Advice needed re: wife's Ultrascan and surgery

mcpmt

Hi,

My wife is 30 years old and has been heavier periods and bout of frequent urination over the past 6 months. She went to her gynecologist who sent her in for an ultrasound. I have pasted the results below. A couple questions, the radiological results definitely sound extremely suspicous of malignancy to me just from the little research that I have done in the last 24 hours regarding findings consistent with malignancy on an US, am I right? The second question is that she is in the process of scheduling a surgery with her gynecologist, who is not a gynecological oncologist, in the next several weeks. Should we get a second oppinion from a gynecolofical oncologist? and what are the benefits of having the surgery performed by a gynelocical ongologist vs a plain gynecologist? I'm worried sick, the doctor basically said that she would be suprised if this was malignant, but the UltraSound report seems like it has malignancy written all over it with the exception of no free fluidd. Any oppinions or advice would be much appreciated. I love my wife so much, but am trying to be realistic and have a bad feeling because of the ultrasound report. Here it is:

 

Gynecological Ultrasonography:

Large multilocated mass of the right ovary. Measurement is approximate as this mass curves around the right aspect of the uterus into the posterios cul de sac and does not fit entirely on the ultrasound screen. Segments of this mass range from nearly anechoic to echogenic, with uniform low level echoes. Multiple septations are noted within, most are <3mm, but a few are thick, measuring up to 1 cm. Some blood flow was seen within one of the septations. An 11 x 8 mm echogenic solid projection was noted within one of the segments. Possible mucinous cystadenoma. Suspicous for neoplasm.

Uterus: anteverted, deviated to the left

Uterus Size: Longitudinal 84mm. Anterior-posterior 48mm, Transverse 53mm. Volume 111.9 ml

Endometrium: dynamic. Endometrial cavity: homogenous. No color visualized. Endometrium thickness total 11.9 mm.

 

Right Ovary abnormal

Right Ovary size: 129 mm x 60mm x 85 mm. Volume 344.5ml

Left Ovary: Not visible

Cul de cas/ pouch of douglass: no free fluid was visualized.

Other findings: Size 105mmx49mmx100mm, volume 269 ml. Structure: internal irregular, septa> 3mm, echogenicity: mixed echogenecity.

Doppler: color flow: some color flow was visualized

 

 

NoTimeForCancer

mcpmt, if there is ANY

mcpmt, if there is ANY question of cancer she MUST have a gyn onc!!!  This is serious and they take extra training on how to deal with this - especially if they get in there and see something is suspicious!!!  RUN to a gyn onc.  I met a woman who had an arogant gyn who thought "they could handle it".  Well she botched it and she had a recurrence.  

There is a blood test where they test for markers.  The CA125 is used in gyn patients so I suspect they would be doing this as well - but don't know.  Patients need advocates and she is lucky to have such a loving husband.

Unfortunately, some doctors have the crazy notion that she may be "too young" to have cancer.  That is just crazy.  There is no age limit on when cancer develops.

 

LorettaMarshall

mcpmt~Not sure what 2 say-U need 2nd opinion

"Mcpmt" - Dear concerned husband~

You’ve listed the results of an ultrasound conducted for your “young” wife who is only 30 years old.  Now “heavier periods” and “frequent urination” are reasons to consult a gynecologist for sure.  The results that you have posted are reason for concern.  Now understand that I am not pretending to be a medical person, only a Stage IV Ovarian Cancer patient, age 77.

Without medical training, but able to find some good information on the web, I’ve been looking at terms you listed below as well as conversion measurements.  So I’ve computed a few “conversion” facts for you relative to mm and cm to inches, and ml to liters to ounces.  But I’ve also found an informative article on “Ovarian cysts.”  They can be either cancerous or benign.  At this point, I’m sure that more testing will be done to determine the exact makeup of the mass that is described on your wife’s abnormal right ovary.

I would say that you have every right to be concerned, because the mass on your wife’s ovary could be either benign or cancerous, according to the description given for masses on one’s ovary.  It must be that the first gynecologist thinks that this is most likely a benign ovarian cyst, however they haven’t stated that in those terms.  But I never like surprises, so I would just as soon have it said presented to me as “either/or” rather than “most likely not”.  

As traumatic as it is, when I hear the word cancer, I want to have the possibilities explained to me in terms that I can understand.  So if I were your wife, I would be keeping a journal of what medical team examined me, and what were their findings.  I would want them to give me a written report and copies of any scans conducted as soon as possible, after the testing.  When I have a CT or PET/CT I always tell them before the test that I wish to take home a copy of the scan, and want to pick up a copy of the report as soon as it is “read” and defined.  If your wife seeks another opinion, and I would always suggest a SECOND OPINION, she will have to gather copies of all these records for the next medical team. 

