Q&A

Samantha H.

Question:

Ultrasound report

I just received the report that was done at the beginning of October. It indicates a complex ovarian cyst with mixed echogenicity, moderate debris, and a small amount of free fluid in the cul-de-sac. This and a slowly rising CA 125 must be why my OB/GYN referred me to oncology. My appointment is tomorrow, and I’m very nervous. The cyst is 24 x 19 x 20 mm, which I believe is on the smaller side, so I guess that is one positive thing. The report also shows I have a nabothian cyst in my cervix, which is something I have never heard of. All of this is on top of adenomyosis. Seems like a hysterectomy is in my future. I was hoping to save my ovaries, but I am uncertain now.

Answer:

Megan

CA-125 can be increased without causing cancer. You’re right; that is a rather small cyst. If you don’t mind me asking, what is your age?

Samantha H.

The late 40s, technically perimenopause age.

Megan

Well, why was the ultrasound ordered? Were you having other symptoms? A nabothian cyst is nothing, and cul de sac fluid is typically nothing. Was the CA-125 at an abnormal level? Could you let me know why you’re having that followed?

Samantha H.

I had a physical about a year ago, and the CA 125 level was a part of their bloodwork. It was outside the normal range in the lower hundreds at that point. For about a year, I have had severe menstrual pain to the point of being debilitating, as well as extreme, heavy bleeding. I’ve had my CA 125 levels monitored, and they have fluctuated a lot but are always in the hundreds. The new doctor ran the test twice, 30 days apart, and noticed the number increased.

Rachel T.

My sister has symptoms i’m worried.

Did anyone have these symptoms? My sister is 27 and has always been skinny, just a little stomach. Over the past few months, she has gained weight in her stomach, and now it feels like it has increased quickly. Her stomach is not hard and bloated but soft. She also recently mentioned some pelvic pain on her left side, and I recall her saying she had loose bowel movements for a bit but could not trace it to any new or odd foods. Omg, and her period was late by a few days.

We leave the country for a month next week. Is that enough time for a doctor’s appointment and, hopefully, a CT scan or ultrasound? I don’t want to tell her my worries because we won’t be home for an entire month, and it’ll just stress her out.

I am trying to encourage a GP appointment this week and was going to tell the doctor in advance on the phone about my concerns. Please help or give any advice or insight.

Answer:

Charlotte

Hi! I am a 25 F and am in a similar position to your sister. I would schedule an appointment with an OBGYN and have a transvaginal ultrasound and CA 125 bloodwork test. Both can determine where your sister is; if her CA125 is elevated, I will push for a referral to a gynaecological oncologist.
Best wishes to you both. In preparation, I would have her make a list of bowl abnormalities such as persistent diarrhoea and if she has had inconsistent periods, fatigue, etc.

Rachel T.

also, I wonder if we can cancel this trip. It’s not necessarily a vacation. I was thinking maybe seeing doctors while we’re there. I don’t know what to do

Charlotte

I would cancel the trip to establish medical relationships where she lives, as OC can develop quickly. The goal would be to get in with an Oncologist if needed as quickly as possible to do biopsies if cysts or other abnormalities are found and if her bloodwork is elevated.

Rachel T.

I’m so scared I haven’t even told any of my family what I think could be happening. Do you think an emergency room visit soon can be good? And maybe then we could get a CT scan or ultrasound. I genuinely don’t know if we can stop this trip. We could easily do CT scans and ultrasounds while travelling, too…

Charlotte

I understand how hard it is and navigate with family. I just found out I could potentially have OC since I have cysts and elevated CA 125, and telling my family was hard.

You can always start with a CT Scan with Contrast and go from there. However, I didn’t notice the severity of my case until I had a transvaginal ultrasound, which is more effective than a standard pelvic ultrasound for examining the uterus and ovaries. The ob-gyn ordered the CA 125 bloodwork. I had just been in the ER, and they did a CT scan. The root of my issue was a kidney stone, and I only mentioned on the fly that I had cysts on my ovaries. When I did the transvaginal ultrasound with my OB, she saw a lot of fluid in my cysts. But just be advised that a CT scan may not be as in-depth as she needs but can be a decent gauge initially of what may be happening.

Rachel T.

If you can’t cancel the trip, which is understandable, scheduling an appointment with an OBGYN when you both return would be very helpful. They are going to be your best bet for starting this journey of deciphering what may be going on. So many symptoms of OC can be other causes or misdiagnosed, so to rule out OC, it could be good to still follow up with them regardless of the CT Scan.

Charlotte

I’m just thinking out loud now, but I think when we are out of the country, we will get the ultrasounds done there and, if needed, a CT scan, too. And hopefully, we can have the bloodwork done this week before we go. and have that ob-gyn appointment scheduled for when we return.

Thank you for your advice, and I’m sorry for all the questions. I’m assuming only OB-GYNs can do transvaginal ultrasounds, not the ER. I wonder if her GP can order the bloodwork, and we can somehow get that done and an ultrasound this week.

Rachel T.

I wonder if ERs offer transvaginal ultrasounds; mine did not. They can always do the CT Scan with contrast to see what may be going on and transfer the records to an OBGYN when she goes for further analysis and do a transvaginal ultrasound if you cannot find a place within your schedules. They might be where you live. Let’s call around and see before you go. No worries about all the questions; it is a lot, and it’s overwhelming!!! I understand, and you are an amazing sister. I would love an update if and when you all have one if you feel up for it.