Re: CA 125 test and Ovarian Cysts
You did not mention your age in your post. Are you close to menopause (ie. in your forties) ? If so, the bleeding may have something to do with perimenopause and be completely normal. If you are on medication, it can also screw up your cycle. You will still have to follow up to find the cause but I would not freak out about this until you have more information (oh and by the way, the depo will definitely change your bleeding pattern and I hope the doctor told you about this).
As for the cysts, what kind of cysts are they ? Are they simple fluid filled cysts or complex cysts with solid components ? This is extremely important as simple fluid filled cysts are very rarely dangerous. Complex cysts are also predominantly benign (about 90% of them as a matter of fact) but ovarian cancer can also appear this way so surgery by a gynecological oncologist would be necessary to remove and biopsy these to be sure. The CA-125 test is a notoriously unreliable test. In women who are premenopausal, this test can show high even though there is no cancer present and it can miss stage 1 ovarian cancer in others (ie. show normal when cancer is present). Just to give you an example, my sister in law had a large 12 cm septated cyst on her ovary and she had a high CA-125. She was very scared and went to a gynecological oncologist who went in and removed the cyst. It turned out to be completely benign. Usually the CA-125 is considered normal for a score of anything between 0 and 35 but a higher reading does not necessarily mean that cancer exists. At the moment they are trying to develop a test that is more accurate (like Ovasure and others) but until that happens, the CA-125 is all that we have.
What do the ultrasound reports say ? These have a higher predictability value than the CA-125. Although the U.S. is not 100% accurate, radiologists and gynecologists can usually look at the morphology (the "look") of a cyst and make a reasonably accurate diagnosis. Ovarian cancer is usually jagged looking with specific looking solid protrusions coming into it. Benign cysts are usually smooth, thin walled structures which are usually anywhere up to around 5 or 6 cms (larger cysts are also benign but the larger they are and the faster they grow, the more abnormal and a cause for concern). Follicular and corpus luteal cysts, which are normal monthly growths on a woman's ovaries, can grow up to 5 or 6 cms in diameter and these normally disappear within 2-3 menstrual cycles. Larger cysts are less likely to go away on their own but depending upon what they look like, they are also most likely benign. I myself had to have a 9 cm ovarian cyst removed last year by laparoscopy (it was benign).
Get a copy of the report and see if you can read what it says. Usually a radiologist or gynecologist will give their impressions of what they think they are seeing at the bottom of the report. This is much more accurate than the CA-125 test. I know that when I was living with my cyst (I "watched" it with regular ultrasounds for 18 months) I was asked to have the CA-125 test and I was very nervous about this test because I knew that if it came out high I might freak out even though I may or may not have cancer. In my case, it came out low (around 7) but I know of a number of people who have had this test and scored very high when no cancer was present. It caused a lot of anxiety in these women for nothing and I don't like this at all. Evidently other things like menstruation or endometriosis can elevate the reading.
All this to say "Don't bank everything on this test". Take a look at the ultrasounds (oh and by the way, the ultrasound is the gold standard for ovarian cysts and not the CT scan .. this scan is good for other things) and if you don't understand something, come back and I or one of the other ladies on these boards (or gentlemen for that matter) may be able to help.
In the meantime, try not to get too anxious and to let your mind run away with you. June 30th is not very far away. Take the time to write down some questions that you will want to ask your doctor such as what the cyst looks like and what he thinks it is (and to have copies of the reports). I am not sure that the depo provera will work by the way. They have since done a number of studies on ovarian cysts and hormonal medication like the pill has no better an effect than simple watchful waiting to see if the cyst goes away on its own. Doctors used to believe that by shutting down the ovaries or regulating them with anti-ovulants, cysts will no longer form but if the cyst is an abnormal cyst (ie. not a normal follicular or corpus luteal cyst that comes and goes with your cycle) then it will not react to hormones .. it is a cyst like any other that could form anywhere on your body (kidney, liver etc..). Normal ovarian cysts that come and go with ovulation will go away on their own, with or without hormonal help and this has been proven in long term studies done on menopausal women (since usually more concern is shown when a menopausal woman has an ovarian cyst ... although they now know that up to 20% of menopausal women continue to grow cysts on their ovaries).
I hope that I have helped to empower you with information that you can use to discuss your situation with your doctor. It is normal to be scared but don't let your fear drive you crazy. At this point the chances are still strongly in your favour that it is not ovarian cancer. You may be recommended for surgery and if you are, you should seriously consider using a gynecological oncologist instead of a gynecologist, just in case. Studies have proven that in cases were ovarian cancer was present, if the woman was operated on by a gynecological oncologist as opposed to a gynecologist, she had a much better outcome. Most likely it will not be cancer but cover your bases because you never know for sure until that biopsy report comes back.
If you have any questions, feel free to come back and ask. I have found that talking to people who have had to go through the ovarian cyst waiting game (and believe me we are many) it helps to alleviate a lot of the anxiety that ends up being unwarranted.
Take good care of yourself.