What are ovarian cysts?
Ovarian cyst is diagnosed as a fluid-filled sac that grow in the ovaries. Diagnosis is made by ultrasound scan. Ovarian cysts can grow from a diameter of 5 cm to 50cm and beyond. Symptoms are variale. Treatment is usually laparoscopic cystectomy. They affect women of all age groups. Majority of the ovarian cysts are benign (harmless), although some of them can turn out to be cancerous. The smaller cysts may disappear spontaneously over a few weeks. Those that continue to grow may rupture (burst), bleed, twist on its own stalk and add pressure to the surrounding organs. The women may complain of mild persistent discomfort to sudden severe pain. Ovarian cyst accidents are surgical emergencies.
Types of ovarian cysts
Ovarian cysts are commonly divided into:
Follicular (physiological) cyst: develops from a normal egg-follicle at the time of ovulation. The dominant egg follicle may have failed to ovulate, or the maturing follicle may have failed to collapse on itself.
Corpus luteal cyst: occurs when the dominant egg-follicle has released the egg, and instead of the usual gradual consolidation and disappearance, the residual follicle fills up with fluid or blood and continue to enlarge.
Endometrioma or endometriotic cyst: cyst that are filled with endometrial lining tissues that developed on the surface of the ovaries.
Dermoid cyst or mature cystic teratoma: benign ovarian cystic tumour that contain fats, hairs, cartilage, bone and other connective tissues.
Cystadenoma: benign tumour that forms from surface ovarian tissue. The content may be watery fluid or viscid mucoid fluid. They may be found on both ovaries at the same time.
Ovarian cancer: an ovarian cancer can arise from any of the different cell types in the ovary. The cancer may form up as cystic or solid tumour. A cystic ovarian cancer normally forms many compartments with thick vascular partitions. Being cancerous, the malignant cells will spread to adjacent organ structures of the abdominal cavity and beyond.
What are symptoms of ovarian cyst?
Small ovarian cyst is usually not symptomatic, except when it is actively secreting hormones which may upset the normal physiological balance. As the ovarian cyst enlarges, it may gradually show some of the following symptom.
Pelvic or lower abdominal discomfort, bloating, fullness, pressure or pain.
Loss of regular menstrual pattern
Progressive menstrual pain
Pain encounter during sexual intercourse
Discomfort or pain during urination or bowel movements, or constant pressure on the bladder and rectum
Abnormal vaginal bleeding, which may be spotty or heavy and prolonged
Nausea and vomiting
Unusual hair growth on face and body
How to diagnose ovarian cyst?
When you suspect that there may be an ovarian cyst, consult your gynaecologist. The ovarian cyst may be confirmed by:
An abdominal and pelvic physical examination. A large ovarian cyst may be palpated in the lower abdomen. The vaginal examination is important to ascertain if the ovarian cyst is freely mobile or firmly stuck to the surrounding structures. The consistency and tenderness of the ovarian cyst may be elicited.
Trans-abdominal ultrasound scan
Trans-vaginal ultrasound scan: applying the ultrasound probe in the vagina offers the best imaging of the pelvis, delineating the structures in a dynamic way
CT scan of the abdomen and pelvis: this is helpful in the large ovarian cyst that has grown out of the pelvis. It gives a global evaluation of the cyst in size, content and relation to the abdominal organs.
MRI of the abdomen and pelvis: MRI is excellent in distinguishing soft tissue involvement when an ovarian cancer is suspected
CA-125 tumor marker: blood is sampled to assay this serum protein. It is released from the surface peritoneal cells and is found to relate to the severity of certain ovarian cancers. It has to be interpreted cautiously as few other conditions also express high levels of CA-125.
Hormones assessment: the profile of LH, FSH, estrogens and androgens may indicate the condition of the ovarian cyst type.
Other tumor markers like ADH, AFP, HCG, CA19-9 and CEA may have to be assayed when germ cell tumor is suspected
How to treat ovarian cyst?
Most ovarian cysts are benign. Every ovarian cyst has to be monitored over time. As the ovarian cyst enlarges, the risk of ovarian cyst accident becomes significant. Changing characteristics of an ovarian cyst likewise increases its cancer potential.
When an ovarian cyst continues to grow or when the structural characteristics evolve to be more complex, it is advisable to have it removed. This is especially necessary when there are symptoms associated with ovarian cyst. The ovarian cyst may be excised via the key-hole surgery (laparoscopic approach) or conventional open abdominal surgery (laparotomy).