Ovary and Adnexal Masses: Your Questions Answered
Ovary and Adnexal Cysts and Masses
- Will dermoid removal affect getting pregnant?
- Following a postmenopausal ovarian cyst with ultrasound
- What is a Ca-125 test?
Can you explain the normal course of treatment for a dermoid cyst (3cm)of the ovary with someone trying to conceive.
The normal treatment of a dermoid cyst of the ovary is removal. When it is that size, usually it can be removed surgically just by cystectomy rather than removal of the entire ovary. If they get larger in size over 5-6 cm, the entire ovary is often replaced by the dermoid and the entire ovary ends up being removed. The removal can be done by laparoscopy or by minilaparotomy.
When dermoids are small they don't affect ovulation that I know of. I think at 3 cm it's unlikely to alter anything. As they get larger, they compress the other ovarian tissue and some follicles are lost. The ovaries are quite adaptive, however, in that if one doesn't work, the other takes over. In that way, the dermoid will probably not affect your ovulation to get pregnant.
Where I have seen it affect ovulation is when a 2nd dermoid is removed by cystectomy when the first ovary has previously been removed because the dermoid was too big to just do a cystectomy. In this case, the woman often undergoes premature menopause (ovarian failure) because there are not enough follicles left in the remaining ovary from which the dermoid has been removed. I have seen this enough times to know that dermoids do destroy follicles if they get big. Again, what is big is probably variable but after 5-6 cm I think follicle destruction begins.
I am a postmenopausal woman, recently diagnosed with a tiny (sub-centimeric) ovarian cyst. I had a CA-125 test, as my mother had ovarian cancer, and the result was normal. The cyst has remained for several months. I have no pain, except a very nervous doctor! She says I need to monitor the cyst - I'm busy! How frequently should I have an ultrasound?
There is no scientific answer to this. Postmenopausal benign cysts are more frequent than we thought 5-10 years ago. (See abstract below) In our office we do an ultrasound and Ca-125 at 3 months (after first finding the cyst), then each 6 months times two (one year) then yearly. I don't have any patients who are more than 3 years but I think certainly at 5 years if there is no change we may just stop monitoring or at least go to every two to three years. This regimen may change as we get more experience for studies in the literature so you need to keep in contact with your doctor about it.
J Ultrasound Med 1998 Jun;17(6):369-372
Simple cyst in the postmenopausal patient: detection and management.
Conway C, Zalud I, Dilena M, Maulik D, Schulman H, Haley J, Simonelli K
Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York, USA.
The aims of our study were to determine the prevalence of simple ovarian cysts in asymptomatic postmenopausal patients and to investigate the natural history of these cysts by ultrasonographic follow-up examinations. Three thousand five hundred and eighty-five women participated in the volunteer pelvic cancer screening program. Entry criteria were as follows: postmenopausal, no clinical symptoms, and no previous gynecologic pathology. An anechoic, small cyst less than 5 cm in greatest diameter was classified as a simple ovarian cyst. A scoring system to determine malignant potential had been established previously. All simple cysts had a score of 2 or less and had a morphology typical of benign lesions. In the case of a positive finding, the patient would be seen at 3 to 6 month intervals. The decision for surgical intervention was made by a private gynecologist or patient or if an interval change was noted. One thousand seven hundred and sixty-nine postmenopausal women (49.34% of all patients from the screening program) participated in this study. One hundred and sixteen simple cysts were found, with a prevalence of 6.6% in our population. Among those patients, 27 (23.28%) simple cysts resolved spontaneously, 69 (59.48%) have persisted, and 20 (17.24%) have been lost to follow-up study. Eighteen women (26.09%) with persistent simple ovarian cyst underwent surgery. No malignant ovarian conditions were identified. In conclusion, simple ovarian cysts are more common in postmenopausal women than previously was thought. This condition is very unlikely to be malignant and can be followed conservatively.
CA-125 is a test developed to detect cancer. Antibodies were made to cancer cells and one of them, OC-125 turned out to often be positive in many cases of ovarian cancer. It is often called Ca-125 by the antigen name and is used in postmenopausal women as a cancer screen and in premenopausal women and postmenopausal women as a baseline prior to surgery for an ovarian cyst or mass in case it turns out to be a cancer.
It is not positive in all cases of ovarian cancer and there are many other benign conditions that can cause an elevation. So many conditions, in fact, that it shouldn't be used as a cancer screen in premenopausal women. There are too many false positives that would create unnecessary surgery and concern when used premenopausally as a screen. After a women has gone through menopause, a positive test as a screen (no symptoms or known masses) turns out to be cancer only one in ten times or less.
Thanks for the info on the CA125 blood work. Then can I be correct in saying that If the CA125 comes back normal (which mine did) then I can rule out the mass on my ovary is NOT cancerous for sure?
No. A negative Ca-125 doesn't mean a mass is not cancerous. Not all cancers have a positive Ca-125. The most important characteristics are how the ovary appears on ultrasound, i.e., does it have solid and cystic components, are there excresences etc.
As I remember from previous messages, you are premenopausal. I tried to make clear in the last response about Ca-125 that in premenopausal women it CANNOT be used for diagnosis either positive or negative. It's only function premenopausally is a baseline in case a mass turns out to be cancerous and (I forgot to mention this) the test is also positive. Then it can be used as a marker after treatment to see if the cancer is under control (because the positive level would go to normal levels).