What is OVARIAN CYST ?

Ovaries are a woman's reproductive organs that make female hormones and release an egg from a follicle (a small fluid-filled sac) each month. The follicle is usually about 2-3 cm when measured across (diameter) but sometimes can be larger.

An ovarian cyst is a larger fluid-filled sac (more than 3 cm in diameter) that develops on or in an ovary. A 2 cyst can vary in size from a few centimetres to the size of a large melon. Ovarian cysts may be thin-walled and only contain fluid (known as a simple cyst) or they may be more complex, containing thick fluid, blood or solid areas.

There are many different types of ovarian cyst that occur before the menopause, examples of which include:

•  A simple cyst, which is usually a large follicle that has continued to grow after an egg has been released; simple cysts are the most common cysts to occur before the menopause and most disappear within a few months
•  An endometrioma - endometriosis, where cells of the lining of the womb are found outside the womb, sometimes causes ovarian cysts and these are called endometriomas
•  A dermoid cyst, which develops from the cells that make eggs in the ovary, often contains substances such as hair and fat.

 Other types of cyst on the ovary are less common.Other types of cyst on the ovary are less common.

INCIDENCE OF OVARIAN CYST

Ovarian cysts are common. Most women will be unaware that they have a cyst as they often cause no symptoms and disappear spontaneously with time. However, up to 1 in 10 women may need surgery for an ovarian cyst at some point in their lives.

SYMPTOMS OF PRESENTATION

Most cysts are diagnosed by chance, for example during a routine examination, or if you have an ultrasound scan for another reason. Therefore you may have no symptoms at all.

However, you may experience one or more of the following:

•  lower abdominal pain or pelvic pain
•  painful periods, or a change in the pattern of your periods
•  pain during sex
•  pain related to your bowels
•  a feeling that you want to pass urine urgently and more frequently
•  a change in appetite or feeling full quickly
•  a distended (swollen) abdomen
•  difficulty in becoming pregnant which may be linked to endometriosis.

How are ovarian cysts diagnosed?

If your obstetrician-gynecologist (ob-gyn) or other health care professional thinks that you may have a cyst, the following tests may be recommended to find out more information:

Ultrasound exam-This test uses sound waves to create pictures of the internal organs. An instrument called a transducer is placed in the vagina or on the abdomen. The views created by the sound waves show the shape, size, and location of the cyst. The views also show whether the cyst is solid or filled with fluid.

Blood tests-You may have a blood test that measures the level of a substance called CA 125. An increased level of CA 125, along with certain findings from ultrasound and physical exams, may raise concern for ovarian cancer, especially in a woman who is past menopause. Several other blood tests also can be used to help identify whether a mass on the ovary is concerning for ovarian cancer.

Ovarian cyst complications

Most ovarian cysts are benign and naturally go away on their own without treatment. These cysts cause little, if any, symptoms. But in a rare case, your doctor may detect a cancerous cystic ovarian mass during a routine examination.

Ovarian torsion is another rare complication of ovarian cysts. This is when a large cyst causes an ovary to twist or move from its original position. Blood supply to the ovary is cut off, and if not treated, it can cause damage or death to the ovarian tissue. Although uncommon, ovarian torsion accounts for nearly 3 percent of emergency gynecologic surgeries.

Ruptured cysts, which are also rare, can cause intense pain and internal bleeding. This complication increases your risk of an infection and can be life-threatening if left untreated.

How are ovarian cysts treated?

There are several treatment options for cysts. Choosing an option depends on the type of cyst and other factors. Treatment options include watchful waiting and, if the cyst is large or causing symptoms, surgery.

What is watchful waiting?

Watchful waiting is a way of monitoring a cyst with repeat ultrasound exams to see if the cyst has changed in size or appearance. Your ob-gyn or other health care professional will decide when to repeat the ultrasound exam and how long this follow-up should last. Many cysts go away on their own after one or two menstrual cycles.

Birth control pills

If you have recurrent ovarian cysts, your doctor can prescribe oral contraceptives to stop ovulation and prevent the development of new cysts. Oral contraceptives can also reduce your risk of ovarian cancer. The risk of ovarian cancer is higher in postmenopausal women.

When is surgery recommended?

Surgery may be recommended if your cyst is very large or causing symptoms or if cancer is suspected. The type of surgery depends on several factors, including how large the cyst is, your age, your desire to have children, and whether you have a family history of ovarian or breast cancer. A cystectomy is the removal of a cyst from the ovary. In some cases, an ovary may need to be removed. This is called an oophorectomy.

How is surgery performed?

If your cyst is thought to be benign, minimally invasive surgery is recommended. Minimally invasive surgery is done using small incisions and a special instrument called a laparoscope. This type of surgery is called a laparoscopy. Another type of surgery is called open surgery. In open surgery, an incision is made horizontally or vertically in the lower abdomen. Open surgery may be done if cancer is suspected or if the cyst is too large to be removed by laparoscopy

Laparoscopy versus laparotomy

Multiple studies have shown that laparoscopy is safer, less expensive, and has a shorter recovery time than laparotomy - a procedure that is performed by making an incision several inches long along the bikini line or in an "up and down" alignment to open the abdomen. Laparotomies are still performed for many gynecologic operations, generally when more extensive damage within the abdomen requires an enlarged space for the surgeon to operate. Laparotomy surgery requires longer recovery than laparoscopy, with the patient remaining in the hospital for several days and being required to wait two to six weeks before returning to a regular level of physical activity.

However, while laparoscopy has many advantages over laparotomy, some types of surgeries may be too risky to perform via laparoscopy, and in some cases it is not clear if laparoscopy yields results equal to the results of laparotomy. The patient should discuss the pros and cons of each procedure with her doctor before proceeding.

Risks of laparotomy

Laparotomy carries the general risks of surgery and use of anesthesia. Additional risks associated with laparotomy vary depending on the underlying problem or disease that the procedure is meant to treat.

Risks specific to the procedure are:

•  infection
•  incisional hernia
•  bleeding from the surgery site
•  injury to abdominal or pelvic organs

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