Dear Dr. Pat,
I live in London and enjoy the Women’s Voices for Change website very much. I found it at 2 a.m. when I was searching for information about ovarian cysts and I now get your emails letting me know when there is another article to read. I am a post-menopausal woman, age 65, who was diagnosed with a small ovarian cyst measuring around 2-3cm in October of 2017. It was monitored and in May of 2018, although it had barely changed in size, it was recommended that I have a laparoscopic BSO. The wall of the affected right ovary is slightly thickened. The registrar pressured me to sign consent as she told me it was 7cm, however, she had misread the report! It was only 3cm.
Two days before admission my operation was cancelled. I was told that it was not an emergency. This led me to rethink and read more, including at your site. Thank you for the excellent information you provide there. I have been monitored since July of this year and now they say I can decide either way as I am low risk. The cyst has not changed and CA125 is normal. There are no guarantees, I know. However, I would like to know whether I could opt to have only the right ovary removed. This does not seem to be an option from my gynecologic oncologist. They now say they see no benefit in continuing to monitor the ovary. I am also unsure as to whether the scans can be a risk. My risk is described as low at factor of 250. I don’t have pain or noticeable symptoms. Have occasional discomfort, which could be due to wind or indigestion! My gynecologist says to forget about it unless I develop symptoms, in which case return. But I am told there is no test for ovarian cancer, and it is very difficult to diagnose. I don’t know of any family members who have developed ovarian cancer. It is so difficult to make a decision as various people have different views! I would appreciate any clarification you might offer and I recognize that nothing is certain.
Dodi
Dear Dodi,
Thank you for reading our posts and sending in a question that troubles so many patients and sometimes their doctors as well. When should an ovarian (adnexal) mass be removed? When should an ovarian mass be observed? The risk of anesthesia and surgery must be part of the decision along with concerns that a mass might be or become malignant. There are guidelines in the United States that we are urged to follow regarding these questions. I have asked Dr. Melisa Frey, Assistant Professor of Obstetrics and Gynecology in the division of gynecologic oncology at Weill Cornell Medicine and the gynecologic oncologist member of our Medical Advisory Board to discuss the major issues raised in your question.
Dr. Pat
Dr. Melisa Frey Responds:
Diagnosis and Management of Adnexal Masses
Adnexal masses are located in the ovary, fallopian tube or surrounding tissue in the female pelvis. Adnexal masses can be found in women presenting with pain but are also commonly found in asymptomatic women either during a routine gynecologic exam or on pelvic imaging. Studies suggest that the prevalence of adnexal masses in asymptomatic premenopausal women is approximately 8% and in asymptomatic postmenopausal women approximately 2-3%. Once identified, the adnexal mass can be managed in one of two ways: 1) Surgical removal and 2) Observation. When deciding on the most appropriate treatment for an adnexal mass, a physician must consider the characteristics of the patient (e.g. age, family history, menopausal status, symptoms) and characteristics of the adnexal mass (e.g. size and complexity on imaging). If the mass is causing the patient symptoms or is concerning for malignancy, then it should be surgically removed.
The goal of an evaluation of an adnexal mass is to determine the etiology but this can be challenging as there are many possible underlying conditions. The differential diagnosis for an adnexal mass includes gynecologic and non-gynecologic conditions. Non-gynecologic conditions include appendicitis (the appendix often resides in the right lower quadrant of the abdomen and can be difficult to distinguish from the ovary especially in the setting of appendiceal infection or inflammation), colonic diverticula, nerve sheath tumors and urologic conditions like pelvic kidneys and diverticulum of the ureter or bladder. Benign gynecologic adnexal masses include functional ovarian cysts (cysts that occur with normal follicular development each month), ectopic pregnancy, leiomyomas (fibroids of the uterus), hydrosalpinx (fluid within the fallopian tubes) endometriomas, tubo-ovarian abscesses (infections of the ovary and/or fallopian tube) and benign ovarian cysts (e.g. mature teratomas, serous cystadenomas, mucinous cystadenomas). Malignant conditions resulting in pelvic masses include gynecologic cancers and cancers from non-gynecologic organs that spread or metastasize to the ovaries (e.g. breast cancer, stomach cancer, colon cancer).