So perhaps the definitions I’ve looked up will be of help to you.  When I have a 2^nd opinion, I don’t necessarily depend on whom the first doctor recommends, after all they are cohorts.  But I would want to have them give me their recommendation.   Then I would want to do some research on that doctor as to where they trained, how many years they’ve been in practice, have they written any medical articles that have been accepted for publication by established medical journals.  Now if I’m really impressed with the first doctor, I will be likely to trust his/her judgment. 

There is a web reference called Vitals.com that helps me with information like that.  And of course, personal recommendations from others with similar diagnoses, can be helpful.  Choosing the right medical team, is of utmost importance.  We often see that a patient is being pushed around from “pillar to post” with no real treatment regimen in mind, and that is a waste of valuable time for the patient.  So do your homework as to where you need to go.  And “close proximity” to home should not be the criteria, unless your insurance limits you to a certain network and a certain area.  That sometimes happens.

Then there are always “questions to ask”, but unless you have researched the initial diagnosis, if you’re like most, you won’t necessarily know what questions to ask.

I’ve found that most doctors will only tell you as much as you ask.  So the more you familiarize yourself with the possibilities, the more intelligent answers you will get.  Most doctors aren’t willing to tell you “the good—the bad—the ugly” unless you pin them down and ask direct questions.  My husband takes along his recorder on his smart phone and sometimes his camera.  Our oncologist doesn’t mind if we tape our consultations, so we find that an easy way to “remember what he said” when we leave his office.  And if the doctor objects to taping the conversation, be sure to take notes, the time and date you spoke with him, etc.  Ask him/her to spell the words out for you that you’ve never heard before—I do!  After all, I’m the inquisitive patient with the cancer, and I don’t like “secrets” or a doctor that just wants me to trust them to make all the decisions.  It’s your wife’s life and therefore, it’s your life as well.  So be a good student as you go along.  And another thing, in my opinion, “bedside manner” would be secondary to a smart doctor who “knows his/her stuff”.  I don’t need someone to hold my hand.  My husband will do that.  I need someone to “dig deep inside my body” and find the culprit that’s giving me trouble.  Now if he’s kind besides, then that’s a plus. 

As I looked at one of the sites describing masses on an ovary, they can either be benign or malignant cysts, so it’s best to be prepared for either diagnosis.  You might have asked the doctor why she thought this was most likely “not” a cancerous mass.  It would have been kind of her to go into a bit more detail.  But I would want to know the pros and cons as well.  I’m proud of you for being realistic, but try to keep your fears where they belong until they are well-founded facts.  It’s good to be informed, but don’t let “fear” control your life.

The more you learn about your wife’s condition, the more confident you will be that she is getting the care that she needs.  This will bring the two of you into a closer loving relationship than ever before.  Your love and mutual admiration will grow, and you will feel more secure than ever in your relationship.  Initially, as young people, we’re often first attracted to someone’s looks or personality, but when hard times come, the real person inside will emerge.  So either cancer will pull you together, or pull you apart.  Your expression of love and care for your wife is a good indication that you’ll be an even better husband as you travel this road with your wife.

So I will just wish the two of you all the best.  

Loretta

Ovarian Cancer, Stage IV/Peritoneal Carcinomatosis

P.S.  Incidentally, here are some conversions for some of the sizes mentioned in the Ultrasound report.

http://www.metric-conversions.org/length/centimeters-to-inches.htm

3mm= 0¹⁄₈in

1 cm = 25/64^th of an inch

11 mm = 7/16^th of an inch   X    8 mm = 5/16^th of an inch

 

Places you might like to visit to learn more about Ovarian cysts and Ovarian Cancer

 1.  http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/questions-ask-your-health-care-team

Questions to ask your healthcare team

 2.  http://www.cancer.net/cancer-types/ovarian-cancer

 Info - Just in case it turns out to be something more than a “benign cyst”

 3.  http://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/choosing-doctor-your-cancer-care

 4.  http://www.mayoclinic.org/diseases-conditions/ovarian-cysts/basics/symptoms/con-20019937

 

5.  http://www.mayoclinic.org/tests-procedures/oophorectomy/multimedia/ovarian-cancer/img-20007472

6.  http://medical-dictionary.thefreedictionary.com/echogenic

 “…ech·o·gen·ic - (ek'ō-jen'ik), Pertaining to a structure or medium (for example, tissue) that has internal echoes. Cf. hypoechoic, hyperechoic, and anechoic, which refer, respectively, to paucity, abundance, and absence of echoes displayed in the image of a structure…”

 

LorettaMarshall

Mcpmt~Trying to finish list of "homework" references 4 U

Hello again: Trying to finish my post - part went - part didn't - hope this works

Loretta

  7.  http://www.medicinenet.com/ovarian_cysts/article.htm

 

10. http://www.obgyn.net/hysterectomy/ovarian-cysts-what-are-they-and-what-do-about-them

Ovarian Cysts -- What Are They, And What To Do About Them

“…By definition, a cyst is a fluid filled structure, and depending where it is located, and what type of fluid is contained within the cyst, it will have a special name… Management of Ovarian Cysts

The following remarks are the usual approaches to cyst management:

In a woman in the reproductive age group, who is not on the pill ( or Depo provera), given a cystic structure smaller than a plum, and the absence of severe pain that would mandate surgical intervention, conservative observation is acceptable.

