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Ultrasound done, fibroids, cysts, diabetic. Suggested surgery. What is the opinion?

May 2013
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Answered by
Practicing since : 2006
Answered : 4909 Questions
Dear Dr.

The menstural cycle commenced on April 24, 2012 last time and slight bleeding continued till May 13, 2012 and then stopped. I had undergone US which revealed the following (as per the report):

"UTerus is bulky and lobulated in appearance, Intramural Hypoechoic Fibroids measures - 4.2x3.5 cm and 3.2x2.5cm seen within posterior myometium causing antrior displacement of endometrium. Endometrium thickness is of 6.2mm. Cystic lesions showing thin XXXXXXX septa seen in left adnexal region likely left ovarian cyst (measures - 5.9x3.9 cm). Right Ovary Normal".

The local gynocologist advised immediate surgery. She even asked a CA125 which indicated 192.50.

We had been to another gyncologist who also advised for surgery but has asked to control the diabetes before surgery. She has askedto wait for about a month and go for another round of US (Pelvis) and return. She has dismissed that CA125 is not required at this stage as there is no requirement as per the US clinicals.

I am 43 years old. Pre-Menapusal. Have been pregnant before (but did not go through the pregnancy for personal reasons). Am Type II Diabetic (am on 28 ml insulin). No other ailment.

I may also give the results of the other tests that I had undergone:
CBC (Complete Blood Count):
*Haemoglobin: 13.7 gm/dl (reference range: 12-15)
*Packed Cell Volume: 40.6% (rr: 40-50)
*Total Leucocyte Count: 7.5 10-9/L (rr:4-11)
*RBC Count: 4.64 (rr: 3.8-4.8)
*MCV: 87.7 (rr: 80-100)
*MCH: 29.5 (rr: 26-34)
*MCHC: 33.7 (rr:32-36)
*Platelet COunt: 291 (rr: 150-450)
*RDW: 13.8% (rr: 11.5-14.5)

Differential Leukocyte Count:
*Neutrophils: 71
*Lymphocytes: 24
*Monocytes: 03
*Eosinophils: 02
*Basophils: 00
CA 125 (Ovarian Cancer Marker)
*CA 125 : 190.5 (rr: <35)
*CEA (Carcino Emryonic Antigen): 1.29 (rr: <3)

Thanks and Regards.
Posted Sun, 1 Jul 2012 in Menstruation and Miscarriage
Answered by Dr. Sree Gouri SR 7 hours later
thanks for the query.

fibroids are known to cause menstrual abnormalities, and most possibly they are responsible for your prolonged bleeding.

treatment of fibroids depends on age group of the patients and symptoms.
normally asymptomatic fibroids need no intervention.
as they are causing symptoms like prolonged periods in your case and as you are in premenopausal age, the treatment is surgery.
medical treatment like hormonal therapy can lead to serious complications at this age.

functional cysts of ovary are common in reproductive age group,
the doctor whom you visited initially might have adviced to check for CA125 levels as you are having cyst more than 5 cms size at this age.

as CA 125 levels will also be elevated in conditions like fibroids apart from ovarian malignancy, because of this the second gynecologist might have told that the test is not necessary.
she adviced you to take ultrasound after one month because functional cysts can resolve with time.

all other reports are normal,
you have to keep your blood sugar levels normal and plan for surgery which is better option.

Hope I have answered your query. I will be available to answer your follow up queries. If you are satisfied with all my answer, please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
Follow-up: Ultrasound done, fibroids, cysts, diabetic. Suggested surgery. What is the opinion? 4 hours later
Do we need to go for removal of ovaries also. The first gynocologist advised removal immediately and also offerred a package deal (3 days package) in XXXXXXX Healthcare IP Extension Delhi. She also said that the surgery can be performed even if I had my sugar levels over 350 (which was at that stage).

What other reasons may lead to elevated CA125. While everything seemed under control before going to the first gynocologist, I am very worried now. What are other reasons why CA could be elevated.

Thanks and regards.
Answered by Dr. Sree Gouri SR 14 hours later
hi XXXXXXX pr,

removal of ovaries during hysterectomy is always a controversial issue,
normally it is recommended after the age of 45 years,
but as you are having ovarian cyst with elevated CA 125 levels, better to get removed to avoid future complications.

high blood sugar levels can impair the wound healing and can also affect other systems of the body which may create problem during anesthesia, recovery etc.
so it will be good if blood sugar is under control.
in case of emergency surgery even with high levels also surgery will be done as there will be no other option.
but in case of elective surgery better to do in ideal circumstances.

the CA 125 levels will be elevated in conditions like,
-ovarian cysts, benign and malignant tumors,
-during menstruation,
-pelvic inflammatory disease,
-malignancies of gastrointestinal tract, endometrium, fallopian tubes, breast, lung etc.

in your case there is more possibility for benign cause like ovarian cyst or fibroids because your findings like,
thin XXXXXXX septa in the cyst,
size of the cyst around 5 cms,
unilateral cyst,
not associated with free fluid in abdominal cavity etc
all suggesting benign cause.
so you don't worry, plan for surgery under guidance of your doctor.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
take care.

Above answer was peer-reviewed by
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