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Ovarian cancer, cyst, or something else?
An_248724 posted:
I am 40 years old and have been having some troubling symptoms in the past few weeks. About my history first...I had gastric bypass 5 years ago and prior to that I had PCOS for over 25 years. After I lost 160 pounds I became fertile and periods returned to normal. I have had three missed miscarriages in the past 2-1/2 years and one successful pregnancy. I have a healthy 15 month old at home. During my pregnancy with my son, I know that I had an ovarian cyst show up on ultrasounds. I think it was 3 or 4 cm at the time. I've also had other cysts and enlarged ovaries in the past. I have had abnormal cells show up on my pap smears in the past (but I know that is cervical, not ovarian). My last miscarriage was 8 months ago (down syndrome) and so far I have been unable to conceive again. With the other 4 pregnancies it only took 2-3 months. My cycle is also getting shorter each month during the past few months (down to 25 days now). Periods normally last around 3 days.

For about 4-6 weeks now, I have been having occasional sharp pains in the left pelvic area and in the center, as well as alot of cramping (not just during my period). For about that same length of time I have felt full quickly and not been able to eat much. I also have had urinary frequency/urgency and thought that I had a UTI twice but tested negative. During the last 2-3 weeks, I have had severe lower abdominal bloating, nausea, shortness of breath. I have been trying for some time to lose weight and cannot lose even at 1200-1500 calories and working on with a personal trainer 3 days a week. I haven't had much unusual bleeding but I have had some spotting a few times (bright red and very small amount).

I do have a family history of both ovarian and breast cancer. I'm concerned that these could be signs of ovarian cancer. I did have a CT scan a couple days ago and am waiting for my doctor's appt tomorrow afternoon.
Jane Harrison Hohner, RN, RNP responded:
Dear An: First of all kudos to you for losing 160 pounds and having your fertility return after 25 years of PCOS. That is an inspiring success story.

A dominant ovarian cyst is very common especially in early pregnancy as it produces pregnancy hormones until the placenta assumes that responsibility. It can also be common for our cycle lengths to shorten as we move into our 40's, by the time of perimenopause they begin to lengthen out and then start to skip months.

As you likely have read, early stage ovarian cancer tends to be silent. As the size of the tumor grows women begin to have more of those vague symptoms such as decreased appetite, menstrual changes, abdominal bloating. A mass at this stage is more likely to be seen on imaging. Thus you did the correct thing in getting a work up that included an abdominal CT scan.

In terms of a family history of ovarian cancer, if a woman has one first degree relative (eg a mom, sister) with ovarian cancer her lifetime risk of ovarian cancer is 5%. With two first degree relatives it is 7%. With a known hereditary form (eg BCRA 1 or 2) the risk can be 35-65%. Thus it would be most helpful if you knew more about exactly what your family members had.

Hope the CT scan shows only normal findings. Let us all know as we will be wondering how you are doing.

clovertyger replied to Jane Harrison Hohner, RN, RNP's response:
My CT scan was good other than an unusually enlarged liver. I also have one VERY tender spot in the lower left pelvic area. When my doctor pressed that area yesterday, the pain was excruciating and it took me over an hour to recover. My ob/gyn thinks that it may be digestive and I am being referred to a gastroenterologist and having more labwork and other tests. It at least appears not to be ovarian cancer, so that is a huge relief.
Jane Harrison Hohner, RN, RNP replied to clovertyger's response:
Dear clovertyger: OMGosh we are so happy for you. That is a big relief. Interestingly, the second most common cause of pelvic pain and abdominal symptoms (after GYN issues) is gastrointestinal conditions. Your GYN is doing the right thing in widening the search for the cause of your symptoms. If you do get a definitive diagnosis be sure and let us know--it could be of help to other women with similar symptoms.


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