Many physicians will perform an ultrasound to precisely measure the size of the cyst, and evaluate the contents. Pathologic cysts sometimes develop tissue partitions (called septations) so that on ultrasound one can see many different fluid compartments.

Also pathologic cysts may develop tissue growths into the cyst, so the wall is not smooth, and these are called "excrescences". Septations and excrescences are not seen in physiologic cysts thus surgical intervention may be warranted immediately

Conservative surgery may be undertaken if the cyst is not malignant, and the patient wishes to salvage the ovary if possible. This is called an ovarian cystectomy…”

11.http://radiopaedia.org/articles/ovarian-mucinous-cystadenoma

Ovarian mucinous cystadenoma

Dr Amir Rezaee◉ and Dr Yuranga Weerakkody◉ et al.

“Mucinous cystadenoma of the ovary is at the benign end of the spectrum of mucin-containing epithelial ovarian tumours...

 Pelvic MRI

Mucinous cystadenomas are seen usually as large multilocular cysts containing fluid of various viscosity. Due to this reason, the loculi of the tumours often show variable signal intensities on both T1 and T2 sequences. This can sometimes give a “stained glass” appearance. They rarely appear as unilocular cysts.

Treatment and prognosis

A mucinous cystadenoma is benign with excellent prognosis (c.f. borderline mucinous tumours of the ovary or mucinous cystadenocarcinoma of the ovary). Nonetheless, they are frequently surgically excised for histological confirmation of benignity, and due to mass effect of the large tumours…”

12.  http://radiopaedia.org/articles/ovarian-cyst-2

“Ovarian cyst

Dr Matt A. Morgan◉ and Dr Mohamed Refaey et al.

Ovarian cysts are commonly encountered in gynaecological imaging, and vary widely in aetiology, from physiologic, to complex benign, to neoplastic.

small cystic ovarian structures should be considered normal ovarian follicles unless the patient is pre-pubertal, post-menopausal, pregnant, or the mean diameter is >3.0 cm…”

13. http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46264

NCI Dictionary of Cancer Terms - neoplasm - listen (NEE-oh-PLA-zum)

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Neoplasms may be benign (not cancer), or malignant (cancer). Also called tumor.

14.  http://www.md-health.com/Complex-Ovarian-Cyst.html

“…Cystadenomas - Cystadenomas are benign cysts that develop from cells that cover the outer layer of the ovary. There are two types, mucinous and serous cystadenoma. Mucinous adenoma contains a sticky, thick fluid. It can grow up to 30 cm (12 in) in diameter and weigh up to 100 pounds. It can fill up the abdomen and cause pressure on other structures such as the bladder and bowel. It can also block the blood supply in the ovaries and cause twisting or torsion of the ovaries. Serous cystadenoma contains a thin, watery fluid. It does not grow as big as mucinous cystadenoma but can cause symptoms when it ruptures…”

LorettaMarshall

mcpmt~Third part of the puzzle-Two remaining references

Hello - It's Loretta again - I'm determined to get all of your "homework" assignment posted.  If you review all these sites, you will probably know as much as your wife's first gynecologist.  I would especially pay attention to the Cancer.net references.  They are all-inclusive.  And on your "second go round" choose a gynecological oncologist, and you will have the best of both worlds.  Naturally, we hope everything turns out to be "fixable".  But one can never be too cautious.  And I would offer one piece of advice.  If and when the doctors recommend a hysterectomy, please consider taking out everything.  I had my uterus removed when I was 36, but my ovaries and fallopian tubes were left intact.  Now it's been found that often times, Ovarian cancer begins in the Fallopian tubes.  Too bad doctors didn't know that when I had only the uterus removed.  And it's even possible to have Ovarian cancer after removal of the ovaries.  Cells can "slough off" the ovaries and remain dormant for who knows how long, and then turn into cancer at some later time in life.  In any event, be thorough, and hope it's minor instead of major.

Loretta

Last two references that would not transmit before.

8.  http://www.foundationforwomenscancer.org/find-a-gynecologic-oncologist/ 

  9.  http://www.md-health.com/Complex-Ovarian-Cyst.html

 ___________Finally....the end______________