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    Complex Ovarian Cyst
    amrcampbell posted:
    Hello, I posted something the other day but didn't get any response so I'm trying again. I have just been told a few days ago that I have an complex ovarian cyst on my right ovary. I was wondering if anyone has any information or experience with this subject. I am really worried from all the things I"ve read about them. Any feed back would be helpful!!!!

    Thanks Amy
    JHarrison_Hohner_RN responded:
    Dear Amy: I saw your post and hoped that someone who had personal experience with a complex cyst would reply. I have not had a complex cyst but can give you some input. A "complex" ovarian cyst generates more concern, than a "simple" cyst. A cyst that is a mixture of solid and fluid elements, or is solid, is not a simple follicular cyst. The presence of irregular borders, or septations (internal walls dividing the cyst into separate spaces) are more concerning features found in complex cysts. Other ultrasound report terminology which may be linked to complex cysts are: mural nodule, fluid-debris level, retracting blood clot, or a mix of anechoic to hyperechoic appearances.

    Complex ovarian cysts usually are not related to variations in normal processes. The following are some examples of complex cysts. Endometriomas are cysts filled with old blood. This gave rise to the nickname ?chocolate cysts? as the cyst fluid looked like chocolate syrup. Endometriomas can grow to 6-8 cm (normal ovary size is about 2 cm x 3 cm). They are formed when bits of uterine lining tissue (?endometriosis?) attach to pelvic organs such as ovaries. Dermoid cysts (?cystic teratomas?) can contain bits of hair, teeth, or other body tissues. It is still not known why dermoid cysts form. At an incidence of 66%, dermoids are most common kind of benign tumors of the ovary. Cystadenomas (?serous cystadenomas?) are formed from epithelial cells on the covering of the ovary. These cysts are filled with a fluid or a gel like material. Cystadenomas comprise 20% of benign tumors. The concept of benign tumors sounds like a contradiction in terms. It means that there is a very small chance of this type of ovarian cyst to become cancerous. For example, in one study (Scully, 1973) less than 2% of dermoid cysts showed evidence of malignancy.

    One worry that many women have is the accuracy of ultrasound in predicting what is a complex cyst and what is an ovarian cancer. While simple ovarian cysts can usually be diagnosed by vaginal ultrasound, the question arises ?How reliable is ultrasound when the cyst is complex?? One well done study (Jermy, 2001), looked at the reliability of ultrasound to make a correct diagnosis for possible endometriosis or dermoid types of complex ovarian cysts. After the mass was removed it was found that ultrasound was successful in predicting 96% of endometriosis cysts and 97% of dermoids. There were no ovarian cancers found.

    Amy, it is common for complex ovarian cysts to be removed surgically through a laproscope. That way the cyst can be sent to pathology for a more accurate diagnosis. Depending upon your age, family history, and how the cyst appeared on ultrasound, your GYN may decide to do additional imaging (eg MRI or CT) and the CA 125 blood test before considering surgery.

    The most important thing to remember is that there are many conditions which are linked to complex cysts. I had a patient (aged 40 something) who had a complex, concerning-looking cyst which had an elevated CA 125 test result. After surgery she was found to have an endometrioma. This was a surprise as she had no symptoms nor family history for endometriosis. Hopefully your cyst will be a benign condition--the odds are in your favor for this.

    Yours, Jane
    Mae1961 responded:
    I've had one of those. It was discovered during a series of tests I had due to endless bleeding. Turns out the bleeding was likely due to a progesterone imbalance, but they did an ultrasound to see if there was evidence of fibroids or cysts. The cyst was over my right ovary and was described as complex. My doctor did have me do a CA 125 test, which came back within the normal range, and so he ordered another ultrasound after some period of time---I think it was one month. The cyst was considerably smaller. Since bad things don't get smaller, no further procedures were ordered.

    The CA 125 test is one of the tools that can help a doctor determine if a cyst might be ovarian cancer. It's such as simple test, but apparently in younger pre-menopausal women, elevated levels may be a false positive and result in surgery for a benign condition. However, when it comes to ovarian cancer, better safe than sorry.

    They also did a cervical biopsy for the bleeding too just to make sure there wasn't anything going on with the endrometrial lining. That was secondary after they discovered the cyst though. They weren't really sure what came first though: the cyst and then the bleeding, or if the extended bleeding exacerbated the cyst.

