Introduction :
Ovarian cysts, also called ovarian masses or adnexal masses, are, much of the time, discovered unexpectedly in asymptomatic ladies. They can be physiologic (having to do with ovulation) or benign growths but sometimes with a cancerous potential.
Symptoms
Most ladies with ovarian cysts are asymptomatic and they are found to have one when they go for a screening ultrasound scan of the pelvis. However, some women experience symptoms such as pelvic pain, abdominal bloatedness or a feeling of fullness in the pelvis. This happens when the cysts grows large and can be felt in the lower abdomen. If there is sudden severe pelvic pain, the cyst may have ruptured, or bled or has undergone a torsion (twisting around its pedicle). In this situation, it is an emergency and medical treatment is advised.
Types of cysts
Benign
- Physiological cysts e.g. follicular cysts or corpus luteal cysts
- Dermoid cysts
- Endometriotic cysts
- Cystadenomas
Malignant
- Ovarian cancer
Others
- Paratubal and para ovarian cysts
- Peritoneal incorporation cysts (otherwise called pseudocysts)
Diagnosis
Ultrasonography is the standard method for the evaluation of ovarian cysts. This can be performed transabdominally through a full bladder or transvaginally but often both ways are used to evaluate the ovarian cysts. If there is any ambiguity regarding the ovarian cysts or cancer is suspected, further imaging with CT scans or MRI scans may be advised.
Management
Most cysts that are seen on ultrasound in asymptomatic women are physiological in nature and do not need any treatment or surgery. Sometimes, if the ovarian cysts found are benign and small, follow up with regular ultrasound scans is usually recommended to monitor their growth and changes. However, if treatment is warranted, e.g. in cases of large dermoid cysts or endometriotic cysts, surgery may be required. Traditionally this is done through a cut in the abdomen (laparotomy) but nowadays, this can be achieved through tiny incisions made in the abdomen via keyhole surgery (laparoscopy) if the patient is suitable. In the event the cyst is malignant, a laparotomy is usually performed to remove the cancer to avoid the potential of disease spread that can happen with laparoscopic surgery.
Prevention
There is no sure way of preventing ovarian cysts. If fertility is not desired and there is no personal history of breast cancer, oral contraceptives can be used to stop ovulation and prevent formation of physiological cysts. It can also reduce the risk of development of ovarian cancer by up to 50% for long term users of more than 5 years…
