Ovarian cysts are masses filled with fluid or other tissues found in the ovaries. They are commonly seen in reproductive-age women. There may be one or multiple ovarian cysts of various sizes. Most of them disappear spontaneously and do not necessitate any treatment.
At younger reproductive age group, most cysts are benign, whereas for postmenopausal women risk of malignancy in an ovarian cyst is higher.
Most ovarian cysts do not cause any symptoms. Some cysts may lead to pain increased with movements. Sometimes the ovary may be twisted around the vessels causing a sharp acute abdominal pain called ovarian torsion. For acute cases like torsion, bleeding into the abdomen or rupture of cysts, emergency surgery may be necessary.
The diagnosis of ovarian cyts is usually possible by either transvaginal or abdominal ultrasonography. Ultrasonography is a method which uses sound waves sent and reflected back from abdominal organs through an ultarsound probe to determine the size, shape, content and location of ovarian masses. In rare cases laporoscopy may be used for the diagnosis and treatment of ovarian cysts. It is a method performed by insertion of a camera through a small incision on the umbilicus.
For especially post menopausal patients, when an ovarian cyst is found, a blood test called Ca 125 can be used to predict the likelihood of malignancy in an ovarian cyst. However in premenopausal patients, Ca 125 may be increased in many benign conditions, therefore it is not suitable to use as a screening test.
Treatment of ovarian cysts in the reproductive age group is most of the time possible by using combined oral contraceptive pills. Actually its effect is to prevent formation of new cysts rather than dissolving the existing one, since functional cysts disappear spontaneously.
Surgery may be rarely necessary in the reproductive age group depending on the type, size and symptoms related to the cyst, accompanying infertility and patient’s age.
With surgery the aim is to remove the cyst totally while leaving as much healthy ovarian tissue as possible, if the preoperative diagnosis is a benign ovarian mass. But sometimes one or both ovaries must be removed. Surgery can be done by laparatomy (open method) or laparoscopy (closed method).
Functional cysts: Follicular cysts and corpus luteum: During the menstrual cycle, the egg grows in a fluid filled sac called the follicule found in the ovary. During ovulation,the follicle ruptures and the ovum is expelled into the abdominal cavity. Rarely the follicle does not rupture and it may stay in the ovary as a follicular cyst that grows to various sizes.
Corpus luteum: After ovulation, the follicule normally disappears. But sometimes it may heal itself and fluid and blood accumulation may continue in it. This is called a corpus luteum.
Dermoid cysts: They are also known as teratoma. They are benign ovarian masses which may contain hair, skin, fat, bone or teeth tissues. They have higher risk of ovarian torsion than other ovarian cysts, therefore surgical removal is usually recommended. Very rarely they may contain cancer cells.
Endometrioma: Endometriosis is a chronic disease when the tissue lining the inner walls of the uterus grows on other places like the abdominal cavity, ovaries or on the walls of abdominal organs. When it exists as a cyst on the ovary, it is called an endometrioma. Because they contain chocolate coloured blood,they are also known as chocolate cysts. They may cause chronic pelvic pain, menstrual pain, pain during sexual intercourse or infertility. Treatment may be medical or surgical depending on the symptoms.
Most ovarian cysts do not cause any symptoms. But sometimes the following symptoms may accompany an ovarian cyst:
If the following signs and symptoms exist, emergency intervention may be necessary:
Such symptoms may mean that the ovarian cyst has ruptured or there may be an ovarian cyst torsion which necessitate emergency surgical intervention.
Sometimes ovarian cyts may be incidentally found during a routine pelvic examination. If an ovarian mass is suspected during a bimanual examination, then a pelvic or transvaginal ultrasonography is needed to confirm the diagnosis. If a pelvic ultrasound is necessary, then the patient needs to have a full bladder for better visualisation of pelvic organs.
In rare cases pelvic MRI or pelvic CT may be, indicated for differential diagnosis of ovarian cysts.
Most ovarian cysts disappear spontaneously therefore they do not need any treatment. A follow–up ultrasound examination may be scheduled to check if the cyst has disappeared in a few months.
If the cyst has not disappeared or has grown, additional tests may be necessary. These lab tests may be a pregnancy test, hormone tests or ovarian tumor markers such as Ca 125, Ca 19.9, Ca 15.3, alpha feta protein or beta HCG.
Most ovarian cysts are just followed up without any treatment because functional cysts dispappear spontaneously within a few cycles. However ovarian cysts that do not disappear or grow in size may need treatment. There are medical or surgical treatment alternatives for the treatment of ovarian cysts.
For recurrents cysts, oral conraceptives are recommended. They inhibit ovulation and thus prevent formation of new cysts. Oral contraceptives decrease the risk of ovarian cancer. Ovarian cancer is more common in post-menopausal patients.
If the preoperative diagnosis is a benign ovarian cyst, it can be removed by laporoscopic surgery. Laporoscopy is a procedure in which a camera is inserted through the umbilicus and several other 0.5 to 1 cm incisions are made in the abdomen. A laporoscope is a small tube shaped camera with magnification and it has a light on the end. It is used to visualize the internal organs so that the cyst can be removed through the small incisions using special equipment.
If the cyst is too big to remove during a laporoscopy or it is suspected to be malignant, open surgery may be necessary. The incision on the abdominal wall may be either vertical or horizantal.
The incision is bigger than for laporoscopy and usually the cyst is examined pathologically during surgery from a frozen section, to evaluate malignancy so that additional ovarian cancer surgical procedure is added to ovarian cyst removal.
Ovarian cancer surgery includes removal of both ovaries, tubes, uterus, omentum and lymph nodes for staging of cancer. It is also known as debulking surgery, which means as much cancer tissue as possible is removed for better prognosis. Staging is necessary to evaluate how much cancer has spread and standart chemotherapy treatment protocols are chosen according to the stage of cancer.
Ovarian cysts can not be prevented. But early diagnosis is possible during routine pelvic examination by ultrasound. Benign ovarian cysts do not turn into ovarian cancer. But when there are symptoms related to ovarian cyst, it is recommended to see a gynecologist for examination.
If the following symptoms exist, it is necessary to make an appointment with a gynecologist as soon as possible: