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waiting to find out if I have a fibroid or tumor on my ovary
waiting to find out if I have a fibroid or tumor on my ovary
Hi, just last week I thought every thing was fine. I went a week earlier for my first ever yearly exam. My doctor told me I had an enlarged Uterus and she ordered an Ultrasound. After having an Ultrasound, Vaginal Ultrasound, an MRI , they still can not tell me if the mass is coming off the Uterus or off my left Ovary. My family doctor sent me to an OB/Gyn, who said I had a stomach of a 20 wk. pregnacy. I was told if it is off the Uterus, then it is a Fibroid, if off the Ovary they suspect Ovarian Cancer. When I went to see my doctor on Friday, I was told not only could they not tell for sure where the tumor originated , but my blood test show an abnormal liver function. So I had to do more blood work , a chest X-ray and I have a CT Scan on April 11, which seems like an eternity to me. (My doctor will be on vacation until then, so while he is off having a good time, I will be sitting on pins and needles).
Now I'm pretty scared, he thinks it is probaly a Fibroid but he needs to be sure just in case it could be cancer. He said I definitely will have a Hysterectomy, and looks for me to have it the week of April 16th. If the CT shows the tumor is off the Ovary then he is sending me to an Oncology GyN. I always thought a Total Hysterectomy was all your female organs, now I know I was wrong. The sad thing is I never really felt like I had any symtoms, I only went to get a Pap exam because I promised my mother ( she has Uterine cancer and now has Pancreatic cancer). I knew my stomach was getting bigger but I thought I was just gaining weight. If anyone has had similar stories I would love to know the out come. I try to stay positive but some days it is really hard.
Hi, Darla Sue,
My yearly exam started the same way. Went in for my yearly & nurse practitioner sent me in for pelvic ultrasound. My mom had fibroids so figured I had them too. Technicians kept saying "large". Pre-op I saw my ob/gyn dr that I hadn't seen in 13 years (3rd child), a woman ob/gyn dr, and a woman oncology dr. I figured if all 4 of them said the same thing, my TAH/BSO had to be done. Ending up having cantelope-sized ovarian, "chocolate", cyst (non-cancerous), a grapefruit-sized fibroid (both on my right ovary); plus, endometriosis and many small fibroids on my left ovary. My surgery and recovery have gone very well, pretty uneventful. I'll keep you in my thoughts & prayers with your tests. Keep posting & visiting HysterSisters. I lived here pre-op and post-op since this was my first major surgery in my life (45). It's OK to be scared. Take care and keep yourself busy while your dr is out of town. I'll be thinking of you.
waiting to find out if I have a fibroid or tumor on my ovary
Hi Darla Sue
I'm so glad you found us at Hystersisters! You say you had your first ever annual exam, but you don't mention your age. These gyn problems are pretty frightening at any age, but I'm especially sad for you if you are in your teens or early 20's.
Is your doctor hoping to determine if you have a fibroid prior to your surgery? From your description, is sounds as though it could be a pedunculated fibroid - one that is growing on a stalk outside of your uterus. Is a hysterectomy the only option that has been suggested, even if this is a fibroid? As you have discovered, the gyns refer to the size of your uterus in terms of weeks pregnant ... so when you were told your uterus was 20 weeks, that means your uterus is the size of a 20 week pregnancy.
It does seem like an eternity to wait until April 11th for the CT scan. Sometimes it seems like the docs have no appreciation for how much we patients worry about all the possibilities!
If you really aren't having any symptoms besides a growing abdomen and this turns out to be a fibroid, please be sure to confirm that a hyst is really necessary. One possibility might be a myomectomy - just the fibroid is removed and your uterus is preserved. Another possible option might be UAE - uterine artery embolization.
If ovarian cancer is suspected, you definitely want to see a gyn oncologist. They are the experts and are very highly skilled surgeons.
Please keep us posted on how you are doing and what you find out. Sending gentle hugs your way.
