Ovarian Cysts

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Do I have ovarian cysts?

Ovarian Cyst - What it is?

Fluid-filled sacs that form within the ovary are known as ovarian cysts. They differ in size and content, and may be benign or malignant. Most cysts are asymptomatic and non-cancerous, and resolve spontaneously without any treatment.

Types of cysts

Functional cysts grow as part of a normal menstrual cycle. These include:

a) Follicular cysts

New follicles develop during the beginning of each menstrual cycle. Each holds fluid that protects a developing egg, which is released at the time of ovulation. If the follicle fails to release the egg, it may continue to grow and form a follicular cyst.

b) Corpus luteum cysts

If ovulation occurs, the follicle grows into a corpus luteum. This produces progesterone, which changes the womb lining to prepare it for pregnancy. The corpus luteum typically dissolves if pregnancy does not take place, but may infrequently bleed or swell with fluid to form a corpus luteal cyst.

• The vast majority of functional cysts resolve spontaneously over two to three menstrual cycles. Nevertheless, some may continue to grow or even twist or rupture and cause acute symptoms.
• Polycystic ovaries are ovaries comprising multiple small follicles. This may be perceived in conjunction with irregular menses, subfertility and symptoms of hormonal imbalance like oily skin, acne and increased hair growth.

Common Benign ovarian cysts include:

a) Endometriotic cysts

Endometriosis happens when cells from the womb lining develop outside the womb. Deposits of these cells on the ovary can outcome in the formation of endometriotic cysts. These cysts consist of thick, dark brown material, and are often adherent to neighboring structures such as the uterus, opposite ovary or intestines, which may make surgery more challenging.

b) Dermoid cysts

Dermoid cysts develop from germ cells, which are cells that bear the ability to develop into any type of body tissue. They may thus contain various types of tissue including teeth, hair and fat, and are more frequently witnessed in younger women.

c) Cystadenomas

These arise from the external surface of the ovary and may contain fluid or mucoid contents.

• A proportion of ovarian cysts are cancerous (malignant). Pregnancy, breastfeeding, usage of the oral contraceptive pill, previous sterilization and removal of the uterus are associated with a lower chance of developing ovarian cancer.

Ovarian Cysts - Symptoms

The large majority of ovarian cysts are asymptomatic. Larger ovarian cysts may rupture or twist, causing acute abdominal pain, nausea and vomiting. Patients with endometriotic cysts may represent painful menses (dysmenorrhea) and intercourse (dyspareunia).

Other symptoms include menstrual irregularities, bloatedness, lower abdominal discomfort, loss of appetite or weight, and passing urine more recurrently or change in bowel habit (constipation or diarrhoea) owing to compression from the cyst.

As ovarian cancer inclines to develop insidiously with vague symptoms, the captioned symptoms should not be ignored, particularly if they are new or experienced on a recurrent basis.

Ovarian Cysts - Causes and Risk Factors

Risk factors include:

• Older age
• Previous history of breast cancer
• Family history of ovarian cancer
• Obesity
• Taking hormone replacement therapy

Yet, as many people who develop cancer own no risk factors, it is imperative that all women with ovarian cysts are properly evaluated for this possibility.

Ovarian Cysts - Diagnosis

Ultrasound is the favored method for characterizing ovarian cysts. Features such as solid areas, multiple internal compartments, irregular margins and high velocity blood flow intensify the index of suspicion for ovarian cancer.

A blood test for CA125 may be taken if there is an alarm about malignancy. This blood protein is regularly raised in ovarian cancer, but must be construed in conjunction with symptoms and ultrasound findings as it can also be raised in non-cancerous conditions such as endometriosis and fibroids.

Ovarian Cysts - Treatments

Management

Management rests on your symptoms, characteristics of the cyst and results of blood tests.

Small asymptomatic ovarian cysts that bear no suspicious features on ultrasound may be managed expectantly. This generally involves a follow-up ultrasound scan in about three to four months to monitor for any change in size or appearance of the cyst.

Surgery will be recommended if the cyst is symptomatic or bears abnormal features.

Laparoscopy (keyhole surgery) is the approach of choice if the risk of malignancy is low, as it is allied with less post-operative pain and a faster recovery.

Laparotomy (open surgery) may be suggested if you have had previous surgery, if the cyst is large or if it has suspicious features.

Cystectomy comprises removal of the cyst with preservation of normal ovarian tissue. This is generally done for pre-menopausal women in order to conserve ovarian tissue for reproductive and hormonal functions.

Oophorectomy is the surgical technique to remove the entire ovary. Post-menopausal women will usually be offered removal of both ovaries as this has the benefit of mitigating the risk of developing ovarian cancer or cysts in the future.

If the risk of ovarian cancer is high, your doctor will deliberate upon frozen section and surgical staging.

Frozen section involves sending the excised ovarian tissue for microscopic examination as you are still under general anesthesia. If this test reveals malignant cells and you have given prior consent, your surgeon may then proceed to perform a full staging surgery as part of the treatment for ovarian cancer. This encompasses removing the uterus, both fallopian tubes and ovaries, the omentum (a layer of fatty tissue that covers the abdominal contents like an apron) as well as lymph nodes.

If you have any of the above associated symptoms/conditions, consult your doctor at once!