6cm multiseptated cyst

Your anxiety is completely understandable.  I don't think there is anything any of us could say to make you feel better, but I hope coming here and voicing your concerns helps some.

Please let us know when your transvaginal ultrasound is scheduled and/or how it goes.

LorettaMarshall said:

rnayriv~Info on "multiseptated" cysts

Good afternoon

As usual, many women that post here have different problems, but the same cause for concern.  When one has already been diagnosed with a cancer of any kind, the suspicions increase when a new problem arises.  Naturally one wonders, does this have anything to do with my previous cancer?  Is it a metastasis?  Am I in the right place to find the best answers and treatment to put my mind at ease? 

So when I read your letter, I keyed in the words “6cm multiseptated cyst” and found a very informative long article from the “Cleveland Clinic”, (a trusted source for information.)  And so I have listed that reference below my name with some excerpts.  Naturally, you will want to read the whole article because it’s too long to copy here.  You and I have different problems, but like so many others here, the anxiety level is understandably high, and we want to be at the best place to find answers to our questions.  And if I were you, and as this article suggests, I would find a gynecologic oncologist to begin with since they are “specialists” and have additional training in matters pertaining to the female anatomy.  Perhaps the surgeon that performed your hysterectomy has an associate that he/she might recommend, if you haven’t already found one.  We don’t have time to be “guinea pigs” at some place not familiar with our problem.  It looks like this article covers everything you need to know about the cyst that has been discovered and which testing methods are most reliable.  No need to send you lots of info on Ovarian cancer itself at this time.  Cross that bridge only if and when you come to it.  Sufficient for the day are the troubles thereof!

Trusting that this information will be helpful in some way. 

Love Loretta

Peritoneal Carcinomatosis/Ovarian Cancer Stage IV

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1. http://www.mdedge.com/ccjm/article/95993/womens-health/incidental-ovarian-cysts-when-reassure-when-reassess-when-refer

ABSTRACT
Ovarian cysts are commonly found on imaging done for other reasons. Proper triage will decrease unnecessary procedures and worry while obtaining the best survival benefit for those ultimately found to have cancer.

KEY POINTS

• Incidentally discovered ovarian cysts are common and most are benign, but a minority can represent ovarian cancer, which is difficult to detect before it has spread and therefore often has a poor prognosis.
• Patients can be reassured if they are postmenopausal and have a simple cyst smaller than 1 cm or if they are premenopausal and have a simple cyst smaller than 5 cm.
• Reassess with yearly ultrasonography in very low-risk situations and with repeat ultrasonography in 6 to 12 weeks if the diagnosis is not clear but is likely benign.
• Refer to a gynecologist in cases of symptomatic cysts, cysts larger than 6 cm, and cysts that require ancillary testing.
• Refer to a gynecologic oncologist for findings worrisome for cancer such as thick septations, solid areas with flow, ascites, evidence of metastasis, or high cancer antigen 125 levels.

Ovarian cysts, sometimes reported as ovarian masses or adnexal masses, are frequently found incidentally in women who have no symptoms. These cysts can be physiologic (having to do with ovulation) or neoplastic—either benign, borderline (having low malignant potential), or frankly malignant. Thus, these incidental lesions pose many diagnostic challenges to the clinician.

The vast majority of cysts are benign, but a few are malignant, and ovarian malignancies have a notoriously poor survival rate. The diagnosis can only be obtained surgically, as aspiration and biopsy are not definitive and may be harmful. Therefore, the clinician must try to balance the risks of surgery for what may be a benign lesion with the risk of delaying diagnosis of a malignancy.

In this article we provide an approach to evaluating these cysts, with guidance on when the patient can be reassured and when referral is needed...

“REVIEWS- INCIDENTAL OVARIAN CYSTS: WHEN TO REASSURE, WHEN TO REASSESS, WHEN TO REFER

Most cysts are benign, but a few are malignant, with a notoriously poor survival rate. How can we tell if a patient truly needs surgery?

Cleveland Clinic Journal of Medicine. 2013 August;80(8):503-514…

OTHER IMAGING

Although ultrasonography is the initial imaging study of choice in the evaluation of adnexal masses owing to its high sensitivity, availability, and low cost, studies have shown that up to 20% of adnexal masses can be reported as indeterminate by ultrasonography (TABLE 1).

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is emerging as a very valuable tool when ultrasonography is inconclusive or limited.³⁵ Although MRI is very accurate (TABLE 1), it is not considered a first-line imaging test because it is more expensive, less available, and more inconvenient for the patient than ultrasonography.

MRI provides additional information on the composition of soft-tissue tumors. Usually, MRI is ordered with contrast, unless there are contraindications to it. The radiologist will evaluate morphologic features, signal intensity, and enhancement of solid areas. Techniques such as dynamic contrast-enhanced MRI (following the distribution of contrast material over time), in- and out-of-phase T1 imaging (looking for fat, such as in dermoids), and the newer diffusion-weighted imaging may further improve characterization.

