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Postmenopausal, Having Extreme Back Pain. Findings Show Increasing Calcification On Right Ovary. Further Risk ?
I am 58 years old (postmenopausal for four years w/no HRT) and began having extreme back pain in July. I had microscopic blood in urine and my family doctor ordered CT Abd/Pelvis. The most significant finding was calcifications on my right ovary, so a pelvic ultrasound was ordered. The most significant findings on the endovaginal imaging on 7/26/2013 were endometrium measuring 0.8cm AP (described as mildly thickened for postmenopausal) and 1.3 cm hypoechoic lesion in right ovary (previous CTs from 7/2013 and 1/2010 were reviewed and calcifications had increased on right ovary). I followed up with GYN and she had me do a urological work-up (because of the back pain and blood in urine) which turned out all normal. Meanwhile my family doctor ordered spine x-rays which led to seeing an orthopedist and having an MRI of the lumbar spine which revealed degenerative disc and some arthritis (I will have PT for that). Also, revealed on my MRI was endometrium measuring 9mm on 8/15/2013. I returned to GYN for follow up on 8/28/2013 at which time they did another ultrasound in her office and endometrium thickening was 13mm. She proposed three options: 1. uterine biopsy 2. D&C and possible removal of right ovary 3. Hysterectomy. She did not give an opinion. Here's how I feel: 1. Uterine biopsy doesn't address the ovary 2. D&C and ovary removal is great, but pathology results could lead to needing a hysterectomy anyway 3. willing to have hysterectomy if this is best option, but concerned about who should do the surgery. I have not been told that there is cancer, but of course, I am concerned. Someone has suggested that a gynecologic oncologist should do the hysterectomy, mentioning that they know to remove lymph nodes, etc. My GYN has not been very communicative and I need answers. I told her I chose to have a hysterectomy and she said she would schedule it 1-2 weeks. It is 8 days since my appt and her office called me today with a surgery date of 9/30/2013 which would be 5 wks since appt. I am considering seeing another doctor, but am concerned about the extra amount of time this could take and if that is a further risk to my health.
Thu, 19 Sep 2013
These are all good questions. Past the age of menopause, and especially if no HRT has been used, the endometrial stripe thickness on ultrasound should be 4mm or less. Any measurement greater than 4 mm is a concern for the development of endometrial cancer. Therefore, prior to performing a hysterectomy, a biopsy of the tissue lining the uterus needs to be performed. The gold standard for that evaluation is hysteroscopy with D&C. An office biopsy may or may not be definitive. If cancer is found, then hysterectomy is appropriate, probably with a Gyn Oncologist so that the proper staging hysterectomy can be performed. Staging is important for future management of uterine cancer.
I have seen patients who proceeded to hysterectomy directly with this scenario and were found to have cancer. Without proper staging at the original hysterectomy, they had to either undergo a further surgical procedure or opt for treatments that were recommended by assuming the cancer had spread beyond Stage 1.
When addressing the ovary, it may help to have a CA 125 level drawn. An elevation of that level is not specific for ovarian cancer (it can be elevated from fibroids, for instance) but is worrisome, which again would lead me to refer you to a Gyn Oncologist. A normal CA 125 level would be reassuring that you are not dealing with a developing ovarian cancer.
Given the situation you are dealing with, I believe you would be best served by a consultation with a Gyn Oncologist prior to making your final decisions. Hopefully, the concerns you express can be addressed at that initial consultation and you will be comfortable with your decision making process.
I hope this helps you answer your questions. I am available for further consult if needed.
I have seen patients who proceeded to hysterectomy directly with this scenario and were found to have cancer. Without proper staging at the original hysterectomy, they had to either undergo a further surgical procedure or opt for treatments that were recommended by assuming the cancer had spread beyond Stage 1.
When addressing the ovary, it may help to have a CA 125 level drawn. An elevation of that level is not specific for ovarian cancer (it can be elevated from fibroids, for instance) but is worrisome, which again would lead me to refer you to a Gyn Oncologist. A normal CA 125 level would be reassuring that you are not dealing with a developing ovarian cancer.
Given the situation you are dealing with, I believe you would be best served by a consultation with a Gyn Oncologist prior to making your final decisions. Hopefully, the concerns you express can be addressed at that initial consultation and you will be comfortable with your decision making process.
I hope this helps you answer your questions. I am available for further consult if needed.
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