Ovary and Adnexal Masses: Your Questions Answered
Will dermoid removal affect getting pregnant?
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.
Following a postmenopausal ovarian cyst with 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.
What is a Ca-125 test?
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.
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).