    The complex cyst does refer to a non-functional cyst meaning that the presence of solid and clear mass cannot be attributed to ovulation and may be something they want to investigate. The ultrasound and the CA125 test, are tools that help them and you decide what should be next.

    Just thought you'd like to know that mine turned out just fine. My cyst was relatively small, and the concern was the appearance of solid mass and clear fluid. However, if the cyst had grown or was already of a certain size, I seem to recall 7 cm being the marker, then surgery would have been the next step. With a large cyst, apparently they get concerned with it twisting the fallopian tube which can be very painful, and potentially very dangerous. So size might become the other reason a doctor would want to do surgery, not just a cancer fear.
    synderlyn responded:
    Hi Amy,

    I was having some pain and went to my doctor in January. They did an ultrasound and located a cyst on my right ovary. They started me on birth control pills in an effort to shrink the cyst. Two months later, I returned to the doctor for another ultrasound. The cyst had became a little smaller so they decided to wait another month and have me return for another ultrasound. When I returned in April, they found that the cyst had actually grown and was now considered complex due to the walls of the cyst itself. They sent me for a CA-125 test. The test returned normal. As a result of the test being normal, they had me in a "watchful waiting" period. I was told to return to the office for another ultrasound in two months unless I had a a lot of pain. At that time, I was having a little bit of pain. Normal things like leaning over to shave my legs or riding my bike for long rides would bother me. I was not having pain at any other time though and it seemed to come in only during strenuous activities or if I bent certain ways. Two weeks ago, I started having daily pain. It was hard to walk around my office which is usually not a problem. I was rushed back into the office. I was told that the weight of a cyst on the ovary can cause the fallopian tube to twist. This can cause the pain. Another ultrasound showed that the cyst had grown yet again and that there was a shortage of blood flow to the ovary. I went in for surgery last Friday. They removed the cyst and the ovary. I am recovering well and should be back to normal soon. I returned to the doctor's office today for a post-op check up and to get my stitches removed. My doctor told me that after the cyst was removed, they performed a biopsy on it and it turns out that it was a benign serous cystadenoma. I could have opted to try to save the ovary during the surgery. I am not planning on having children at this time but my doctor assured me that if I do decide to try to have children, it would be possible with just one ovary.

    My advice to you is to become a partner with your doctor and keep an eye on your cyst. Make sure that you tell your doctor of any pain that you are having. I hope my story has helped you and not scared you.
    crazyl3itch responded:
    Hey Amy. I'd had pain in my lower abdomen from the time I was 12. For years I saw different doctors who said there was nothing wrong with me. Or they'd do a sonogram, say I had a cyst, then say it went away. At the age of 20 I finally found a doctor who went in through laparoscopy and found that I had a softball-size complex cyst on my right ovary. It had been there for years, but "tricked" those looking at the sonogram because it had grown so big it enveloped my fallopian tube and twisted it. Eventually it had attached to my abdominal wall. I suffered for years with this. My GYN removed my right ovary and the relief was immediate. I can only tell you that I turned out ok as well, not all complex cysts are something to worry about. I wish you the best of luck!
    Galeorama responded:
    This question, and the response to it, have been extremely helpful to me. I was recently diagnosed with complex cysts of both ovaries, and the radiologist's report referenced "suspicion for ovarian carcinoma is relatively high." Of course, that scared the wits out of me. In addition, my CA-125 was somewhat elevated. After seeing the oncology GYN (he being the first in the process to actually do an exam), he said he is "very hopeful" that they are not malignant. They are roughly the same size (8 cm), and I show no other signs of illness or symptoms, including no reference to enlarged lymph nodes or any irregularities of the uterus. However, I had a ruptured colon last year, resected with a temporary colostomy which was taken down 3 months later, hernia repair, and later a hematoma evacuation. All in less than a year. So he is worried about adhesions almost more than the masses themselves. Still, I am scared crazy and riding the emotional rollercoaster associated with such a potential diagnosis.

    Thanks for posting the question and thanks to Jane for her thoughtful answer!
    sleepershedreams responded:
    I've posted here before about a pedunculated uterine myoma and came back to ask a question about this subject. My GP ordered an MRI since the GYN I saw was dismissive of me and did not take even a moment to listen to my symptoms and read the report from a sonogram I had.

    The MRI also found a complex ovarian cyst. Small I believe but with my symptoms should it be investigated?

