Ovarian Cysts: Symptoms, Diagnosis, and Treatment Options

A suspected chocolate cyst was found on the left ovary?

Hello, Doctor! My menstrual period started on February 22, and I usually experience menstrual cramps.
Then, from March 1 to March 3, I had occasional lower abdominal pain, and on March 3, I took a painkiller.
On March 8, I experienced lower abdominal pain again, and in the evening, I visited a gynecologist.
The doctor performed an ultrasound and found a tumor over seven centimeters on my ovary, but did not specify what type it was and asked me to have my CA levels checked.
During my follow-up on March 15, I was informed that my CA level was 393, and I was advised to transfer to a larger hospital.
On March 20, the hospital's ultrasound showed it was over six centimeters, and they speculated it could be a teratoma or a chocolate cyst.
However, I am reluctant to undergo surgery; the doctor did not insist on it but told me to return for a follow-up at the end of June.
I would like to ask if that tumor could be pressing on my lower back, as I have been experiencing soreness in my left lower back today (the tumor is on the left ovary) and I also feel a bit of urinary urgency! Recently, I have been sleeping poorly, eating less, and I have lost six kilograms over the past seven months (but it has been gradual), and I feel fatigued.
Does this confirm that the tumor is benign? Could hitting a pothole while riding my bike be related? My mother is very worried that I might hit the tumor.
Thank you!

Fina, 20~29 year old female. Ask Date: 2017/03/23

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I had my menstrual period on February 22, and I usually experience menstrual cramps.
Then, from March 1 to March 3, I had occasional lower abdominal pain, and on March 3, I took a painkiller.
On March 8, I experienced lower abdominal pain again and went to see a gynecologist in the evening.
The doctor performed an ultrasound and found a tumor over seven centimeters on my ovary, but did not specify what type it was and asked me to have blood drawn to check my CA levels.
During my follow-up appointment on March 15, I was informed that my CA level was 393, and I was advised to transfer to a larger hospital.
On March 20, the hospital reported that the tumor was over six centimeters and speculated that it could be a teratoma or a chocolate cyst.
However, I am reluctant to undergo surgery, and the doctor did not insist on it, only advising me to return for a follow-up at the end of June.

I would like to ask:
1.
Could the tumor be pressing on my lower back? Because today my left lower back is very sore! (The tumor is on the left ovary) and I also feel a bit of frequent urination!
Answer: The ovarian tumor is unlikely to be pressing on your back, causing soreness in the left lower back or the sensation of frequent urination.
2.
I have been sleeping poorly, eating less, and have lost six kilograms over the past seven months (but it has been gradual).
I feel fatigued.
Does this confirm that the tumor is benign?
Answer: Whether the ovarian tumor is benign can only be determined after surgical removal and pathological examination.
3.
Is there any relation to hitting a bump while riding a bike? My mother is very worried that I might hit the tumor.

Answer: It should not be a concern.

Reply Date: 2017/03/23

More Info

Understanding ovarian cysts is crucial for women experiencing symptoms such as abdominal pain, changes in menstrual cycles, or unusual urinary patterns. Ovarian cysts are fluid-filled sacs that can form on the ovaries, and while many are benign and resolve on their own, some may require further evaluation and treatment.

In your case, the ultrasound revealed a cyst measuring over 7 cm on your left ovary, and subsequent blood tests indicated an elevated CA-125 level of 393. CA-125 is a protein that can be a marker for ovarian cancer, but it is also elevated in various benign conditions, including endometriosis and pelvic inflammatory disease. The context of your symptoms, including abdominal pain, frequent urination, and weight loss, raises concerns that warrant careful monitoring.

1. Symptoms and Diagnosis: The abdominal pain you are experiencing could indeed be related to the cyst. Large cysts can exert pressure on surrounding structures, including the bladder, which may explain your frequent urination. Additionally, if the cyst is causing discomfort or pain in your lower back, it could be due to the pressure it places on nearby nerves or muscles. It’s essential to communicate these symptoms to your healthcare provider, as they can help determine if the cyst is affecting your quality of life and whether further intervention is necessary.

2. Treatment Options: While surgery is a common treatment for large or symptomatic cysts, it is not always the first line of action, especially if the cyst is not causing significant issues. Your doctor’s recommendation to return for follow-up in June suggests they are taking a conservative approach, which is often appropriate for cysts that are not causing severe symptoms. However, if your symptoms worsen or if you experience sudden, severe pain, it is crucial to seek immediate medical attention.

3. Monitoring and Follow-Up: Regular follow-up appointments are essential for monitoring the cyst’s size and any changes in your symptoms. If the cyst does not resolve on its own and continues to cause discomfort, your doctor may discuss the possibility of surgical intervention. It’s also important to consider lifestyle factors, such as stress management, diet, and exercise, which can impact your overall well-being and may help alleviate some symptoms.

4. Concerns About Cancer: While your elevated CA-125 level is concerning, it is important to remember that many factors can influence this marker. Your healthcare provider may recommend additional imaging studies, such as a CT scan or MRI, or even a biopsy if there is suspicion of malignancy. It’s essential to have open discussions with your doctor about your concerns and the next steps in your care.

5. Impact of Physical Activity: Regarding your concern about riding a bike and encountering bumps, while it’s unlikely that minor jolts would cause harm to a cyst, it’s wise to listen to your body. If you experience increased pain or discomfort during or after such activities, it may be best to limit them until you have further clarity on your condition.

In conclusion, while ovarian cysts can be concerning, many are benign and manageable with careful monitoring. It’s essential to maintain open communication with your healthcare provider, report any changes in your symptoms, and follow their recommendations for follow-up care. Your health and well-being should always be the priority, and addressing your concerns with your doctor will help ensure you receive the best possible care.

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