On Ovaries

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Time is such a crazy thing.  I seriously feel like I JUST updated this thing and bam! a week has gone by.  And at the same time, it seems like the MRI was absolutely forever ago.  Lately I find myself doing this trippy thing where I figure out how many weeks till my surgery (20 from today to be exact), then count backwards and see what I was doing that amount of weeks ago just to have an estimate of the time left… it’s bizarre.  And now that it’s at the point that my surgery is in a less amount of time than how long I’ve been in this new job… well that just messes with my head.  How it’s been almost 6 months is absolutely unreal.  So yeah.. 20 weeks ago was around the end of October.  Sounds like a long time ago, then I look at my calendar and that was the week of one of my most favorite people on the planet’s wedding.  And really didn’t that just happen?  No way! I keep being told “August will be here before you know it!” and what can I say? There’s some serious truth to that.  Sometimes I wonder if I’m crazy to be waiting till then, but no… it’s perfect timing.

Kudos if you made it through that word vomit… suffice to say, time is a funny thing, and I find myself thinking about it all the time (ha!) lately.  Just weird.

Okay moving on… topic du jour is ovaries.  And honestly this part is really for me when I look back and want/need to remember, but anyhow…

I found out the same day as my tests last week that my MRI was normal (woot! Still can’t celebrate that one enough – “no evidence of malignancy on MRI” was the official awesome verbiage!) but it was a couple days later I got the results of my ultrasound. So to backtrack just a bit, when I met with my gyn-onc we had an in-depth discussion about how screening for ovarian cancer basically sucks (in terms of finding it early) but at the same time we can’t just sit around and do nothing.  So we came up with the plan to do the two tests that are the best the medical world has to offer right now (transvaginal ultrasounds and CA-125s) and do them either every 6 months or a year, depending how things look and monitoring for changes more than anything else.  This I totally am okay with and I respect that she acknowledged the gap in efficacy and that research is being done to improve screening.  Also important to note is her explanation of how different BRCA1 and BRCA2 are in regards to ovarian cancer.  They get lumped together all the time, but BRCA1 carriers have a higher risk of ovarian cancer, and it’s usually earlier in life than BRCA2.  That coupled with my being on OCPs for more than 5 years continuously means my risk is even lower.  All good things.  So all that said, the day of the consult I had a CA-125 drawn (just a simple blood test). The low-down on the CA-125 is that basically, it’s not awesomely accurate and here’s why:

A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in your blood.

Many different conditions can cause an increase in CA 125. These include uterine fibroids, endometriosis, pelvic inflammatory disease and cirrhosis, as well as pregnancy and normal menstruation. Certain cancers, including ovarian, endometrial, peritoneal and fallopian tube, also can cause CA 125 to be released into the bloodstream.

A CA 125 test isn’t accurate enough to use for cancer screening in all women — especially premenopausal women — because many benign conditions can increase the CA 125 level. What’s more, CA 125 levels are normal in many women with early-stage ovarian cancer.” (Mayo Clinic)

So normal is anything less than 35 and mine came back at 42.  Clearly not anything to be concerned about (the nurse in me says that’s like freaking out over a potassium of 3.4… not gonna happen!), however, it did of course catch my eye.  The only reason we drew one in the first place was to have a baseline, and now we have it.  However, it was interesting when I got my ultrasound report back and it read “1. Normal sonographic appearance of the uterus and ovaries.  2. Small amount of free fluid in the cul-de sac, a greater amount than is considered physiologic… likely related to the ventriculoperitoneal shunt, compatible with findings on prior imaging studies.”  YAY for the word “normal” but here we go with that darn shunt again!  Seriously I would have never imagined the thing could cause so many issues… I had it put in summer of 2006 and other than a couple minor issues when I first had it placed I have barely even thought about it being there since I don’t feel it!

I know I briefly described the shunt concept at some point but just as a visual… you can see where the fluid drains and ends up in the peritoneum (and also why there will be a neurosurgeon on call for boob surgery day…)

So to get to my point, doctor/nurse friends and I have this theory that the free fluid (which is obviously the CSF my shunt is draining) is causing the slight raise in CA-125 (peritoneal irritation, etc).  That’s the issue with the blood test in the first place – false positives abound, and often it’s not elevated when you think it should be!  Will be interesting to inquire if our theory has some validity come July, but it certainly does seem to make sense.

Anyhow, that’s the update to finish the last update.  So now everything really is good to go until July!  And for that I am grateful – work and life have been crazy!  Good crazy, but crazy nonetheless!  Though if you know me you know I love being busy… I joked at the FORCE meeting Saturday (more on that later) that I have such peace with everything that the surgery is simply another date in the calendar… a “surgication” if you will!  Tongue in cheek of course, but it bodes well for the planner in me.

So to finish with a bang… the most important part of this post is to wish my fabulous friend Amy good luck tomorrow with her surgery!!  I’m sure her tatas are going to look amazing, and I’m so excited for her to reach this part of her journey.  All good thoughts headed her way!!