    There is alot of info on the report. I am just so tired I dont even want to go to the doctor and have them yet again be dismissive of me.

    Doing research on the net doesnt help. Most sites say a complex cyst needs to be investigated. But then I hear oh they just use watchful waiting. So none of it makes sense to me. Even if there is very little risk of cancer isnt there possibility of it bursting and causing problems?

    I am having alot of pressure and bloating and fullness in my belly area I eat healthy watch my weight yet it went up about 12lbs no reason at all and focused in my belly area and had to go up in pant size just to fit my belly. Lately I am constantly nauseous and when I try to eat I feel overly full from small meals. My bladder has been very irritated having to go too many times. Im having more pelvic discomfort and pain even when not near my period. Also noticed breast tenderness and pain when I shower. plus come other issues.

    Was not sure if I needed to post under a seperate heading.

    someone told me that its fine because the MRI didnt show cancer. since when does an MRI tell you if its cancer. I thought that required a biopsy.

    I have to make an appointment for a test the GYN said I should have and will need to see a URO/GYN for it should I ask that she review the results?

    Im just frustrated because a matter of MONTHS and my uterus is filled with fibroids and now a complex cyst. and all I get is ... nothing?
    princess__spot responded:
    Christine...I would definately find a doctor who will listen to you! I went to my gyn in June and told her I was having some vague discomfort in my right pelvic area and thought it might be a small cyst (I've had them before). She asked me if I wanted an ultrasound or just to wait. I opted for ultrasound since it had been going on for a couple of months already. They called a few days after the ultrasound to tell me I had a cyst on both ovaries and they wanted to wait and do another ultrasound in a month. I already had an appt with my GP and he read me the ultrasound report and told me the cyst on my right ovary was 6 cm. He was concerned at the size but we decided to wait. I had the next ultrasound last tuesday and they called me wednesday morning first thing to set up surgery to remove the ovary with very little explanation. I saw my GP yesterday and he again read me the entire ultrasound report. The cyst is now 7cm and complex with some fluid and some solid parts. There is also a "suspicious" nodule growing on the cyst. The radiologist said suspected cystadenocarcinoma. and said ct scan was indicated as well as removal and biopsy of the cyst. Why couldn't my gyn have told me this? I guess she would have in my preop appt maybe. My GP decided to do a ct scan of the abdomen and pelvis to check out everything else as I've had gas, abdominal bloat, and pain in my upper right quadrant for a couple of months. Never thought they might be related. He's also doing full bloodwork because I'm so tired. I have the ct and bloodwork today so fingers crossed. If there's anything wrong though I want it all taken out at once...I hate surgery!

    It just floors me that in a month I went from "do you want to do an ultrasound?" to you may have cancer and we're removing your ovary!

    Hang in there girls and stay tough on your doctors. You know you're body best!

    someonewhocares3 responded:
    As Jane stated, most complex cysts are benign. 80% of serous cystadenomas are benign and 90% of mucinous cystadenomas are benign. I had a cystadenoma on one ovary and my long-time trusted ob/gyn used ovarian cancer fear tactics and rushed me into surgery and removed both ovaries and my uterus. After months of hell from being in surgical menopause despite being on hormones, I got all my records. The (mucinous) cystadenoma was benign and my other ovary and uterus were perfectly healthy. There was no justification for the removal of these healthy organs. And this doctor is considered reputable with his surname prominent on the hospital's campus. And even more suspect, the oncologist to whom my ob/gyn referred me stated in the office visit report that the diseased ovary should be removed with possibility of TAH/BSO but failed to communicate this to me and my husband and the ob/gyn didn't follow this recommendation. The oncologist's records also stated that my sister had ovarian cancer; she didn't.

    My point is that chances are that the cyst is not ovarian cancer and if you need surgery, proceed with caution and be sure your doctor will only remove diseased organs (or preferably just the cyst). Also be sure that your consent form is explicit about what organs can and cannot be removed. I hope all goes well.
    erika40long responded:
    have the same situation I just read from the results of my ppelvic transvaginial ultrasound that i have complex hemorrhagic cysts , and enlarging left ovarian mass with complex cystic componet I need some clarafiation on what does this mean also
    erika40long replied to princess__spot's response:
    Hello I'm going through the same thing I have several complex cyts with septations which thet say are enlarging 7.5 I'm wonderig is this huge Do you know? Help noone has responded to my questions

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