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Have ovarian cyst, pain during periods, discharge. Ultrasound shows uterine fibroid. Can this be ovarian cancer?

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My wife (39 years, two daughters via normal delivery) has been having regular annual-health check-ups for last 4 years. She was diagnosed with a small cyst in the ovary around 3 years back. For last 12 months she has very high pain during periods and discharge (hope this is the right word).
On 7th CA125 resulted in 47.8. AND
on 8th CA125 resulted in 39.29
On 4th September 2012 Pelvic Ultrasonography (TVS) along with some blood tests (Hepatitis - B&C, HIV) were done on advice of a gyne. Blood tests were normal. HOWEVER:
TVS report mentions:
"UTERUS is retroverted and has normal shape and size.
Shows Hypeochoic lesion measuring 2X1.5 cms noted in the posterior wall.
Nebothian cyst in cervic measuginr 9.5 mm
Uterus measures 7.2X4.6X 5.8 cms
Right Ovary: 3.2X2.2 cms, shows complex cyst measuring 2X1.5 cms with XXXXXXX septations.
Left Ovary: 2.7 X 1.5 CMS, normal in size, shape and echotexture
POD & adnexa are free.
No evidence of ascites.
RIGHT OVARIAN COMPLEX CYST WITH XXXXXXX SEPTATIONS (might be heammorhage within the cyst.)

One GYNE has suggested D&C and Laparoscopy
Can this be Ovarian cancer? IF yes can we identify the stage with biopsy?
Posted Sat, 29 Sep 2012 in Vaginal and Uterus Health
Answered by Dr. Timothy Raichle 17 minutes later
Hello, I would be happy to help you today.

Based on what you are describing, and given her age, my concern regarding cancer is very low.

1. First, the "hypoechoic" lesion on the uterus likely represents a fibroid (common benign tumors) that are associated with painful, heavy periods. They, in fact, can be associated with an elevated CA125
2. Second, ovarian cancer is almost always associated with fluid in the pelvis (they commented that there was no ascites, or fluid in the pelvis)
3. Third, the cyst is small. While it needs followup because of complex features, in all likelihood it is not cancer.

One other possibility that could lead to a high CA125 is a condition called "endometriosis". You can look this up, but is associated with painful cycles, and when it involves the ovaries, they can develop complex appearing cysts.

So, the usual followup of the findings you describe would be:
1. A followup ultrasound in 6-8 weeks to see if the cyst goes away
2. If she has significant pain, then a laparoscopy sooner would be reasonable not only to evaluate and remove the cyst, but also to evaluate for other causes of her pain

There are no other things on that report that make me nervous. Perhaps based on the cyst, her pain, and the elevated CA125 it would be reasonable to proceed with the laparoscopy. This will put everyone's minds at ease. I do not know the purpose of the D&C in this case, as this really is not indicated based upon what you are telling me (perhaps the lining of the uterus inside is thickened, in which case a camera in the uterus would be more helpful - called 'hysteroscopy').

I hope this helps. - DR XXXXXXX
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