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Dr.M.D.Mazumdar, Doctor
Category: OB GYN
Satisfied Customers: 9036
Experience:  MD (Obst&Gynecology)
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I am 43 and premenopausal. I have had LLQ pain and general

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Hello. I am 43 and premenopausal. I have had LLQ pain and general pelvic pain for about 6 months. In the past 2 months the LLQ pain has increased significantly. I had a partial hysterectomy 4 years ago due to DUB. I saw a GYN today who performed a pelvic exam and told me that he didn't think my left ovary felt abnormal, but my colon felt "irregular and knobby." He sent me for a pelvic u/s and the results say that I have 2 irregular complex cysts on my right ovary. What could this mean? I don't see the GYN again until next week and I'm quite concerned. What other tests would you expect to see performed? How likely is it that this could be cancerous?
Welcome and thank you for your question.
Does the report mention the size of the cysts?
What does the report say about the left ovary?
Customer: replied 4 years ago.

Pelvic and transvaginal u/s were done

right ovary:

3.5x2.7x2.8 cm right ovary

1.2x1.2x1.1 slightly irregular complex cyst

1.4x1x1 cm slightly irregular complex cyst

otherwise normal appearance on grayscale and color Doppler

left ovary

3.2x1.5x1.5 cm left ovary

small cortical follicles, the largest measures 6x8 mm

normal appearance on grayscale and color Doppler.


Two irregular slightly complex cysts in the right ovary measuring 1.4 and 1.2 cm

Thank you for the added information.
Your left ovary is normal, but the reports of the right ovary are concerning.
Complex ovarian cysts are cysts that contain both fluid as well as solid areas. I am sorry to say that about 5-10% of all ovarian complex cysts are malignant and need to be removed.
At your age (above 40 years), these cysts need to be investigated very carefully.
Please ask your obgyn for a blood test for CA-125 - this is a tumor marker for ovarian cancer and will be elevated in the cysts are malignant.
It is very likely that you will be asked to go in for a surgery to remove the cysts for a biopsy.
I hope that helps.
Customer: replied 4 years ago.

Thank you for your quick and thorough response. Would it be prudent to have the ovaries removed completely just in case?

Also, why does my colon appear irregular and knobby on pelvic exam, and what could be causing this very strong, constant LLQ pain? During the transvaginal u/s I was in great discomfort as the technician moved the wand, especially on the back wall of my vaginal vault. I felt the pain was coming from that area directly.

it would be prudent for them to be removed. In fact, that is likely to be what your obgyn will suggest - since they are quite small, they will need to be removed to get adequate tissue for a biopsy.
The pain and irregularity of the intestines is probably because of inflammation. Inflammation can set in around a cyst and this can then set up radiating inflammation and pain in the surrounding tissues.
Customer: replied 4 years ago.

Again, thank you.

At my age of 43 a paternal aunt who had ovarian cancer at age 37 and a cousin with breast cancer at 30, what are the realistic chances that these are going to be cancerous? If they are cancerous and they're removed, how do they determine if the cancer has spread to other areas of my body? Would I then have to undergo chemotherapy?

At your age and with your family history, the chances of cancr is quite high.
At biopsy, spread is usually determined by checking if there is a layer of healthy tissue around the cancerous tissues. But in case of ovarian cancer, spread can occur through blood vessels and lymphatic channels so this does not apply. If these are cancerous, then you will need chemotherapy, since there is no sure way of determining spread.
But the fact that the intestines feel knobbly and that you have pain at the back of abdomen is not a good sign - these are frequently seen either when there is an infection or when the cancer has spread locally to these tissues. I am sure that this sounds scary but i thought it will be better to tell you the truth.
Customer: replied 4 years ago.

I'm a nurse and I can handle the truth. Thank you for your honesty. I really appreciate your help.

You are welcome.
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