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Laparoscopy done. Started feeling nausea, fatigued, flank pain and frequent urination. Chances of ovarian cancer?

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31 yo female.

History of: Dermoid tumor on R ovary. Pain was initially in my R rib cage area then gradually moved to my pelvic bone area. When surgery was completed they found endometrosis which was taken care of. R ovary & falliopian was removed. Prev periods have always been regular w/no cramps or other issues.

Current symptoms that started in April 2012 & increasing getting worse: weight gain of 17 lbs, excessive bloating (looking like 8 months prego) after eating (even w/something as small as a yogurt) & sometimes w/o eating, constant nausea, fatigue, Constant R flank pain, feeling full after a few bites, Increase in urination, irregular period (as early as 2 wks or 6 wks late, 1-3 days of spotting, 1-2 days of heavy (changing tampons 1-2 hrs) then 2 days of spotting), bowel movement changes (conspitation vs almost like diareha), & gas. All of the above symptoms happened on a daily basis for the past 2 months. In the past 2 wks I have started to have pain in the R side of my abdomen.

Avoided dairy @ one pt & gluten @ another. Abdomen ultrasound (kidneys, gallbladder, etc) was neg. CA-125 is 48. XXXXXXX ultrasound showed: Complex cyst w/a septation w/in it (possible hemorrhagic or degenerating cyst). Multiple physiological follicles, sm amt of free fluid in cul de sac.

My FNP believes there is a possibility that it could be ovarian cancer. Referral made to Gyno. Treated w/Gyno once (today) & was told not female related bc of age & ca-125 is to low. Also stating current symptoms are not related to female issues. No need to do a biopsy. Going for a 2nd opinion nxt wk.
Posted Mon, 5 Nov 2012 in Women's Health
Answered by Dr. Timothy Raichle 3 hours later
Hello, I would be happy to help you with your questions.

First of all, it sounds to me like the endometriosis at the time of your first laparoscopy was more of an incidental finding given your lack of cycle related pain prior to that - so I am going to say that when the current symptoms became an issue, I would not guess that it is all of a sudden related to endometriosis.

Second, since you lost your right tube and ovary, I will assume that the new findings of a complex cyst is involving your LEFT ovary (you did not specifically say).

So to summarize your symptoms: 7 months of weight gain, bloating, nausea, fatigue, right flank pain, urinary frequency, bowel changes, with worsening of bowel symptoms over the last 2 months, and worsening right sided pain over the last 2 weeks. Your main findings are a complex ovarian cyst on ultrasound and a CA-125 that is slightly elevated.

With regard to the diagnosis of ovarian cancer: at 31 years of age this would be really unusual, even in the setting of the ultrasound and CA125 leves (which are, in fact, slightly elevated). So don't move forward thinking that you have cancer. If I am correct, the complex cyst would be on the wrong side for your worsening pain. On top of that, your symptoms started about 7 months ago - if this was cancer, it would be more obvious and your belly would be full of fluid at this point (called ascites). Obviously, your bloating and weight gain do not appear to be related to the accumulation of something like cancer in your belly based on the ultrasound findings.

I would agree with two things: this is likely not GYN related AND a second opinion is a great idea. You have a lot of symptoms that might actually be more unconnected that connected. It is nice when we can pull them all together as a picture, but you have GI issues, urinary issues, cycle related issues, and pain issues.

So here is what I would say should happen (given the severity and progression of your symptoms):

1. You need a GI consult and possibly a colonoscopy
2. You need a CT scan which might give a better / different view of what is going on with your bowels and kidneys.
3. With regard to the cyst, you need a followup ultrasound about 6 weeks from when that one was performed (and a repeat CA125) unless pain becomes an issue that might be attributed to the complex cyst.

It is important to sort through this in a methodical manner. Try to write down your symptoms and what has been done in a timeline - it will help the Physician at the time of the second opinion. If you were 61, then cancer would be higher on the list, but at 31, the chances of this are extremely low. Consider that the GYN today who said that your symptoms are not GYN-related is ignoring the irregular cycles and possible cycle related symptoms that are likely confusing the situation if it is, in fact, something else (they did you no service today!).

I hope this helps you. Please let me know if you have more questions.
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