In one study of MRI as second-line imaging, contrast-enhanced MRI contributed to a greater change in the probability of ovarian cancer than did CT, Doppler ultrasonography, or MRI without contrast.³⁶ This may result in a reduction in unnecessary surgeries and in an increase in proper referrals in cases of suspected malignancy.

Computed tomography

Disadvantages of CT include radiation exposure and poor discrimination of soft tissue. It can, however, differentiate fat or calcifications that may be found in dermoids. While CT is not often used to describe an ovarian lesion, it may be used preoperatively to stage an ovarian cancer or to look for a primary intra-abdominal cancer when an ovarian mass may represent metastasis.³²…

WHEN TO REASSURE, REASSESS, REFER

 Ovarian masses often pose diagnostic and management dilemmas. Reassurance can be offered to women with small simple cysts. Interval follow-up with ultrasonography is appropriate for cysts that are most likely to be benign.

If malignancy is suspected based on ultrasonography, other imaging, blood testing, or expert opinion, referral to a surgical gynecologist or gynecologic oncologist is recommended. If malignancy is strongly suspected, direct referral to a gynecologic oncologist offers the best chance of survival if cancer is actually present.

Reassure

• When simple cysts are less than 1 cm in postmenopausal women
• When simple cysts are less than 5 cm in premenopausal patients.

Reassess

• With yearly ultrasonography in cases of very low risk
• With repeat ultrasonography in 6 to 12 weeks when the diagnosis is not clear but the cyst is likely benign.

Refer

• To a gynecologist for symptomatic cysts, cysts larger than 6 cm, and cysts that require ancillary testing
• To a gynecologic oncologist for findings worrisome for cancer, such as thick septations, solid areas with flow, ascites, evidence of metastasis, or high cancer antigen 125 levels…”

• ASSESSING AN INCIDENTALLY DISCOVERED OVARIAN MASS

  Certain factors in the history, physical examination, and blood work may suggest the cyst is either benign or malignant and may influence the subsequent assessment. However, in most cases, the best next step is to perform transvaginal ultrasonography, which we will discuss later in this paper…

•  Age is a major risk factor for ovarian cancer; the median age at diagnosis is 63 years.⁹ In the reproductive-age group, ovarian cysts are much more likely to be functional than neoplastic. Epithelial cancers are rare before the age of 40, but other cancer types such as borderline, germ cell, and sex cord stromal tumors may occur.¹⁹

• In every age group a cyst is more likely to be benign than malignant, although, as noted above, the probability of malignancy increases with age.

 2.  https://www.ncbi.nlm.nih.gov/pubmed/20554314

“Abstract

OBJECTIVE:

To determine the risk of malignancy in septated cystic ovarian tumors…

CONCLUSIONS:

Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery…"
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3.  https://www.ncbi.nlm.nih.gov/pubmed/24379701

“Transvaginal ultrasonography in ovarian cancer screening: current perspectives.

Abstract - Transvaginal ultrasonography (TVS) is an integral part of all major ovarian cancer screening trials. TVS is accurate in detecting abnormalities in ovarian volume and morphology, but is less reliable in differentiating benign from malignant ovarian tumors.

When used as the only screening test, TVS is sensitive, but has a low positive predictive value. Therefore, serum biomarkers and tumor morphology indexing are used together with TVS to identify ovarian tumors at high risk for malignancy. This allows preoperative triage of high-risk cases to major cancer centers for therapy while decreasing unnecessary surgery for benign disease. Ovarian cancer screening has been associated with a decrease in stage at detection in most trials, thereby allowing treatment to be initiated when the disease is most curable…”

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4.      https://www.reference.com/health/septated-ovarian-cyst-d595fec0b05f224c#

Q: What is a septated ovarian cyst?

A: QUICK ANSWER

A septated ovarian cyst has some solid areas called septations inside it, according to Johns Hopkins Medicine. The presence of these solid areas adds complexity to ovarian cysts and is a reason to consider surgical removal as opposed to continued observation…

 FULL ANSWER

When it comes to early-stage ovarian cancer, symptoms are not specific, states Johns Hopkins Medicine. Many conditions that are not cancer yield symptoms that resemble symptoms of cancer, causing possible confusion and misdiagnosis. When ovarian cysts are present, regular monitoring is necessary to prevent cancer from developing or reaching an advanced stage.

When cysts remain stable in size or shrink, and other symptoms of cancer disappear, observation alone is sufficient. However, growth in the cyst, the development of septations or aggravation of symptoms are all cause for surgery.

If the patient and doctor decide surgical removal is the best option for a septated ovarian cyst, having the procedure done by a gynecologic oncologist is the ideal choice, explains Johns Hopkins Medicine. If that is impossible, the next best choice is to have that specialist available to assist if ovarian cancer becomes the diagnosis as a result of the surgery.

Having the procedure at a facility that performs a high volume of ovarian cancer procedures produces a longer average survival period in comparison to a center that only handles a small number of these procedures…”

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

“…Management of Ovarian Cysts

The following remarks are the usual approaches to cyst management:

1.      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…”

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Miss Loretta!  So good to hear from you.