ok i have ovaqrian cyst the size of a lemon for six months now the size has not changes at all....my doctor says he cant tell me whether it is cancer or not - now i keep getting weird pains in my ribs hip bones and kidney area and the fromt of my chest, i have had a normal ca-125, i am afraid that i do have ovarian cancer and it has spread to my bones and kidneys - could this be true - i am also frequently short of breath the cyst is complex It sounds like you have done an Ultrasound to 鈥減icture鈥?the cyst? Is it filled with clear fluid or blood or any internal solid elements?
Have you had a Doppler Study? This is a special ultrasound measuring the flow of blood to and from the ovary and cyst and may help in deciding if the cyst is actively growing and being fed by the vascular system. If the cyst is found to have solid elements, it鈥檚 also helpful to get an x-ray which can detect characteristic teeth, bone and/or cartilage in dermoid cysts.
Finally, a CT scan or MRI can help determine whether the cyst is suspicious for malignancy or whether it鈥檚 pressing on or invading adjacent organs, lymph glands or blood vessels.
Most cysts are benign, especially those that occur during the reproductive years. The incidence of ovarian cancer begins to increase after menopause. If there is no significant family history of ovarian cancer or combinations of certain cancers, such as breast, colon, and prostate cancer, you don鈥檛 have a known genetic risk, and if you are younger than 50, you should be reassured. If the cyst appears on ultrasound to be filled with clear fluid ( a simple cyst), it鈥檚 less than six centimeters in diameter and you鈥檙e not in pain, a wait-and-see approach over the next three months is appropriate.
Know that 90 percent of simple cysts are functional and will disappear after five weeks. Your doctor may repeat the ultrasound to make sure the cyst is gone. If, however, you are over the age of 50 and/or the cyst has solid elements and appears complex (with internal walls), further workup is usually done. This includes a blood test for the protein CA125, which you have done and is normal. That is a good sign but, this test is not foolproof. About 50 percent of early ovarian cancers don鈥檛 produce detectable amounts of CA125. And non-cancerous diseases such as uterine fibroids and endometriosis can cause mild elevations in the level of the CA125 protein.
The final diagnosis, especially if the cyst looks suspicious, may have to be surgical via a laparoscopic procedure. The cyst (and sometimes the ovary) will be removed and examined. In women who are menopausal, both ovaries are usually excised in order to prevent recurrences and/or reduce the future risk of ovarian cancer. If the doctor has a very high suspicion of cancer, a laparotomy (an abdominal incision) may be indicated. And if ovarian cancer is found, the surgery usually includes hysterectomy, removal of both ovaries, tubes, adjacent lymph glands and an excision of all visible cancer. This should be scheduled at surgical centers where a specialist in gynecologic cancer surgeries (a gynecologic oncologist) can be present.
Hope this info helps, it sounds like you should ask your Dr. to do further testing. I agree with you, it is always better to err on the side of caution, whenever there is any question of cancer. It most likely is not cancer but, in my experience, Ovarian Cancer is very difficult to detect & my Gynecologist doesn't even like to use the CA-125 test because of it's unreliability. I also am encouraged by the fact that the cyst isn't growing, but more testing is needed to provide you with a definitive diagnosis. Good luck!
Edit:
Here's what I found on complex cyst.
Differentiating between benign and malignant ovarian masses is necessary because ovarian cancer is lethal, and there are no proven screening techniques. Clinicians must consider the patient's medical profile (ie, risk factors, size of the mass, clinical presentation) to critically evaluate the likelihood of an early ovarian cancer. Diagnostic screening must include three essential components: an accurate medical history, a careful physical examination, and the judicious use of diagnostic procedures (eg, ultrasound, computed tomography [CT] scan, laparoscopy).
15-year retrospective study reviewed medical records of 72 patients who developed early stage ovarian carcinoma. The study showed that 78% of these patients presented with one or more of the following signs or symptoms:
* ascites (12.5%),
* bloatedness or increased abdominal girth (32%),
* increased CA-125 (approximately 52%),
* palpable abdominal mass (72%),
* pelvic pain (35%),
* simple cyst noted in ultrasound (15%),
* simple cyst noted on CT scan (17%), and
* vaginal bleeding (19%).
