Question for the ladies...

Posted By
momof4boys
11/19/2017 5:56pm
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Replies: 6

Ok, so long story short... I was diagnosed nodular mel, 3b in 6/13 in my right calf. Did the SNB, CLND, and 1 1/2 years of Ipi 3mg. So I've had a couple things pop up in my lungs which have been biopsied and showed normal tissue so I probably get scanned way more than most people at this stage in the game. Anyways, my Ct last week showed a new, enhanced nodule on my left ovary, suspicious for metastatic disease. It's small, only 1.7 cm. So when my onc told me this initially I wasn't worried because I have had a follicle cyst on that same ovary in the past. But I could tell my Dr's demeanor had changed after reading the report. She didn't even notice the spot on a quick glance because that is not typical of melanoma. So what she said is because they are saying it is enhanced it actually has blood flow which is why it sucked up the contrast. My last scan was in May and it was a PET, my last CT was last Nov and I had a vag U/S in April of 2016 due to heavy bleeding/clotting. Nothing has ever showed on any of these scans and I've probably had 10 pet scans and 15 or more CT's since diagnoses in 2013. So ladies, any input here would be much appreciated as my mind is wandering today. I go back tomorrow for U/S. I have a couple in my church that is going through Ovarian cancer right now and he agreed it was his understanding if it has blood flow that would be more like an active tumor, right? I could see having a functional cyst show up on imaging but would it really have blood flow if it was just a normal cyst? BTW, Im 35.

This is why I really like PET/CT combo scans. A PET scan to compare would give better info as to whether it is "active" or not. A CT is just showing a cyst, so with CT alone there isn't a way to know if there is a lot of blood flow or activity with the cyst. I assume when you get the US they will do a doppler flow to see how much blood is actually flowing to the cyst. Maybe depending on what US shows they will have you do a PET scan. 

Sending positive vibes your way. 

Jenn - stage IV NED - Completed Ipi/Nivo (Yervoy/Opdivo) + surgery

Prd10 - (11/19/2017 - 6:58pm)

Sorry you are dealing with this.  I don't have a medical answer on blood flow v tumor v cyst but I had to respond.  I've had probably the same amountish of CTs and also 35.  I can tell you that at least once, if not twice a year they find cysts on my ovaries.  My Dr just mentions them so I know it's on the report but is not usually concerned with them bc it's not that common for melanoma to spread there.  Not impossible of course but not very common.  On my last CT they mentioned my uterus looking different (there was a medical term for it) but there wasn't a concern.  I just suspect that either at our age things are happening that we wouldn't otherwise know about without the scans or even the immunotherapy drugs we've taken are causing some hormonal things.  I'm probably not putting your mind at ease but I wanted to share that I've had similar things show up and I'm definitely sending good vibes your way hoping it's nothin!

Anonymous - (11/20/2017 - 9:09am)

Sorry you are dealing with this worry.Blood vessels do feed malignant tumors that's how they grow.However you should request a copy of the CAT scan report and go over the conclusions.Malignant tumous are usually  round in morphology and have a specific pattern of heterogenous enchancement.Considering this it would have been concluded  in the final report that the lesion is highly suspicious for metastatic disease.However the only way to know is biopsy/PET scan that will actually show the metabolic activity.Try no to stress out it could be nothing but better further investigate  to be on the safe side.Best of luck to you.

Anonymous - (11/20/2017 - 9:09am)

Sorry you are dealing with this worry.Blood vessels do feed malignant tumors that's how they grow.However you should request a copy of the CAT scan report and go over the conclusions.Malignant tumous are usually  round in morphology and have a specific pattern of heterogenous enchancement.Considering this it would have been concluded  in the final report that the lesion is highly suspicious for metastatic disease.However the only way to know is biopsy/PET scan that will actually show the metabolic activity.Try no to stress out it could be nothing but better further investigate  to be on the safe side.Best of luck to you.

Ultra sound seems like a good call. It never hurts to check into things further. But "blood flow" enhancement really depends on whether it is a simple or complex cyst. Over the past 4 years, my ovaries will show "spots" which have set off alarms with my gyn. Perhaps not the best health care practice for me to ignore them at this point, but they've come and gone with fair amount of regularity. CT's were every 3 months for me (now pushed to 4), and there has usually been at least one "area of enhancement" on one ovary or the other. 6 months ago, I had three of them... one on the left and two on the right. 2 months ago, I was back to only one on the right... 9 months ago, I had none. Because there are different types of cysts, a CT can sometimes show vasculature, but the cyst may still be a benign finding. I found this in an article online, when digging into my own CT findings ----

"When a Graafian follicle or follicular cyst bleeds, a complex hemorrhagic ovarian cyst (HOC) is formed.

On ultrasound hemorrhagic ovarian cyst presents as an unilocular thin-walled cyst with fibrin-strands or low-level echoes and good through transmission.
On MRI hemorrhagic cysts are bright on pre-contrast T1-FatSat, and dark on T2.
There should be no internal vascularity on Doppler ultrasound or internal enhancement on CT or MRI.
Hemorrhagic ovarian cysts have variable wall thickness, and often some circumferential vascularity can be seen.
Clinically the classic presentation is with acute pain.
However HOC can also be an incidental finding in an asymptomatic patient."

Sometimes we have to rely on the skill level and/or experience of the radiologist for accurate labeling practices. I would wonder how EXACTLY it was enhancing. Is it possible that it is vasculature along the outer edges of the wall... or did the little glow ball show internal blood too? They may not be able to answer that question, until you've had an ultra sound or possibly an MRI or even a PET. 

Good luck with the ultra today. Fingers crossed for some plain old ordinary run of the mill cyst that'll disappear in the next few months! 

Forgot to include the link to the radiology page regarding cysts........ http://www.radiologyassistant.nl/en/p4cdf9b5de7d3b/ovarian-cysts-common-...