Patient education: ovarian cysts (beyond the basics)

Patient education: ovarian cysts (beyond the basics)

Ovarian cysts are fluid-filled sacs that develop in or on the ovary (Figure 1). Ovarian cysts commonly occur in women of all ages. Some women with ovarian cysts have pelvic pain or pressure, while others have no symptoms. Irregular periods are usually not related to an ovarian cyst.

Fortunately, most ovarian cysts do not require surgical removal and are not caused by cancer. The size of cysts can vary from less than a centimeter (half an inch) to more than 10 centimeters (4 inches).

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This section discusses the various causes of ovarian cysts, how ovarian cysts are diagnosed, and follow-up tests and / or treatment that might be recommended.

CAUSES OF OVARIAN CYST

The most common causes of ovarian cysts depend on whether you still have your period (premenopause) or have stopped your period for at least a year (postmenopause). (See "Differential Diagnosis of Adnexal Mass".)

Premenopausal Women - For premenopausal women, the most common causes of ovarian cysts include:

● Ovulation - “Functional” ovarian cysts develop when a follicle (sac) grows, but does not rupture to release the egg. These cysts usually go away without treatment.

● Dermoid cysts - Dermoid cysts (teratomas) are one of the most common types of cysts in women between the ages of 20 and 40. A dermoid cyst is made up of ovarian germ cells (germ cells are reproductive cells, such as eggs) and may contain teeth, hair, or fat. Most dermoid cysts are benign, but rarely can they be cancerous. (See “Ovarian germ cell tumors: pathology, epidemiology, clinical manifestations and diagnosis”, section “Mature teratoma (dermoid)”.)

● Polycystic ovary syndrome (PCOS) - Women with PCOS can have many small cysts. These cysts do not need to be removed or treated with medication, but women with PCOS may need treatment for other PCOS problems, such as irregular periods. (See “Patient Education: Polycystic Ovary Syndrome (PCOS) (Beyond the Basics)”.)

● Endometriosis - Women with endometriosis can develop a type of ovarian cyst called endometrioma or “chocolate cyst”. (See “Patient Education: Endometriosis (Beyond the Basics)”.)

● Pregnancy - An ovarian cyst develops normally in early pregnancy, to help support the pregnancy until the placenta forms. In some cases, the cyst remains on the ovary until later in the pregnancy.

● Serious pelvic infections - Serious pelvic infections can spread and affect the ovaries and fallopian tubes. As a result, pus-filled cysts form near the ovaries and / or fallopian tubes.

● Non-cancerous growths.

● Cancer - Cancer is a relatively rare cause of ovarian cysts in premenopausal women; less than 1% of new growths on or near the ovary are linked to ovarian cancer.

Postmenopausal women - In women who have stopped having periods, the most common causes of ovarian cysts include:

● Non-cancerous growths

● Collection of fluid in the ovary

In postmenopausal women, new growths on or around the ovary are slightly more likely to be caused by cancer than in premenopausal women.

Do i have ovarian cancer? - Although ovarian cancer is not the most common cause of ovarian cysts, many women who are diagnosed with a cyst worry that they may have cancer. Ovarian cancer is more likely in women who have:

● A genetic predisposition to ovarian cancer (for example, a family history of ovarian cancer or related cancers)

● History of breast or gastrointestinal cancer

● A cyst that appears complex (a cyst with solid areas, a nodule on the surface, or several areas filled with fluid)

● A collection of fluid (called ascites) found in the pelvis or abdomen during the imaging test

However, women without cancer can also have these characteristics. In most cases, additional tests will be recommended to assess the likelihood of cancer.

If your doctor is concerned that you may have ovarian cancer, he or she may recommend that you see a specialist doctor, called a gynecologist oncologist. These doctors have been trained in the surgical treatment of ovarian cancer and can improve your chances of survival. (See “Patient Education: Ovarian Cancer Treatment (Beyond the Basics)”.)

SYMPTOMS OF OVARIAN CYST

Ovarian cysts can be symptomatic or asymptomatic. Women with symptoms of ovarian cysts usually feel pain or pressure in the lower abdomen on the side of the cyst. This pain can be dull or sharp; it can be constant or come and go. Lower abdominal cramps are usually not related to ovarian cysts. If an ovarian cyst ruptures, a woman may experience sudden sharp pain, which can be severe. Women with a twist (twist) of an ovary may experience pain as well as nausea and vomiting. Abnormal periods or vaginal bleeding are usually not related to ovarian cysts.