These tumor growths are generally asymptomatic. Often, they are first felt on a pelvic exam. Fibroids usually present as a central lower abdominal mass rather than totally involving the adnexa. Ultrasound or magnetic resonance imaging often can differentiate uterine leiomyomata from ovarian tumors, but not always. Malignancies such as leiomyosarcoma, mixed mesodermal sarcoma or endometrial stromal sarcoma may appear on MRI as a degenerating fibroid and cannot as yet be differentiated from a benign fibroid undergoing degeneration .These tumor growths are generally asymptomatic. Often, they are first felt on a pelvic exam. Fibroids usually present as a central lower abdominal mass rather than totally involving the adnexa. Ultrasound or magnetic resonance imaging often can differentiate uterine leiomyomata from ovarian tumors, but not always. Malignancies such as leiomyosarcoma, mixed mesodermal sarcoma or endometrial stromal sarcoma may appear on MRI as a degenerating fibroid and cannot as yet be differentiated from a benign fibroid undergoing degeneration.
Microscopic analysis is the gold standard to differentiate a benign leiomyoma from a malignant leiomyosarcoma. The pathologist looks for the active number of cell mitoses per high power microscopic field. The definition of less than 5 mitoses per 10 high powered fields or less than 4 mitoses is a commonly used criteria for declaring a fibroid as benign but the pathologist also looks for cellular atypia and coagulative tumor cell necrosis and sometimes DNA ploidy in making this judgement.
Other features Pelvic pressure and fullness presents when the size of the uterus with the fibroids(s) grows as big as a 3-4 month pregnancy. If the fibroids are on the anterior uterine surface they can cause bladder pressure and urgency and if on the posterior surface, they may produce rectal urgency.
Abnormal menstrual bleeding is a problem if there is one or more submucosal fibroids or if an intramural fibroid gets so big it impinges upon the endometrial cavity and compromises the blood supply to the base of the uterine lining.
Pain is not a common symptom of fibroids. Most of these tumors are asymptomatic except when they increase in size, the weight alone causes pelvic discomfort. Leiomyomata can produce acute pelvic pain if they outgrow their blood supply. This is called degeneration of a leiomyoma and the pain lasts for several days to a week or more. Degeneration of smooth muscle can be like a heart attack of the uterus. Monthly menstrual pain or cramps is not characteristic of myomas and should signal a search for coexisting adenomyosis.
Cause Fibroids are composed of uterine smooth muscle cells that are "monoclonal", i.e., all of the muscle cells in a leiomyoma are descendents of one cell that has reproduced itself extensively. It is not known whether the initial or ongoing stimulus is genetic, viral, inflammatory repair of normal cell loss or any other cause.
Fibroids grow in size if estrogen and progesterone is present and do not increase in size if estrogen and progesterone levels are low. Birth control pills probably play a role in stimulating fibroid growth and the fibroids may regress in size when the pills are stopped . As to whether oral contraceptives cause an increased fibroid incidence, the studies are somewhat conflicting from no increased incidence to a slightly increased incidence.
It was previously thought that just estrogen was necessary for growth but it now appears the progesterone is critical to fibroid growth.
Unless there is an extremely high suspicion of malignancy based upon size, contour and MRI characteristics, transcervical core needle biopsy is unnecessary prior to surgery because the incidence of malignancy is so low.
Natural history untreated:
Fibroids are almost unknown before an adolescent starts having menstrual periods. They grow slowly unless they are under the stimulation of extra estrogen and progesterone such as oral contraceptives. After menopause, the fibroids and entire uterus get smaller unless hormone replacement therapy is given
Taking postmenopausal estrogen and progestin replacement therapy can cause fibroids to grow. It appears that the progesterone/progestin component is needed because that is the hormone that increases cell reproduction (mitotic activity) in the fibroid itself .
Fibroids shrink as more time after menopause passes. They may become calcified and it is not unusual to have an incidental finding on xray or ultrasound in the decade of the 70's and 80's show round calcified areas in the region of the uterus.
Goals of therapy:
Prior to menopause the goal is to keep the fibroids from growing too large or too fast. If a woman can get to menopause without having symptoms from the fibroids, then it is likely that she will never have problems from the growths that require treatment. If there are symptoms of abnormal uterine bleeding, the therapeutic goal becomes to control the bleeding. If the symptoms are pelvic pressure due to size of the fibroids, surgical removal, myomectomy, hysterectomy, or medical shrinkage of the fibroids is the goal.
1st choice therapy:
Therapy is very dependent upon what symptoms a woman is having and whether she is trying to conceive now or in the not too distant future.
For fibroids suspected to be causing infertility, difficulty carrying a pregnancy, or interfering with labor and delivery of a pregnancy, surgical removal (myomectomy) either by laparoscopy or by laparotomy is the procedure of choice.
