I was almost successful in counseling a depressed patient when she came back to me again in tears!
During her follow up a week ago, I saw her in a cheerful aura with no signs of anxiety or despair. She has been worried of her sister's condition and has been compalining of mild colicky pain on her left lower quadrant. Previous work- up for UTI or kidney stones were normal. She has a history, though, of uterine polyps and endometriosis as shown in her ultrasound done a year ago. Thinking that there is progression of the condition, I requested for a repeat transrectal ultrasound as she has no sexual experience at her age of 57.
When she saw the report of the ultrasound, she was very happy. While waiting for the gynecologist, she was already thanking God because there were no uterine polyps nor endometriosis seen except for bilateral ovarian cysts measuring 1x1 cm each. Her happiness subsided when the gynecologist told her " we have to make sure it's not cancer, so let's do CEA, AFP and B-HCG titers...". She wanted further explanation but the doctor gave her the request and told her to have it done before she goes back to her clinic gesturing her to leave. She went straight to my clinic in tears thereafter.
Are ovarian cysts cancerous in nature?
Most ovarian cysts are functional, meaning, they're benign. It is common in women of all ages caused by failure of an ovarian follicle to rupture and release the egg during ovulation. The fluid remains and can form a cyst in the ovary. While cysts may be found in ovarian cancer, ovarian cysts typically represent a normal process or harmless (benign) condition. Requesting for cancer markers which cost a lot is really not necessary when symptoms are not proportionate to or referrable to an ovarian malignancy.
On top of that, my patient has a very melancholic personality. She is currently recuperating from depression and now another depressing diagnosis is posed on her! I had to go back to educating her, counseling her and making her understand that her condition is benign and there is no need to worry and that the best thing to do is observe... at the moment.
I really hope all doctors look at the patient and not the ancillary procedure. If her concern was explored prior to telling her that her cysts may be cancer, we could have spared her of another depressive moment. I understand that the gynecologist only wants to make sure that her two tiny cysts are not cancerous but she could have explained to her statistics first before outrightly telling her , "let's make sure, it's not cancer".
I know it's hard to be in the surgical field as I heard a gynecologist friend telling me that if given the chance to go back, she wouldn't be a gynecologist. She said her children suffer the most when she leaves in the middle of the night to deliver babies. I told her though not to feel sorry as God made her an instrument to bring new life in the world but to also learn to prioritize. Well, better said than done of course, especially from a family physician.