OVARIAN CYST DIAGNOSIS

Ovarian cysts can sometimes be detected on a pelvic exam, although an imaging test, usually a pelvic ultrasound, is needed to confirm the diagnosis. Computed tomography (CT) or magnetic resonance imaging (MRI) are also sometimes used, but less frequently. These imaging tests can also provide information about the size, location, and other important characteristics of the cyst. (See "Ultrasound Differentiation of Benign Adnexal Masses Versus Malignant Adnexal Masses".)

Blood tests - One or more blood tests may be recommended if you have an ovarian cyst. The blood test (s) can help determine the nature of the cyst.

● Pregnancy test - A blood or urine pregnancy test is often done in premenopausal women with an ovarian cyst. Ovarian cysts are common during pregnancy.

● CA 125 - CA 125 is a blood test that is sometimes taken from women with ovarian cysts. However, ovarian cancer cannot be diagnosed based on the results of a CA 125 test. Many women with early ovarian cancer will have normal levels of CA 125. CA 125 is abnormally high in women. about 80% of women with advanced ovarian cancer.

In addition, non-cancerous conditions can lead to an elevation of CA 125, including endometriosis, uterine fibroids, pelvic infections, heart failure, and liver and kidney disease. Therefore, measurement of CA 125 is not recommended in all cases. (See “Patient Education: Ovarian Cancer Screening (Beyond the Basics)”.)

• CA 125 is often recommended for postmenopausal women with an ovarian cyst.

• CA 125 may be recommended for premenopausal women whose ovarian cyst appears very large or suspect for cancer on ultrasound.

• CA 125 is generally not recommended for premenopausal women whose ovarian cysts are small and do not appear to be suspected of cancer.

● Other blood tests are also available to test women with an ovarian cyst for ovarian cancer.

Next Steps - Depending on the results of the imaging test, your age, symptoms, blood test results, and family history, your healthcare professional may recommend watchful waiting or surgery. (See "Approaching the Patient with an Adnexal Mass".)

OVARIAN CYST TREATMENT

Ovarian cysts don't always need treatment. In premenopausal women, ovarian cysts often go away on their own within one to two months, without treatment. In postmenopausal women, ovarian cysts are less likely to go away.

If a cyst is large, causes pain, or looks suspicious for cancer, treatment usually involves surgery to remove the cyst or the entire ovary.

Watchful waiting

Premenopausal Women - In premenopausal women, watchful waiting usually involves monitoring for symptoms (pelvic pain or pressure) and repeating the pelvic ultrasound after six to eight weeks. If the ovarian cyst does not enlarge or if it resolves during the watchful waiting period, it usually does not require surgical removal. Some premenopausal women may be advised to take birth control pills during this time to prevent the development of new ovarian cysts.

If a cyst is shrinking or not changing, the ultrasound is often repeated at regular intervals until your health care provider is sure the cyst is not growing. If the cyst resolves, no further testing or follow-up is necessary. (See “Ovarian Cyst Tracking” below.)

Postmenopausal women - In postmenopausal women, the decision to undergo watchful waiting depends on the initial test (ultrasound and CA 125). If the cyst does not appear cancerous, watchful waiting may be an option and includes a pelvic ultrasound and CA 125 measurement every three to six months for a year, or until the cyst resolves. However, ovarian cysts do not always go away in postmenopausal women.

If CA 125 levels increase or if the cyst grows or changes in appearance, surgery to remove the cyst may be recommended.

Surgery - Surgery may be recommended in the following situations:

● A cyst causes persistent pain or pressure, or may rupture or twist.

● A cyst appears on ultrasound because of endometriosis and is removed for fertility reasons.

● Large cysts (> 5 to 10 cm) are more likely to require surgical removal than smaller cysts. However, being large in size cannot predict whether a cyst is cancerous.

● If the cyst looks suspicious for cancer. If you have risk factors for ovarian cancer, or if the cyst looks potentially cancerous on imaging studies, your healthcare professional may recommend surgery.

● If the suspicion of ovarian cancer is low but the cyst does not go away after several ultrasounds, you may choose to have it removed after a discussion with your healthcare professional. However, surgical removal is usually not necessary in this case.

Surgery to remove an ovarian cyst - If surgery is needed to remove an ovarian cyst, the procedure is usually done in a hospital or surgical center. Whether the surgery is to remove only the cyst or the entire ovary depends on your age and what is found during the procedure. (See "Oophorectomy and Ovarian Cystectomy".)