If abnormal bleeding is a major symptom and there is any suspicion from ultrasound or saline sonohysterography of an abnormal uterine cavity shape, hysteroscopy and D&C with intent to perform a resection of any polyps or submucosal fibroids is the preferred treatment.
For symptoms of pelvic pressure or pain due to size, abnormal uterine bleeding not due to submucosal fibroids but associated with intramural fibroids, or suspected degeneration of fibroids, the preferred treatment is surgical removal of the fibroids. Hysterectomy is the treatment of choice for this since myomectomy has a significant recurrence rate, but treatment can also be performed by myomectomy if a woman wants future pregnancies or just wants to avoid removal of the uterus.
It is important to find a surgeon who takes time to talk to you and after a thorough evaluation discusses all of your treatment options. It's difficult to evaluate surgical skills without talking to medical personnel who observe surgery, but you can get some idea of someone's comfort level with a procedure by talking to them. While it's important to understand that there are risks to any surgery, I would steer away from anyone who states that myomectomy is too difficult to do, bleeds too much, or if they do not seem comfortable with the procedure. While there is no fixed number of cases required to gain the necessary skill, you want to be sure that you have someone who does more than an occasional myomectomy, and who has the expertise and determination to complete the procedure.
Are fibroids cancerous?
Fibroids are benign tumors. This risk of cancer in a fibroid is estimated to be less than 1 in 500. There is no evidence that benign fibroids will become cancerous.
Will my fibroids grow back?
Once fibroids are removed those particular fibroids cannot grow back. But fibroids are caused by genetic mutations within uterine muscle cells. This process can over time create new fibroids. In addition, there can be tiny fibroids that cannot be seen or felt, and therefore cannot be removed. This is most likely to happen in someone who has many little fibroids. Recurrence is least likely in women with one or a few large fibroids than with multiple small ones.
What can you tell me about shrinking fibroids with Depo-Lupron®.
Depo-Lupron® is a medication that induces temporary menopause. This causes modest and temporary shrinkage of fibroids. It is not a long term solution, but is used at times prior to surgery. I offer it for large fibroids if I feel it will allow a substantially smaller incision. Most women have annoying but tolerable side effects such as hot flashes. Disadvantages of Depo-Lupron® include the possibility that it may make small fibroids more difficult to find so that they are more likely to be left behind, and that at times it can make it more difficult to separate the fibroids from the wall of the uterus. I will recommend its use occasionally for very large fibroids, but in most cases see no advantage to its use.
How Do I Know I have Fibroids? Symptoms and Diagnosis:
The most common bleeding abnormality is menorrhagia (prolonged and/or profuse uterine bleeding, also called hypermenorrhea). Normal menstrual periods typically last four to five days, whereas women with fibroids often have periods lasting longer than seven days. Women with fibroids also can have such heavy bleeding that they need to change sanitary protection frequently (perhaps every hour) or hesitate to participate in their normal activities for fear of socially embarrassing bleeding. Bleeding between periods is not usually associated with fibroids and should always be investigated by a physician. Although abnormal bleeding can occur with any of the three classes of fibroids, women with submucous fibroids seem particularly prone to this complication.
Pelvic pressure results from an increase in size of the uterus or from a particular fibroid. Most women with leiomyomas have an enlarged uterus; in fact, doctors describe the size of a uterus with fibroids as they would a pregnant uterus, for example, as a 12 week-size fibroid uterus. It is not unusual for a uterus with leiomyomas to reach the size of a four to five month pregnancy. In addition to vague feelings of pressure because a fibroid uterus is usually irregularly shaped (having many lumps and bumps), women can experience pressure on specific adjacent pelvic structures including the bowel and/or bladder. Pressure on these structures can result in difficulty with bowel movements and constipation or urinary frequency and incontinence. Rarely, fibroids can press on the ureters (which carry urine from the kidneys to the bladder) which can lead to kidney dysfunction.
Leiomyomas are also associated with a range of reproductive dysfunction including recurrent miscarriage, infertility, premature labor, fetal malpresentations, and complications of labor. Although few studies exist regarding fibroid-related reproductive dysfunction, the prevailing clinical perspective is that these complications most often occur when fibroids physically distort the uterine cavity. Therefore, women with large or symptomatic fibroids may choose to undergo assessment of the uterine cavity before attempting pregnancy. If fibroids are detected on the inside of the uterus (termed submucous fibroids) and distort the uterine lining, they are a significant cause of reproductive problems and should be removed. It is less clear whether fibroids in the wall of the uterus cause reproductive problems. Generally, if the uterus is small, fibroids do not need to be removed in women contemplating or attempting pregnancy.
