Oncology for possible ovarian cancer

Patient

Q: My 59 yo wife has multiple complex cysts on Left ovary only with some thickening of endometrium. Present for some time after 12/2013.
CT scan of body shows only an axillary 12x14x16 lymph node. Last last one groin node was determined to be follicular lymphoma.
Lymphoma treated by radiation and site clear.
Do ovary growths sound like cancer? No symptoms

Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,
At 59 years of age, it is assumed that she is post menopausal already. So in a post menopausal lady presence of multiple complex ovarian cysts and also thickened endometrium, both are ominous signs of possible ovarian and an endometrial cancer. After menopause, with loss of oestrogen function, the ovary reduces in size and no follicle development takes place and hence there are no chances of simple follicular cyst formation at all, but if there are cysts formed then they are likely to be tumours. Complex cyst of ovary with possible thick septations and presence of mural nodules on Ultrasound or MRI does indicate a cancerous pathology and it has to be further evaluated with tumour markers like CA125, CEA, AFP and betaHCG which if found to be raised then she has a cancer.
Also post menopause, the uterine endometrium is no more functional and hence usually thin or less than 3mm. But as the endometrium is thickened, it is necessary that an endometrial biopsy may be done and subjected to histopathological evaluation to diagnose the level of endometrial hyperplasia and stage of possible endometrial cancer as well. She may have experienced occasional spotting per vaginum in last 6 months.
So, she has to be evaluated in detail by your physician and after confirmation of diagnosis, she would have to undergo a laparotomy for surgical staging of ovarian cancer which may involve total abdominal hysterectomy with bilateral slapping-ophorectomy + bilateral pelvic lymph node dissection+ bilateral para-aortic lymph node dissection + total omentectomy. This is the complete procedure and post the procedure after Histopathological examination and type of cancer devised, she would be subjected to concurrent chemoradiation further for 6 cycles. You may discuss your options with your physician in detail and take an informed decision.
I hope i have answered your query in detail,
Wishing her good health,
Regards

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