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Old 03-25-2013, 08:33 PM   #1
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Question Post menopausal with possible suspicious ovarian cyst

Hello,

I have a cyst on my left ovary my gyn has been watching for about 2 years. It recently grew a little (4.2 cm to 4.7 cm). Since I'm 60, I decided to get the opinion of a gyn oncologist. She had a new ultrasound done that showed the cyst was still 4.7 cm but had developed 2 compartments and I also had a new simple cyst (2 cm) on my right ovary. She told me that ultrasounds are not always conclusive but gave me the choice of having both ovaries removed or waiting 3 months to see how things looked. Since recent studies indicate that the ovaries are health protective even after menopause, I'm having a hard time making a decision. I could use some help. Thank you.

 
Old 03-26-2013, 08:35 AM   #2
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Re: Post menopausal with possible suspicious ovarian cyst

Quote:
Originally Posted by Zialov View Post
She told me that ultrasounds are not always conclusive but gave me the choice of having both ovaries removed or waiting 3 months to see how things looked. Since recent studies indicate that the ovaries are health protective even after menopause, I'm having a hard time making a decision. I could use some help.
I'm responding based on my experience of hysterectomy and ovary removal and everything I've learned since my surgery. For one, the removal of my organs at age 49 turned my life upside down. I had a suspicious looking cyst. The frozen section done while I was under anesthesia showed it to be a BENIGN mucinous cystadenoma. But my gynecologist removed all my organs anyway! I aged in appearance 10-15 years within about 5 months post-op. I hate to think how much I've aged on the inside.

You're absolutely right that many studies show the ovaries to be health protective long after menopause. They show them to produce hormones into a woman's 80's. I know women in their 70's who had their uterus and/or ovaries removed whose quality of life and health quickly spiraled downward. Our female organs (ovaries, uterus, tubes) work together and have non-reproductive functions that are essential our entire life.

With the overuse of female organ removal, it can be difficult to find a gynecologist or oncologist who uses conservative treatments. It seems to me that since your oncologist gave you the option of monitoring, she must think the cyst isn't cancerous. And most aren't even when they look suspicious.

It seems odd though that:
1) She didn't mention removal of the just the cyst (cystectomy) leaving your ovary (or enough of it) to keep hormone production. This can be a more "delicate" surgery so maybe she doesn't have the skills or it's less profitable. You may want to check with your insurance to see what the reimbursement rates are for the two procedures (cystectomy and oophorectomy) if they'll even tell you. That can be eye-opening. Another possibility is that insurance won't pay for a cystectomy but only pay to have the ovary removed. I know a woman experienced this situation and had to file an appeal with her insurance to have this covered by a non-network doctor. She couldn't find a network doctor to remove just the cyst. She lost the appeal but then went to the state's insurance board and they ruled in her favor and made her insurance company pay 100% for the cystectomy plus a fine. I'm telling you this to understand some of the roadblocks you may encounter if the cyst ends up needing to be removed.
Also, the frozen section done while under anesthesia should dictate if more than the cyst needs to be removed. Obviously, if it's benign, there shouldn't be any need to remove more tissue (the ovary). This can all be spelled out on the consent form (may require changes by you) with the doctor signing off. If a doctor balks at this, you know something's amiss.

2) Why would the ovary with the simple cyst need to be removed? I assume you're past menopause so maybe that's why? But I thought simple cysts were never a problem. And if the cyst needs to go, why not a cystectomy (same as the other cyst if it's benign)?

It also seems common to remove the uterus when ovaries are removed (and vice versa) but, again, why remove organs needlessly?

Hope this helps!

 
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Old 03-26-2013, 12:06 PM   #3
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Re: Post menopausal with possible suspicious ovarian cyst

Thank you STLouisgal,

I really do wonder if there isn't a more conservative approach. I think because I'm post menopause (I went through menopause at 56) and am now 60, most doctors think the ovaries aren't very useful anymore. Also, after menopause, women are at greater risk for ovarian cancer. I've read that one reason they take the ovary is that they don't want to risk the cyst rupturing if it were cancer and that they actually bag it to assure prevention of a rupture. There is a medical term for this but I don't remember what it is. Has anyone had a cancerous or possibly cancerous cyst removed and yet were able to save the ovary? I'd really love to hear more responses to this post. Thanks again!

Last edited by Zialov; 03-26-2013 at 05:56 PM.

 
Old 03-26-2013, 02:04 PM   #4
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Re: Post menopausal with possible suspicious ovarian cyst

Sorry, posted same reply twice.

Last edited by Zialov; 03-26-2013 at 03:13 PM.

 
Old 03-27-2013, 08:11 AM   #5
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Re: Post menopausal with possible suspicious ovarian cyst

Quote:
Originally Posted by Zialov View Post
I've read that one reason they take the ovary is that they don't want to risk the cyst rupturing if it were cancer and that they actually bag it to assure prevention of a rupture.
This too seems to be a function of surgical skills. Bagging the cyst and removing via laproscope requires a different skill set than removing via an abdominal incision.

But of primary concern is keeping the ovary especially if the cyst is benign (and maybe even if it's malignant). Just as they remove malignant breast tumors leaving the rest of the breast, it would seem that there are cases where ovarian cancer is contained to the cyst itself which would be an early stage.

The method of removal would seem to be secondary to keeping the ovary or enough of it to produce hormones. I believe I read that as little as 1/8 of ovarian tissue is needed to continue producing hormones. They can "slice and dice" the ovary and it's very resilient.

Abdominal surgeries seem to be more "old school" although definitely warranted in some cases. Minimally invasive techniques seem to be the current preferred surgical method (not necessarily via robot though). And doctors using these less invasive techniques may be more apt to use organ-sparing procedures (cystectomy in your case). So you could do a web search to find these oncologists. And keep in mind that they can start the surgery as laprascopic and then convert to abdominal if the frozen section comes back malignant and they have to check margins and debulk.

If I'd been a more savvy medical consumer, I would have realized that I was being "sold down the river" by the gynecologist I'd trusted for 20 years. Although, knowing what I now know I'm not sure it would have saved all my organs but it would have at least allowed me to keep everything but the one ovary.

 
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ovarian cancer, ovarian cyst, ovarian cysts, post menopause



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