulmonary doctor, too. I'm hoping that these are three unrelated conditions, but Im fearing the worst.

[old_before_my_time]

Sorry to hear about your mother's diagnosis and that she and your sister are BRCA1+. But glad to hear you do not have the gene mutation. It seems then that you should have a "normal" lifetime risk of ovarian cancer (less than 2%). MOST ovarian cysts, even complex ones, are benign (non-cancerous). Occasionally, complex cysts will go away on their own. Once they get larger than about 7 cm or are very suspicious looking, surgery is warranted.

There are a number of traits that they consider when determining the malignancy potential. If you look on radiology sites (including radiopaedia or RNSA) for "complex ovarian cysts" you'll see that cyst size, THICK septations, papillary projections, solid components, mural nodules, high vascularity, and ascites are the most concerning traits.

Since you had an ovary removed and had a hysterectomy, it is not surprising that you have menopausal symptoms at this relatively young age.

Let us know what you find out from your doctor. Hope it is nothing serious.