Hi, It is good that the pap is normal. The cyst is small in size. However, the doctor is worried as it has an internal septum. In medical terms we call these cysts as complex cysts. Presence of the septum is a finding that indicates that the cyst may not be a simple one and a small possibility of being cancerous. Ca125 will not always be positive in ovarian cancer and it may be positive in non cancerous conditions too. So if positive, than it indicates malignancy but if it is negative, it does not mean that cancer is not possible. I hope this explains the doctors concern. Having said all this, my advice to patients like you would be to get Ca125 done. If positive, do surgery at the earliest. If it is negative and you do not want surgery, wait and do a monthly ultrasound to see if the cyst is growing. If it is growing get it removed as early as possible. In any case, if women like you walk into my clinic, considering that the age is already near menopause, you are missing your periods and the cyst has a septum: I advice surgery even if the cyst turns out to be non cancerous. I hope that now you would be able to reach a decision. Do not worry as the cyst is small and has been detected early. Thanks for using health care magic. Dr. Madhuri Bagde Consultant Obstetrician and Gynecologist