Ovarian Tumours and Cysts
Ovarian Tumours and Cysts Ovarian tumours / cysts are found in women of all ages. Approximately 75% of ovarian tumours are benign (non-cancerous) and only 25% are malignant (cancerous). Benign tumours are commonly found in women aged 20-45 years with malignant tumours found in the older group of 45-65 years, with the greater majority found in women who are post-menopausal.
Ovarian cancer is also more common in developed countries such as the USA, UK, etc.
During a normal menstrual cycle follicles form on the ovaries to facilitate ovulation. In some women these do not clear during menstruation and this may lead to cyst development. Functional cysts are by far the most common and are seen in women during their reproductive years.
Follicle cysts, Theca Lutein cysts and Corpus Luteum cysts are all functional cysts and usually present no danger to women diagnosed with them.Some women may go to their doctor with complaints like abdominal swelling, discomfort, pain, irregular periods, pain during intercourse, constipation and urinary problems. Clearly these complaints are not specific to any disease especially not ovarian cysts. Most functional cysts have no symptoms and are usually diagnosed incidentally by doctors, causing anxiety and unnecessary referrals for further testing.
When cysts are suspected a proper history should be taken and a physical examination done. If cysts are suspected (especially with vague abdominal complaints) the doctor should send you for trans-abdominal and internal ultrasounds.
A benign cyst on an ultrasound will have: unilocularity (only one cyst), clear content, thin cyst walls, smooth cyst walls, a size of less than 8 cms in diameter, unilaterality (one sided cysts) and there will be no fluid in the abdomen. Functional cysts will often disappear on their own. They can also be treated with pain medication and the oral contraceptive pill but medication is not needed in most women.
Ruptured and bleeding cysts usually cause significant stomach pain requiring surgical exploration. In young women shelling the cyst (removing the cyst only without removing the ovary) is usually enough to treat.
Torsion: cysts may also complicate by torsion (twisting). Women will have sudden abdominal pains, nausea and vomiting. Fainting and a low-grade fever may also be present. In this case there is a risk of tissue death (necrosis) in the ovary. Surgical removal of the involved ovary and tube will be required. The necrosis causes pain and fever and may release toxins into the blood stream requiring a hospital stay and, possibly, antibiotics.
Non Functional Cysts
Persisting cysts (last longer than four months): in this case it is unlikely to be a functional cyst and surgical removal is the best approach. Surgery can be by laparoscopy for smaller cysts or laparotomy for bigger cysts. It is usually possible to remove the cyst without injury to the ovary.
Other benign cysts include:
- Polycystic ovaries: which are markedly enlarged, multiple and tumour-like. Usually treated medically and surgery is the very last resort.
- Endometriomas: ovarian cysts as a result of endometriosis. These cysts can be larger (5-8cm), filled with old blood and may be painful, especially related to periods, and can rupture requiring surgery.
- Para-ovarian cysts can be fairly large, clear fluid-filled and usually painless. Removal usually treats it.
- Women, especially younger women, who have had a hysterectomy (had their womb removed) can also have cysts or pain as the ovaries are often left behind. (Residual Ovarian Syndrome).
- Severe pelvic / tubal infection can appear like cysts on an ultrasound.
- Dermoid cysts are usually benign cysts that may appear cancerous on ultrasound, but are not always ovarian in origin. They require surgical removal.