Pregnancy or tumour?

All Woman

Dear Dr Mitchell,

I keep feeling as if I am pregnant, because shortly after having unprotected sex I started experiencing nausea, dizziness, spotting, sore, growing breasts, and more symptoms. When I went in for my first pregnancy test it was negative. They cannot find a baby, just cysts and water in the cul de sac. Blood tests are also negative for pregnancy. Doctors are insisting that it's an ovarian problem, so I've been monitored over the past three months. I am very skinny and my stomach has grown a lot bigger, bloated and hard. The most recent ultrasound again detected no baby, but I'm having more severe symptoms. I am concerned about some sort of ovarian cancer, but my gut feeling is that something is moving and growing around in there. The doctors can only see the ovarian enlargement but they can't explain why yet, and keep monitoring. If my gut is right, I am almost four months pregnant. What do you think?

The absence of the menstrual period for four months and the negative blood pregnancy test with no evidence of any gestational sac or foetus on ultrasound definitely rules out a pregnancy. The fact that you have lost weight and experience bloating and abdominal distension are important factors that might suggest the presence of an ovarian problem. The presence of free fluid in the pelvis (cul de sac) and enlarged ovaries could also suggest an ovarian malignancy. This may be a primary growth in the ovaries or may be as a result of spread from another organ such as the stomach or bowel.

A CT scan of the abdomen and pelvis should be done to get more detailed information on the stomach, bowel, liver and other intra-abdominal and pelvic organs. You should also get a blood test to determine if the tumour markers for ovarian cancer are elevated. These include CA 125, CEA and alpha fetoprotein. These tumour markers, and in particular CA 125, can be elevated in endometriosis. This is a condition where the tissues that normally line the inside of the uterus are present elsewhere in the pelvis and abdominal cavity. It is sometimes associated with enlarged ovaries and fluid in the peritoneal cavity. There is usually significant pelvic pain with the menstrual periods or the pain may be chronic and constant in severe cases. In some women endometriosis may be present otherwise without any symptoms.

Polycystic ovarian syndrome is a condition associated with the absence of the menstrual period, enlarged ovaries, features of excessive testosterone production and usually excessive weight gain. This condition can also be seen in women who are slim, so the absence of excessive weight gain does not rule out the condition. A blood test can be done to check your levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone to help in confirming the diagnosis of polycystic ovarian syndrome.

It might be necessary for you to have surgery done to biopsy the ovaries and rule out an underlying ovarian malignancy and endometriosis. This may be done via laparoscopic or open surgery. Consult your doctor urgently, who will advise you further.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

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