Multilocular right ovarian cyst - requiring surgery?

Hello,

Thanks for using Ask a doctor service from Doctor spring.

I can very well understand your concern for your wife’s health. You need not worry much; it is not a major dangerous problem. From the ultrasound finding, the condition most likely looks like chocolate cyst of ovary or endometrial cyst of right ovary. It is a very common problem affecting mainly women in childbearing age group. Approximately five to ten per cent of all women will have one at some point during their life. Endometriosis is a condition in which the inner lining of the uterus called the endometrium is present abnormally in the other locations in the pelvis. The commonest site being ovaries. Endometrium gets implanted on the ovaries; it grows and develops into a sac like structure called a cyst filled with chocolate like material.  

This condition will not cause any major danger to your wife’s health. However, it will cause discomfort to her by giving her severe pain during her menses, or during sexual intercourse. It can cause pelvic pain and the most concerning problem being infertility. Ovarian cysts affect fertility if they interfere with normal ovulation or represent a mechanical obstacle for the fertilization process. Taking into concern your wife’s age, I would advise you to treat this problem with laparoscopic ovarian cystectomy. Oral medications are available for this problem, which will only giver her symptomatic temporary relief, but the permanent solution is to go for a laparoscopic ovarian cystectomy surgery usually done under general anaesthesia. Drugs may be helpful in relieving symptoms temporarily but do not treat or actually remove the cyst. However, following surgery hormonal therapy might be advisable which will give long term relief from this problem. Most women-about 60% to 95%-report pain relief in the first months after surgery. Surgery is also shown to improve the fertility. Studies have shown pregnancy rates increase by 50% to 70 % in the first 3 years following treatment. Laparoscopic ovarian Cystectomy is most likely will relieve pain for a longer time, prevent the cyst from growing back, and prevent the need for another surgery, because ovarian cyst as known to be notorious in causing recurrence following treatment. The entire ovary will not be removed in this surgery, only the cyst which is sitting on the ovary will be removed. Rarely, in some instances if the endometrial tissues have spread in adjacent area to the cyst, then some part of the ovary which contains endometrial implant might be removed. Doing this will prevent future recurrence of similar cyst in ovary. But your surgeon will definitely pay attention to your wife’s fertility, and will try his best to preserve maximum of normal ovarian tissue. I would recommend you to approach an experienced skilful surgeon for doing this surgery. It might require a hospital stay of 1 or 2 days. And she might be able to get back to her regular activities in a weak time. Laparoscopic cystectomy had advantage like small incision is made on the abdomen, which will give very minimal scar, usually there is minimum or no scarring at all, less pain and there will be shorter hospital stay and shorter recovery time as well. Best fertility enhancement & Fertility results are seen following Laparoscopy. You will also be given a DVD/CD with the recording of the entire surgery done, you must keep this safe as it might be required at later stage for any medical purpose. With this surgery and subsequent hormonal therapy, I’m sure it will set everything right in your wife’s health.

Hope this helps. If you have any followup query you can ask it here itself via this email.

Thank you

Hi,

Thank you for the explanations.
My wife did a CA 125 blood test a few days ago and the levels are elevated. Her numbers were 135 while normal rates are 35. Is it ovarian cancer? will she have to have her ovaries removed? How can they find out for sure whether it's ovarian cancer or not?
Having in mind that the mild septation exist inside the cyst.

What's the best thing she should do right now.
BTW she is a hemoglobin S trait, do the doctors have to do any precautions for her surgery?

Thanks, 

Hello,

My apologies for the delay getting back to you.

CA 125 is not a specific test. It has many false positives and negatives. It means, the levels can be high in not just in Ovarian Cancer, but in many other conditions of ovary. For example CA125 can be high in Endometriosis. So you need not be worried about Cancer now.

The only sure shot way to know what kind of ovarian mass by getting a Biopsy sample. For that your Surgeon will have to remove the cyst, take a small slice of it and get it examined by a pathologist.

Ovarian Cyst is a common condition and I am sure your Doctor will take very good care of you. So the best thing would be to follow the Doctors opinion.

Regarding HbS trait and Surgery , I am not the best person to comment on it, but I don't think its going to be problem . Make sure you discuss this with your Anesthesiologist 

Hope this Helps

Thank you