Ovarian Cysts: The Essentials

This week I have had many questions about ovarian cysts.

Here is what you need to know……

So enjoy this info-blog!

 

WHAT IS AN OVARIAN CYST?

 

Ovarian cysts are fluid-filled sacs or pockets that occur within the ovary or on the surface of the ovary. Women generally have two ovaries, each one situated on either side of the uterus. Ovarian cysts can occur at any age but are most common from puberty to menopause.

 

WHAT IS THE MOST COMMON TYPE OF CYST?

 

Functional or follicle cysts: These are the most common, are not cancerous, and most go away by themselves within 8-12weeks. They occur because of a failure of an egg, growing and developing within in the ovary, to be released or “ovulated”. They mainly contain fluid but sometimes can contain blood.

A variation of this is a corpus leteum cyst, which occurs after an egg has been released.

 

HOW DO I KNOW IF I HAVE A CYST?

 

Most of the time, the cyst will not cause any symptoms. It is usually picked up on routine gynaecological examination when a vaginal ultrasound is performed by your doctor.

 

Typically, it can produce the following:

  • Pain: consistent, dull, or sometimes only with intercourse.
  • Pain during movement.
  • Pressure pain with a full bladder.
  • Sudden severe pelvic pain with or without nausea and vomiting. This may be related to bursting or twisting (torsion) of the cyst.
  • Period abnormalities: late period or spotting in between periods.

 

 

HOW IS IT TREATED?

 

Because most will disappear by themselves, often a “wait and see” approach is undertaken. Your doctor may call you back for a repeat ultrasound in 2-3 months to ensure that the cyst has resolved.

In some instances, oral contraceptive pills are prescribed for short periods. Longer term usage may reduce the risk of new cysts forming.

Surgery for cysts may be necessary under special circumstances. This can be either a laparoscopy (key-hole surgery) or an exploratory laparatomy (opening up the abdomen).The type of surgery you have will depend on the expertise of your doctor and on what is available.

This is performed in the following situations:

  1. Cysts causing pain or symptoms and have not gone away.
  2. Simple cysts larger than 6-10cm
  3. Cysts in women who are perimenopausal or menopausal.
  4. If a torsion or twisted cyst is suspected.
  5. If there is any suspicion that the cyst could be cancerous.

 

HOW WOULD I KNOW THAT MY CYST IS CANCEROUS?

 

Ovarian cancer usually shows up when the cancer is advanced. Subsequent treatment options are limited and often not curative.

The most important point to remember is to have any unusual symptoms checked out by your doctor. This vigilance may make the difference and be life-saving.

 

Symptoms to watch for:

 

  1. Pelvic pain
  2. Weight loss
  3. Lack of appetite
  4. Gastro-intestinal symptoms: nausea, constipation, indigestion, increased gas.
  5. Bloating or swollen belly area.

 

These symptoms are very vague and general but are more significant if the following factors co-exists:

 

  • If you are older, especially 5th or 6th decade of life.
  • If you have previously been treated for breast cancer.
  • If you have a family history of breast or ovarian cancer.
  • If you are carrying the BCRA1 or BCRA2 gene defects
  • If you have previously taken Estrogen only hormone replacement therapy (not with Progesterone) for 5 years or more.

 

Medical examination is usually normal. In advanced cases, abnormal fluid or a mass is detected.

Other tests usually are performed. These can include an ultrasound, CT or MRI scan of the pelvis.

 

A blood test called Ca 125 is also usually performed. This is not always high. In fact in 20% of women with ovarian cancer it is normal. The drawback of this test is that, this level can be elevated in many non-cancerous conditions.

 

                               CAUSES OF ELEVATED Ca 125 LEVELS

 

BENIGN                                                                               MALIGNANT

 

– Pregnancy                                                                             – Uterine cancer

Menstruation                                                                         – Lung cancer

– Endometriosis                                                                       – Breast cancer

– Uterine fibroids                                                                    – Pancreatic cancer

– Pelvic inflammatory disease

– Pancreatitis (inflammation of the pancreas)

 

 

The value of this test is not so much detecting ovarian cancer but rather in monitoring response to treatment or recurrence of disease,

 

HOW IS OVARIAN CANCER TREATED?

 

Very much like breast cancer, treatment is based on the stage of the cancer, the histology, the patient’s age and general condition. Surgery and chemotherapy are the main options used. Radiation therapy only in selected cases. Surgical treatment usually consists of a total abdominal hysterectomy, removal of both ovaries, fallopian tubes and the omentum (fat pad around the intestines). Also, multiple biopsies are taken. This helps to further stage the disease.

 

WHAT ARE THE OTHER TYPES OF CYSTS?

 

DERMOID CYSTS

These are bizarre tumours, usually benign and contain hair, teeth, bone and thyroid. The average age that they occur is around 30 years. Up to 15% of the time they occur in both ovaries. Surgical removal is the treatment of choice.

 

ECTOPIC PREGNANCY

This happens when a pregnancy occur and implants on or in the ovary. Because of the danger of internal haemorrhage that can be life-threatening, this is usually also surgically removed. Very rarely is medication used.

 

ENDOMETRIOTIC CYSTS

This usually occurs as part of the condition of endometriosis, when the endometrial cells presents within the uterus form deposits around the ovary and pelvis. Sometimes this leads to a collection of blood in the ovary. Typical symptoms are painful periods and infertility. Surgery also is usually the treatment of choice.

 

POLYCYSTIC OVARIAN SYNDROME

Multiple small cysts on the ovary occur here, as a result of an associated hormonal imbalance.

Other features that co-exist are difficulty with weight loss, acne, excess body hair, and infertility and period abnormalities.

This condition is usually treated medically.






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