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Suggest Treatment For Abdominal Pain Due To Ovarian Cyst

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Posted on Sat, 25 Oct 2014
Question: I am a 39-year-old female with a 5-cm complex ovarian mass on my sole remaining ovary. The mass was discovered incidentally on a CT during a recent trip to the ER for severe abdominal pain and cramping that began and has progressively worsened over a month's time. It started out as mild discomfort about 10-20 minutes after eating, but now it is severe pain shortly after eating and serious discomfort in my abdomen and lower back all of the time. I've lost about 25 pounds in 2 months--some of that was intentional, but I'm now losing about 1 pound/day and am severely malnourished due to my inability to eat very much without pain. My GYN wants to surgically remove the mass and my ovary, but warned that I have an extremely high risk of incurring damage to my colon or kidneys due to my numerous previous abdominal surgeries (2 C-sections, right ovary removal, hysterectomy, gall bladder, appendectomy) and being overweight. Although I am BRCA1-, my mother and sister are positive (maternal grandfather's line carries the gene mutation), and my mother is dying of Stage IV ovarian cancer--her mother was not a carrier, but also died of ovarian cancer. A GI specialist wanted to do a colonoscopy today, but canceled because I was too weak and ill to undergo the procedure. My questions are: Given my family history of ovarian cancer, should I proceed with the surgery despite the high risk of damaging my colon and/or kidneys? Should I see a gynecological oncologist even though malignancy can't be confirmed before a biopsy? Do my symptoms sound consistent with either ovarian or colon cancer (most important question). Thank you so much for your response!
doctor
Answered by Dr. Soumya (1 hour later)
Brief Answer:
Biopsy required

Detailed Answer:
Hello,

Welcome to health care magic.

You stand risk of ovarian cancer. Hence better to go ahead with removal of ovary. Your present symptoms are not conclusively indicative of cancer. Please get biopsy of ovarian cysts first for diagnosis.

It is important to know biopsy report before surgery as if malignancy is proved on biopsy the extent of surgery is different and removal of lymph nodes might be needed. So biopsy is extremely important.

It is difficult to say whether it is a ovarian or colon cancer as it is important first to diagnose whether it is a cancer or not. As CT scan has picked up a mass in ovary and no findings on colon, if proved to be cancer on biopsy then could be a ovarian one.

Due to previous surgeries it is technically difficult to operate as there will be adhesions in abdomen. Injury to abdomen and kidney can avoided if surgery is done by experts gynecologist and surgeon. Better to see a gynecologist oncologist once.



Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Follow up: Dr. Soumya (16 minutes later)
Thank you! My follow-up question is about the biopsy you mentioned. How would the doctor obtain a biopsy from the ovarian mass without performing surgery? Could the surgeon biopsy a piece of the mass in the OR to help make the decision to remove the entire ovary or will the entire ovary need removed anyway, given the size of the mass? Thank you.
doctor
Answered by Dr. Soumya (2 hours later)
Brief Answer:
Biopsy

Detailed Answer:
Hi,

Biopsy of ovary can be done from abdomen under ultrasound scan guidance. No surgery required for this. It is a minor procedure.

Yes. Biopsy can be done in OR ( Called frozen section biopsy) and then proceed with surgery based on report. If malignancy, he will have to remove some more structures like lymph node after removing ovary.
Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Dr. Soumya

OBGYN

Practicing since :2010

Answered : 3106 Questions

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Suggest Treatment For Abdominal Pain Due To Ovarian Cyst

Brief Answer: Biopsy required Detailed Answer: Hello, Welcome to health care magic. You stand risk of ovarian cancer. Hence better to go ahead with removal of ovary. Your present symptoms are not conclusively indicative of cancer. Please get biopsy of ovarian cysts first for diagnosis. It is important to know biopsy report before surgery as if malignancy is proved on biopsy the extent of surgery is different and removal of lymph nodes might be needed. So biopsy is extremely important. It is difficult to say whether it is a ovarian or colon cancer as it is important first to diagnose whether it is a cancer or not. As CT scan has picked up a mass in ovary and no findings on colon, if proved to be cancer on biopsy then could be a ovarian one. Due to previous surgeries it is technically difficult to operate as there will be adhesions in abdomen. Injury to abdomen and kidney can avoided if surgery is done by experts gynecologist and surgeon. Better to see a gynecologist oncologist once.