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Found cyst on ovaries. Started feeling breathlessness, chest tightness. Family history of cancer. Worried

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Practicing since : 2009
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Hi Doctor,

If I could get a response it would be greatly appreciated. Sorry if this seems too long, but I'd like to give an accurate picture and start from the top...

I had my appendix removed in Dec.'11 (8 mos. ago), and haven't felt quite right since (my current issues may or may not be related, this is just when I first began having issues). I went to the ER complaining of the classic appendicitis symptoms, so they did an abdominal CT scan, and saw that it was slightly inflamed and went for surgery. Also on the scan were 2 "small" cysts on my ovaries. Following the appendectomy, I had nausea (which was typical) for 6 months (which is not typical). My GP and several OBs said the nausea could be related to my cysts. So, I had an ultrasound on my ovaries, and they found that I had a 3cm and 4cm cyst on each ovary. They considered these to be normal and fluid-filled, so they ruled out cancer. They started me on a low-dose birth control. After my follow-up ultrasound showed that I still had the cyst (only one and 3cm this time), they urged me to stick with the birth control. Around two months later, I began having back pain around my left shoulder - towards my spine. I also suddenly had a tickling in my chest that, when I forced myself to cough, sounded like a XXXXXXX hacking cough, but was non-productive. I am also unable to take a XXXXXXX breath without a tight pain around my chest cavity. Because of this breathing difficulty, I am also very anxious. I went back to my GP, concerned that I might have a pulmonary embolism. She did a Chest CT, and everything came back clear ("likely" no embolism, pericarditis, or pleurisy). So, I left without a diagnosis. I came back 1 month later because the back pain, SOB, chest tightness, and tickling in my lungs was still present. I told her I could only force myself to have that hacking cough when I take a XXXXXXX breath, that I didn't have a naturally occurring cough, just the need to clear my chest. She responded with, "Oh, I can make myself do that too XXXXXXX This cough is not pleasant sounding, and I have never been able to "make myself" do this before. I know something's not right at this point. Now, within the last 3 weeks, I stopped my BC (I have had issues in the past with finding one that worked with me), and have noticed constant breast tenderness, sharp pains in my breast and armpits, and difficulty keeping a bra on b/c of tightness around my chest. I would just like to know what's going on, if any of this seems related, and if cancer can be ruled out (my biggest concern).

Some things to know:
-I am 24 y/o female
-Have had abdominal ct Dec. '11
-Chest CT March '12 (all clear/normal)
-3 ultrasounds (all pos for at least one 3cm cyst)
-1 abdominal ultrasound for gall bladder, liver, and pancreas (all clear/normal)
-Current problems: breast/chest/armpit soreness and sharp pains occasionally, upper back pain near shoulder spine area still present (this pain is in a very specific small area), trouble taking XXXXXXX breaths, SOB, tickle in chest and forced cough, anxiety as a result, occasional heartburn, pain worse at night.
-Have considered everything from GERD, muscle spasm in my back, cancer (breast, lung, ovarian), IBS (post-surgery, I had bouts of diarrhea/constipation that lasted a solid 3 months)
-Family hx of cancer (mother-lung) and heart disease (father).

*My GP seems unwilling to take my problems seriously, but you know when something's wrong with your body. Thanks again for any help!
Posted Tue, 28 Aug 2012 in Women's Health
Answered by Dr. Arnab Maji 1 hour later

First of all I want to thank you for giving such detailed history which is really helpful for us. But I would be pleased if you can provide me further details to understand this chest problem better.

1. The intensity of your cough is more in which period of the day?
2. Is your chest tightness is more in the morning hours?
3. Is there any aggravating and relieving factors of breathlessness and could you mention about its intensity?
4. You mentioned you stopped birth -control pills, did you stop it by yourself? And how long ago did you stop?
5. Does the cough and SOB disturb your sleep at night? - Any episodes where you got up of sleep with cough and SOB?
6. Are you a smoker?
7. What's your profession?
8. Is your day-to-day activity limited due to these complaints?
9. Do you notice expectoration / sputum accompanying your cough?
10. Lastly can you specify your current height and weight?

The description of your chest pain sounds me a pleurisy chest pain which may be caused by pleural inflammation. It can be associated with pneumonia, tuberculosis and rarely a tumour. You may also have asthmatic symptoms. In addition breast problems will need to be ruled out.

My suggestions here are you would need further investigations to sort out/rule out the aforementioned possibilities. The tests needed include:
1. Recent chest X-ray PA view,
2. ECG,
3. Mammography of both breasts.

Cancer is a rare possibility though cannot be denied. I would be able to provide more information after receiving the above details from you. If X-rays, EKG and Mammogram were also done, please let me know about the reports too.

Thank you once again for writing to us.

Dr. Arnab Maji
Above answer was peer-reviewed by
Follow-up: Found cyst on ovaries. Started feeling breathlessness, chest tightness. Family history of cancer. Worried 38 hours later
Hi Dr. Maji,

Thanks for your reply. In response to your questions:

1. My cough is more intense at night. Though I have a history of allergies, this doesn't seem to be a reaction to an allergen. Again, the cough is only present when I take a XXXXXXX breath and force air out.
2. Chest tightness is also more profound at night, not morning.
3. The breathlessness seems to occur randomly, not at any particular time of day or during a particular activity. For instance, I was driving my car and suddenly just felt the tightness and breathlessness.
4. I stopped the birth control on my own 3.5 weeks ago. I thought I needed to stop in order to determine if it was causing my symptoms, and rule out a birth control effect.
5. The cough and SOB have never woken me of sleep.
6. Non-smoker
7. I am a research assistant, which is rarely stressful, though at the very start of my chest pain (3 mos. ago), it was particularly stressful since we began a new study.
8. I have noticed a decline in my ability to perform daily functions, but only somewhat. I am still able to accomplish everything, I just have these symptoms to deal with in addition.
9. My cough does not produce expectorant/sputum.
10. 5'8", 225 lbs.

I need to add that I have had an ECG done (around 3 mos. ago, before my chest CT scan), and it read "abnormal XXXXXXX but did not show any significant problems. I was told it was common to have an "abnormal" readout. Also, my doctor cleared me of heart problems by my CT scan. I see that you mentioned pleurisy; would that not have been caught by the CT? I am unsure what the CT scan really rules out.

I have an appointment with my OB for a follow-up ultrasound, and I am going to mention my breast issues. The new breast issues are probably related to my quitting the birth control and hormonal imbalance, but I will have her examine.

I thank you again for consulting with me. I understand it seems like my symptoms are not worrisome, but because of the cancer and heart disease history in my family, I am concerned. I have begun a plant-based whole foods diet, in hopes of losing the excess weight, and gaining overall health.

Again, it's the chest/back pain and chest tightness that concerns me.

Thank you again,
Answered by Dr. Arnab Maji 17 hours later
Thanks for writing back.
It does seem that we are looking at just an allergy ( where the difficulty breathing and the overall effort can cause chest pain) or some infection. A pleurisy will not always be picked up by a CT scan.
But what we can do here is to give you a course of antibiotics like amoxicillin-clavulanate for 5 days along with an inhaler ( with either a long acting beta agonist like salmeterol or a low dose steroid).
You will also need to keep a symptom diary and identify what you are allergic to. This will help you prevent such episodes in the future.
Also, wash your bed linen in hot boiling water and try and use allergen proof bed covers and pillow covers.
Hope that helps.
Let me know if you have any more questions
Above answer was peer-reviewed by
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