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Ovarian Cysts

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An ovarian cyst is a sac or pouch containing liquid or solid material, that develops in or on the ovary. Ovarian cysts are very common, between the ages of 30 and 60. They may be single or multiple, and can occur in one or both ovaries. Most are benign (non-cancerous), but approximately 15 percent are malignant (cancerous).

 

TYPES OF CYSTS
There are five common types of ovarian cysts: functional cysts, polycystic ovaries, endometriotic cysts, cystadenomas and dermoid cysts.
Functional Cysts
They develop as part of the natural function of the ovary. There are two types of functional cysts
• Follicle Cyst – This cyst occurs when a developing egg fails to rupture. These cysts grow from 3 to 5 cm in diameter, and will usually dissolve within one to three months.
• Corpus Luteum Cyst – This cyst is caused by a malfunction of the corpus luteum, it fills with fluid and remains in the ovary.

Polycystic Ovaries
Polycystic ovaries (also known as polycystic ovarian syndrome or disease) is a condition in which the follicles never erupt from the ovaries, rather are produced again and again. Both ovaries become filled with tiny cysts and can become enlarged.

Dermoid Cysts
Dermoid cysts consist of skin, hair, teeth or bone. It develops from the ovary’s germ cells (cells that produce the egg and the beginnings of all human tissues). They generally grow to be between 3-10cm sizes.

Cystadenomas
Cystadenomas are known as neoplasms (new growths). Ovarian neoplasms are new and abnormal formations that develop from the ovarian tissue. There are two types of cystadenomas – serous and mucinous.
Serous cystadenoma is filled with a thin watery fluid and can grow to be between 5-15 cm sizes.
Mucinous cystadenoma is filled with a sticky, thick gelatinous material and can grow to be between 15-30 cm sizes.

Endometriotic Cysts
Endometriotic cysts (also known as endometriomas or “chocolate cysts”, filled with dark blood) form as a result of endometriosis. Endometriosis is a disease in which the endometrial tissue normally found in the uterus grows in other areas. After successive menstrual cycles, this misplaced endometrial tissue bleed, gradually forming endometriotic cysts. Over time the cysts grow and can become as large as 5-10 cm.

SYMPTOMS
Cysts may grow quietly and go unnoticed until they are found on routine examination. However, if they are ruptured (by sexual intercourse, injury or childbirth) and/or become large enough, the following symptoms may occur:
• Abdominal pain (in all types of cysts)
• Menstrual changes such as late periods, bleeding between periods or irregular periods (in corpus luteum cysts and polycystic ovaries)
• Heavy menstrual flow (in polycystic ovaries)
• Infertility (in polycystic ovaries and endometriotic cysts)
• Internal bleeding (in endometriotic cysts)
• Severe menstrual cramps, pain with sexual intercourse, pain during a bowel movement (in endometriotic cysts)
• Weight gain (in polycystic ovaries and endometriotic cysts)
If a cyst becomes twisted or ruptured, the woman may experience sudden or sharp spasmodic pain. This may increase infection rate. If the woman is experiencing abdominal pain, fever, vomiting and symptoms of shock such as cold, clammy skin and rapid breathing, get help immediately.

DIAGNOSIS
The doctor will take a thorough medical history, perform a physical and pelvic examination, and conduct tests.
Laboratory tests include a complete blood count (CBC) to detect infection and internal bleeding, and a pregnancy test to detect uterine pregnancy or ectopic (tubal) pregnancy.
Your doctor might test the level of a protein called CA-125 to see if he suspect the cyst could be cancerous.
Diagnostic tests include an ultrasound, and if needed an MRI. Using this technology the doctor can see where, how big, how many and what the cysts are made of.
Doctors will recommend an additional diagnostic test called a laparoscopy if endometriosis is suspected, if the cyst is very large, if the cyst is not fluid-filled, or if the woman is over the age of 40 when the risk of cancer begins to increase.

TREATMENT
Treatment depends on the type of cyst, its size, its location, the type of material it contains and the woman’s age.
For functional cysts a “watch and wait” approach is taken, however, it requires the woman to return after two menstrual cycles for repeat pelvic exam and/or ultrasound. The doctor may prescribe birth control pills to reduce the hormones that promote growth of cysts.
If the cyst is still present and growing (over 5cm), the doctor may recommend a laparoscopy to remove the cyst.
For polycystic ovaries the treatment varies. If the woman is trying to conceive, the doctor will prescribe medicines to stimulate ovulation. If the woman is not trying to conceive and is having infrequent or no periods, the doctor will prescribe Progestin. Progestin restores normal menstrual flows.
For Endometriotic cysts, cystadenomas and dermoid cysts the treatment is to surgically remove the cyst. Most of the cysts can be removed by laparoscopy.The available procedures are:
• Ovarian cystectomy – It involve separation of the cyst from the ovary and reconstruction of the ovary. It is done for benign (non cancerous) cyst in young patients who want to preserve fertility.
• Salpingo-oophorectomy – removal of the cyst, ovary and fallopian tube. This procedure is done dependent upon the size of the cyst and complications encountered such as bleeding, rupturing and twisting of the cyst.
• Hysterectomy with bilateral salpingo-oophorectomy – removal of the cyst, both ovaries, fallopian tubes and uterus. This procedure is rarely used unless the cyst is cancerous.