Ovarian Cysts


Ovarian Cysts
Ovarian cysts can be found in women of any age group and simply means enlargement of ovaries.  The ovaries are two small organs located on either side of a woman's uterus. These are the organs that produce eggs in the reproductive period in women's life.  An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. It is normal for a small cyst to develop on the ovaries due to hormonal effects and these cysts disappears in a few cycles. In other cases, they may cause problems and need treatment.

Types of Cysts
Ovarian cysts are of various types and can vary in size.
OVARIAN CYSTS CAN BE OF FOLLOWING TYPES-

  1. Functional- these are due to hormonal changes, usually less tha 5 cms and often need no treatment.
  2. Benign Cysts- These are tumours of the ovary and often need surgical treatment as medicines do not treat them. They also grow large and can undergo torsion or rupture requiring intermediate surgical intervention. The common tyoes of benign cysts are Dermoid, seroud cyst adenoma or mucinous cyst adenoma. There is a 10-12 % chance of occurrence of these cysts in both the ovaries.
  3. ENDOMETRIOMA-(hyperlink to endometriosis page) can be seen in upto 60% of women with endometriosis. Often associated with severe dysmenorrhoea and infertility. Laparoscopic Cystectomy is the best treatment for improving symptoms as welll as fertility.
  4. Malignant or Cancerous Cysts- These can be various types. Ovarian cancer is often diagnosed late due to its silent nature. Requires a combined treatment of surgery and chemotherapy .

Most cysts are benign (not cancerous).  These can be functional which develop due to hormonal effects and do not require surgical treatment. Benign cysts require surgical treatment if they are big (>5cms), growing rapidly or are symptomatic. These types of cysts can be dermoid cysts, endometrioma (chocolate cysts) or cystademonas. Rarely, a few cysts may turn out to be malignant (cancerous). What type of cyst a woman develops also depends on the age of the woman. Cysts like dermoid are common in girls and young woman. Reproductive age is likely to be associated with functional cysts or cystadenoma. Malignant are more common in woman above 40 years.

Cysts can be a source of problem and it is best to consult your gynecologist if it has been diagnosed.

Symptoms 
Most ovarian cysts are small and do not cause symptoms. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.

In rare cases, a cyst may be cancerous. In its early stages, ovarian cancer often has no symptoms, so you should be aware of its warning signs Be sure to see your doctor if you have any of these signs. Ovarian cancer is very rare in young women, but the risk increases as a woman ages.

Diagnosis
A woman having lower abdominal pain or discomfort either constantly or intermittently is suspected to have an ovarian cyst. 

Some can even have severe dysmenorrhoea (painful periods), which is of recent onset. Dysmenorrhoea is mostly associated with endometrioma or chocolate cysts. Some women may present with acute pain along with nausea vomiting and giddiness. In such situations we suspect that either the cyst has ruptured or has undergone twist. In the later two situations an emergency medical attention and even surgery may be required. 

Confirmation of ovarian cyst may be done during a routine pelvic exam or an ultrasound scan. Once a cyst is diagnosed you may require further tests to determine the type of the cyst. Some blood tests like CA 125, CEA,LDH, alpha feto protein etc can also be done. MRI can be a useful tool in patients were there the dignosis is not clear.

Treatment
Once a woman is diagnosed with ovarian cysts there are various treatment options available. Choosing an option primarily depends on Size and type of cyst; the woman's age, severity of symptoms, desire for future childbearing. Treatment may also depend on the family history of the woman especially if there is history of such cancers in the immediate family.

 “Watchful” Waiting
If the cyst is not causing any symptoms, we may simply monitor it for 3-6 months and check to see whether it has changed in size. This monitoring is normally done by repeated USG scans. Most functional cysts disappear on their own after one or two menstrual cycles, as they are dependent on ovulation that is associated with menstrual cycles. IF a woman has tendency to form functional cysts repeatedly we can prescribe them oral contraceptive pills (OCP) as these pills prevent ovulation and this process reduces the chance of functional cysts.

Surgery
Surgical intervention is recommended if the cyst is symptomatic, growing in size, persisting for more than 6 months without change in size, very large, associated with other conditions like infertility, ascites or other findings. If we suspect the cyst to be non cancerous our approach is LAPAROSCOPY.

In non-cancerous condition whatever may be the type of cyst, or size of cyst or situation (woman has had previous surgeries), the approach of surgery is LAPAROSCOPY. It is certainly possible to do a complete surgery via this approach and give the benefit to the woman. Laparoscopy surgery is associated with quick recovery of the woman with minimal postoperative pain or discomfort.Even cysts that are 15-20 cms in size can be removed laparoscopically at our center.

During the surgery a cystectomy (removal of the abnormal tissues and saving the normal ovarian tissues) is the most common treatment in young women with noncancerous lesions. In older women depending upon the cause, oophorectomy (removal of the complete ovary) may be done. IF the situation requires complete removal of the uterus can also be done laparoscopically.

In situations where ovarian cysts are of cancerous nature then an open surgery with cytoreduction is done.This can be done as primary surgery or after few cycles of neo adjuvant chemotherapy.
Ovarian cysts are common in women during their childbearing years. Although most cysts are harmless and go away on their own, you should consult a gynecologist to keep track of the cyst to be sure that it does not grow and cause problems.

When does ovarian cyst need emergency intervention?

  • Torsion- (INCLUDE PICTURES) when ovarian cysts typically grow to a size of 7-8 cms the chance of torsion is high. The ovarian cyst along with the ovarian pedicle twists on its own axis thus cutting off the blood supply. This requires immediate surgical intervention (laparoscopy) to save the ovary from necrosis. If detected and intervened early the removing the twisted cyst and saving the ovary is possible.
  • Rupture- At time the ovarian cyst ruptures inside the abdomen filling it with blood. This also requires immediate surgical intervention (laparoscopy) to remove the cyst as well as the blood that has collected.


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