A finding of a simple cyst on either ultrasound or CT scan should not be clinically alarming; however, 15% of the women whose ultrasound showed a simple cyst and 17% of the women whose CT scans showed a simple cyst actually had early ovarian carcinoma. These results demonstrate that false negatives are possible with radiological tests for ovarian carcinoma. The interval time from presenting symptom to time of diagnosis is 4.6 months as a result of these false negative results. (22)
Symptoms usually are associated with the location of the tumor and its effect on surrounding organs. The most common symptoms reported by women found to have ovarian cancer include ascites (ie, peritoneal seeding), abdominal distention/swelling/ bloating/pain/discomfort, dyspepsia, nausea, anorexia, and constipation. (23) Vaginal bleeding may occur if the ovarian tumor is active hormonally. Symptoms tend to be nonspecific and can mimic nongynecological conditions, such as irritable bowel syndrome. Acute abdominal pain should alert the clinician to a possible ectopic pregnancy, ovarian torsion, cyst rupture, or bleeding hemorrhagic cyst.
Diagnostic screening. When screening for ovarian cancer, clinicians use three main approaches. Clinicians must be aware of other differential diagnoses that can mask an ovarian cancer (Table 2). Limitations, however, exist for all three screening methods. The three screening examinations include
* transvaginal or pelvic ultrasound,
* CA-125 tumor marker, and
* pelvic examination. Pelvic ultrasound can
* determine ovarian cyst size;
* differentiate between cystic or solid components including the description of internal echoes and septae;
* determine whether the cyst is unilocular or multilocular; and
* describe borders as either regular or irregular.
Transvaginal sonography provides a better image compared to the transabdominal approach. Radiologists may report a cyst as complex if there is no clear and convincing evidence that the mass is simple in nature because of the fear of missing an ovarian cancer. A CT scan should be considered if malignancy is suspected, or an abdominal flat film may be ordered to rule out a calcified fibroid or teeth from a possible dermoid.
Neovascularization is characteristic of malignant tumors. Vessels in malignant tumors have an irregular course, fail to taper, and have arterial-venous shunts with high flow velocities. There is low resistance to flow with little systolic versus diastolic variation in blood velocity because of the incomplete muscularization of tumor walls. (24) Doppler scanner sonography has improved the ability to evaluate ovarian cysts for increased vascularity and lower flow impedance to the ovarian cyst, which are possible signs of an early malignancy.
A recent study of 191 patients demonstrated that preoperative regression analysis of several variables could discriminate accurately between malignant and benign adnexal masses. These useful variables include
* menopausal status,
* CA-125 tumor marker,
* presence of at least one or more papillary growths greater than 3 mm in size, and
* a color score indicative of increased vascularity and blood flow.
This regression analysis has a documented sensitivity of 95.9% and specificity of 87.1%. (25) A similar study described the Tumor Ovarian Index as an accurate method for predicting ovarian malignancy of a suspected ovarian mass in the clinical setting. This tool combines age and specific ultrasound markers. (26)
Intravascular sonogram contrast agents, such as microbubble echo-enhancing contrast agent provide improved visualization of tumor vasculature compared to color doppler sonography as a result of three mechanisms. First, the number of recognizable vessels before and after contrast enhancement was significantly higher in malignant tumors compared to benign ones. Second, the time interval from administration of contrast to its visually detectable effect in tumor vessels was shorter in malignant tumors compared to benign tumors. Third, doppler signal intensity after contrast was higher in malignant tumors than in benign tumors. Sonography-enhanced studies using contrast agents, therefore, are superior to doppler sonography in differentiating between a benign ovarian mass versus a malignant ovarian mass. (27)
Tissues derived from coelomic epithelium produce the antigen CA-125 tumor marker. Only 80% of ovarian epithelial carcinomas produce CA-125; therefore, some women with ovarian cancer will have normal CA-125 levels or false-negative sera tests. (28) The CA-125 antigen also is expressed by various other pathologic and normal tissues of mullerian (ie, mesodermal) origin (Table 3). The CA-125 antigen has a low specificity, especially in premenopausal women. In women younger than 50 years of age, an elevated CA-125 is associated with a malignant mass less than 25% of the time compared to women older than age 50 with an elevated CA-125 who have a malignancy 80% of the time. (29)
Based on its lack of specificity, no recommendation can be made to order an annual CA-125 on all women as part of screening for ovarian cancer. Testing for CA-125 is best reserved for postmenopausal women with an identified adnexal mass found on either routine pelvic examination or on pelvic ultrasound. It also can be effective in detecting relapse of a known ovarian cancer and for monitoring during primary therapy in women being treated for ovarian cancer. (30) Detection of a truly early ovarian cancer is not pos i had the samw problem.,...seriously if you quit thinking about it , the pain will go away. its all in your head no, IF you had that kind of cancer spread it would show in the blood test, you more than likely have a benign cyst, if you would like ask your doctor to remove it. |