The diagnosis of leiomyomas is usually easily determined by bimanual pelvic examination. During this routine office exam, the clinician evaluates the size and shape of the uterus and surrounding pelvic structures by inserting two fingers of one hand into the vagina while palpating the patient's abdomen above the pubic bone with the other hand. During this exam, a uterus with fibroids often feels enlarged and/or irregular and may be felt abdominally above the pubic bone. In contrast, a non-pregnant uterus without fibroids is not palpable above the pubic bone.
In addition, imaging studies such as ultrasonography, MRI (magnetic resonance imagery), and CT (computed tomography) may be useful in confirming the diagnosis. Currently, ultrasonography is the most common method of confirming the diagnosis of leiomyomas, but MRI may prove to be the most useful method because it can often distinguish leiomyomas from other intramural lesions.
Risk of malignancy low in small, ovarian cystic tumors, study shows:
A comprehensive study released at the Society of Gynecologic Oncologists annual meeting on Women's Cancer shows that the risk of malignancy in ovarian cystic tumors less than 10 cm in diameter is very low.
These findings suggest that serial ultrasounds may be a significantly less invasive alternative to surgery and may now be the only treatment required for many patients.
"The purpose of this study was to determine the risk of malignancy in ovarian cystic tumors in women over the age of 50," said Dr. van Nagell. "But, the results mean much more - that surgery isn't the only option. This study should be encouraging for women of all ages, to know that most simple cysts of the ovary will resolve spontaneously, and that they can be followed safely without immediate surgery."
The utilization of transvaginal ultrasound as a method to screen women for ovarian malignancy has increased in recent years. Since most women with small ovarian tumors have no symptoms, the University of Kentucky team set out to determine risk of malignancy in cystic ovarian tumors less than 10 cm in diameter. The results were astounding. Eighteen percent of the 15,106 asymptomatic women participating in the program developed unilocular ovarian cysts. After an average of 6.3 years follow-up, no woman with these tumors developed ovarian cancer. In fact, the vast majority of the tumors (69%) resolved spontaneously while being followed conservatively with serial ultrasounds.
"When solid areas or papillary projections develop within these tumors, the risk of malignancy increases and immediate operative removal is recommended," added Dr. van Nagell. "However, these results are very encouraging for many women who will develop small cystic ovarian tumors." http://www.obgyn.net/newsheadlines/w...0030325-26.asp
Good Luck Pls let us know how your upcoming CT Scan goes...((((hugs))))
Today, I had my 5 wk post-op check-up (abdominal hysterectomy) & everything is healing fine. When I read your post, your situation reminded me of what I recently went through. I am 46 yrs old (no children) and I had no symtoms that something was growing inside my pelvic area. I had no pain, no bleeding. But I did notice that my belly was getting bigger and I felt full/bloated most of the time (I thought I just needed to diet/exercise more). I also noticed that in the past couple of months I was unable to urinate whilst wearing a tampon (I thought that was related to getting closer to menopause and loss of estogen, so I didn't think too much about it at the time.)
Jan 22, at my yearly pelvic exam (about 6 months late) my ob-gyn said I had a "16 wk pelvic mass" that must be removed. She sent me for tests: First, a pelvic/abdominal Ultrasound, and the result indicated an ovarian cyst on the left ovary, but this was not conclusive so I had an MRI done next. MRI result indicated the mass was a uterine fibroid not ovarian cyst. (I also had a barium enema as a precaution to check out the colon, etc.) She had me meet with an oncologist ob-gyn because the cyst could be cancerous. (Basically he told me that it probably wasn't cancer, because for that size a mass I would feel a lot "sicker" if it was cancerous.) Bottom line, my doctor didn't really know what I had until she opened me up to see. It turned out to be a fibroid after all (like a big eggplant my doc told me later).
The same oncologist ob-gyn was on-call during the surgery, just in case things looked bad (i.e. cancerous), but he ended up doing the whole surgery because this T*H*I*N*G was just everywhere and his surgical expertise was needed to extract all its "tentacles". I lost my uterus, cervix, the left ovary and appendix. (I was able to keep my right ovary because it looked normal.) All pathologies have come back as non-cancerous, so I consider myself very fortunate. I'm cleared to return to work (desk job) next week. Happy endings happen all the time. May God bless you.