Question: I have attached my abdominal ultrasound, intravaginal ultrasound and my CT with IV contrast. I am a 37yr old female. I had severe sudden onset upper right quad abdominal pain April2. ER gave donnatol and sent home. Pain persisted so went to primary care and her Ultrasound showed small amount ascites around liver, morrisons pouch and pelvic cul de sac. Sent back to ER. Transvaginal US showed a 3cm complex cystic structure, on right ovary with with moderate free fluid. Also several simple cysts present on rt ovary. Rt ovary measures 5.9x2.8x4.6cm. Is that normal sized or enlarged? Left ovary not visible. Small free fluid in endocervical canal. 6mm echogenic hypervascular lesion found anterior to endometrial stripe near cervix and radiologist made a point to say it did not look like a fibroid or cesarean scar mass. CT with IV contrast showed no problems with liver or other abdominal organs and blood work supported that. Theory is the ascites is from the ovaries. Does this indicate ovarian cancer or can the ascites in abdomen be from a benign ovarian cyst? When I research I can only find ascites from ovaries associated with ovarian cancer. I can't find a single case where ascites from benign ovarian cyst. Hemoglobin record April2 15.8, April 3 13.6, April 4 13.6. I don't have my blood work, but I was told all standard blood work normal.
So here are my pressing questions.
1.Can this ascites be from a regular/ benign cyst?
2.Also had enlarged mesenteric lymph nodes. Is this a sign of cancer?
3. Is my right ovary enlarged? what is standard ovary size range?
4. Does this paint a picture of ovarian cancer? I don't want to be shocked when I see Obgyn on Tuesday. Is ovarian cancer a possibility based on these scans?
5. Is it ok that I am at home and not hospitalized right now?
6. Is my abdomen being washed in cancerous ascites fluid since April 2 and I can't see my doc until the april 7th? And lastly,
7. what blood tests should I expect to ordered when i do see my Obgyn? Please tell me what tests you would order if I were your patient and you wanted to rule out ovarian or uterine cancer.
8. Is there a way to test the ascites fluid? ER doc said needle draw would not work, it would have to be an open surgery. Is that true?
9. My White blood Cell count was normal- is this the definitive test for cancer or can I have a normal WBC and still have ovarian cancer.
10. Regarding the uterine lesion. Do you think the vascular nature of this lesion suggests malignancy? Are there lesions with this vasculature that are bengin?
11. Is it reasonable to think they will biopsy the ovarian cyst and the uterine lesion? Are there other ways to determine if these two lesions are benign or cancerous?
12. If Ascites is cancerous, is that how it spreads to other organs, by moving around my abdomen?
13. Can ascites fluid be benign?

If you can answer some of these questions the best you can with the info you have I would be so relieved. The ER doctors wanted me to have follow up the next day and stated this in their discharge instructions, but my doctors never returned my call and the receptionist gave me first avaialable appt which is April 7th without any urgency.

I have corresponded with my Ob/gyn and he has ordered these two blood tests.

ca-125
CEA (Carcinoembryonic Antigen)

Is this sufficient to find out if I have ovarian cancer? If I were your sister or daughter would you stop investigating if these two blood test results are normal? What other tests would you perform based on my CT, US and TVUS?

Kindly,
XXXX

thanks. I have a list of things to discuss with obgyn tomorrow. I will ask him to add the bHCG, LDH and AFP. I am so anxious that he will say no. So far he is minimizing and has already said simply from looking at the same reports as you only that he "pretty certain" I don't have ovarian cancer. I requested the ca-125, CEA and the three mentioned above, but he only ordered the two. I know I am no doctor, but I am not a fool and I know women get diganosed in late stage ovarian cancer with much less clinical evidence than what I have presented with. Anyway, just nervous about advocating for myself. Thanks for your suggestions and I will get copies of the lab results and upload them once they are in. I appreciate your careful attention to this matter.

I saw my obgyn. based on the same reports you see he said there is nothing at all to worry about and he has no plans to follow up or do any other imaging studies. my ca-125 was 29.8 and CEA was .5 He said these tests prove that I don't have ovarian or colon cancer and i should not worry about it at all.

He said it was a normal ovulation where a drop or two of blood escaped into abdomen causing pain. he said uterine lesion was a polyp and those are never cancerous. he said its not possible for a 3cm ovarian complex cyst to cause ascites and he thinks i don't have ascites, even though 3 reports say I do. He said it is the normal moisture that comes of the organs, like sweat. He did not do a pelvic or even touch me. He has no follow up planned. He will not give referral to gyno/oncology.

I don't know what to do. He is head of OB/gyn department at my medical group.

what do you suggest?