Multicystic Ovarian Mass and Multiple others.. Cancer??? Questions please help!!

I am very scared right now and generally I am a private person when it comes to medical matters.  I have told my family what is going on (immediate, mother and father).  I need some answers, or some support in terms of psychologically handling what is going on. 

So... here is my story.... 

Relevant med history and current issue:

I am 38 years old, I have had 2 c-sections (1998 and 2001), a tubal ligation in 2001. Abdominal surgery on Sept 7th of this year (2017). I have had two aunt dies from ovarian cancer and my maternal great grandmother had breast cancer.  My mother has fibroid cysts in her uterus and often gets breast cysts that come and go (all benign).

Over the last year or so I have had increasing back pain - so much so that I take daily oxycontin for chronic pain (10-325 4x day).  I have had a low grade fever, usually coming on in the evenings when it gets dark for some reason (ranging from 100 - 102. F), I have weird bloating in the middle of my abdomen where it is very hard like a rock (about the size of a small cantaloupe put together right above my navel to my xyphoid process) and it happens intermittently throughout the day / eve regardless of eating, I have nausea & vomiting after I eat, and severe back / pelvic pain usually on the right side however I get occasional sharp, stabbing pain on my lower left  and lower right side. Also, I started having irregular periods about 6 months ago, as well as occasional spotting between periods.  For instance, something common that is happening: I had three periods that lasted for four-five days each with heavy bleeding within a 42 day period, then a week later, I had spotting for one-two days.

I had a surgery on Sept 7th (Stomach / abdomen) and during the operation, they found a large mass sitting in my pelvic region.  The surgeon called in a gyn/onc to look at it while I was under anesthesia and then I was referred to him after that surgery.   I went to the gyn/onc and had my initial visit.  He said not to worry about anything, it is more than likely not cancerous; then he scheduled me for an MRI and the CA125 marker (had both done on December 6th, 2017) and after the MRI I started to worry.. a lot!  His demeanor changed too...so that made me freak a little bit and i am still freaking out.  The internet does not help with that!

My test results were:  CA125: 12.7 (below 35, normal) and here is my MRI report:

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Exam: MRI of the pelvis with and without contrast.

/HISTORY/>

Multiple ovarian cysts, severe low back pain. Complex ovarian cyst.

Procedures: Axial, sagittal and coronal T2, axial T1W in and out of phase, axial STIR, axial T2 and T1 fat-saturated images of the pelvis were obtained prior to the intravenous administration of 27 ml MultiHance. Postcontrast axial, sagittal and

coronal T1 fat-saturated images of the pelvis were obtained.

Findings: There are no prior studies of the pelvis of this institution. Limited visualization of the kidneys demonstrates no hydronephrosis. There is a 12 mm fluid density nonenhancing cyst at the lower pole of the left kidney. The visualized

portions of large and small bowel appear nondilated. The urinary bladder is nondistended. The uterus measures 13 cm in length including the cervix, by 4.9 cm AP x 8.5 cm transverse. There are multiple small fluid signal nonenhancing probable Nabothian cysts in the superior cervix/inferior uterus, the largest measures up to approximate 9 mm in diameter.

A normal left ovary is not seen. What appears to be the right ovary is noted posterior to the right uterine fundus, measuring 3.3 cm x 2 cm x 2.7 cm and demonstrate a few sub-centimeter nonenhancing cysts. Posterior to the right ovary there is a 3.1 cm x 2.7 cm fluid signal nonenhancing cyst. There is a large, complex multicystic lesion at the midline along the superior margin of the uterus. This measures up to approximately 17 cm x 14 cm x 14 cm. The largest individual cystic lesion measures 12 cm x 14 cm x 14 cm with multiple smaller fluid signal cysts. Along the left inferior margin there is a 3.3 cm x 2.0 cm x 1.3 cm T2 hyperintense, T1 hyperintense nonenhancing lesion within this complex cystic lesion.

There is no free fluid or lymphadenopathy identified in the pelvis. The visualized portions of the bilateral common iliac and external iliac arteries and veins appear patent. There is no joint effusion. The osseous marrow signal appears within normal limits.

Impressions: There is 17 cm x 14 cm x 14 cm complex multicystic mass in the anterior pelvis above the uterine fundus. This contains a 3.3 cm x 2 cm x 1.3 cm nonenhancing probable hemorrhagic cyst. No discrete enhancing nodule is identified. The origin

is certain however a left ovarian origin is suspected.

What appears to be the normal right ovary is visualized posterior to the right uterine fundus, with a 3.1 cm x 2.7 cm nonenhancing cyst posteriorly.

Probable Nabothian cysts in the cervix.

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During my next visit, he said he wanted to do a total hysterectomy including ovaries (and of course all the cysts/lesions/masses) immediately - no biopsy, no vaginal exam, nothing.... he just wants it all out "ASAP".  I have not been diagnosed with PCOS, or anything other than "multiple ovarian cysts."  My surgery date is January 8th because that is when the very next available OR will be.  

I am basically concerned because, of course, there are these cysts and I have no idea why they are there, how they developed, etc... .  I am also concerned because I did not go through a regular gynecologist before being automatically referred to a gynecological oncologist and I have not have a vaginal exam, ultrasound, or anything before the onc wanted to go straight to MRI, then immediate surgery.

The onc stated that he is going to aspirate and then pull out the cysts, the ovaries, "all of it."  he also said:  "We are going to  try and do this vaginally, but I have to tell you, if I get in there and do not like the look of things, then I will have to cut you open  - a laparotomy.  Are you okay with this, because that very well may happen and I need to know if you are okay."  Well, of course, I was not going to say no.    --- Does it seem like he is worried now that it is cancer?

Can the doc tell just by a nonmicroscopic visual if the masses are malignant?  Why would he need to cut me open if it is cancer?  Why would he rush the surgery, even though he told me in the first visit that he did not think it was cancerous?  Is a total hysterectomy standard for what my MRI shows and my age of only 38?  What does nonenhancing mean?  What about the T1 and T2 imaging.. is "hyperintense" a bad (malignant) or a good (benign) thing?  Does any of the information in the MRI suggest malignancy?  Can I have cancer, even if my CA125 is at 12.7?  

--a "funny" story: when I was first told about my CA125 results, the lab tech said 127 and I did not know better for a full day until my doc office told me 12 POINT 7.  Talk about freaking out! 

Other questions:  Will I need hormone replacement therapy after surgery? If I do not take hormones (if the doc does not give me them), then what will happen to my body and my moods, sexual desires, etc..? I had a serious depression after having a tubal ligation in 2001 and I have never struggled with depression before or since then... will I become depressed again after a total hysterectomy?  Will this surgery cause me to gain weight due to hormone changes?

What if it is cancer - What are the next steps after surgery?  

Any and all information or personal stories are GREATLY appreciated! Please help!

Thank you, Laura~ 

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