Friday, July 2, 2021

Ovarian Cyst: Management, Treatment & Prevention

Ovarian Cyst: Management, Treatment & Prevention

An ovarian cyst is a fluid-filled sac that can occur inside or on the surface of the ovary. Many women will develop an ovarian cyst at some point in their life. Most cysts are benign (non-cancerous), non-dangerous, resolve on their own, and require no treatment. Ovarian cysts are usually painless and only cause discomfort if they twist, rupture, or bleed

A postmenopausal woman who develops an ovarian cyst is less likely to have a benign cyst than a woman of reproductive age. If an ovarian cancer is removed and subsequently found to be malignant, the patient may need to undergo additional abdominal surgery for proper treatment and staging. This includes removal of the contralateral ovary, hysterectomy, and omentectomy.

Ovarian cyst size

The most important question in evaluating ovarian cysts is whether there are any suspicious features for malignancy. There are several factors that can help predict whether a cyst is cancerous or not. The first is the size of the cyst. Very large cysts, usually larger than 9 or 10 cm, are less likely to resolve spontaneously than small cysts. If a cyst contains a large number of solid components or separations, this can also be a sign of malignancy

Ovarian Cyst Management

Doctors detect most ovarian cysts accidentally during a routine pelvic exam or an ultrasound of the lower abdomen that is done for other reasons. When a woman has symptoms, they are often nonspecific in nature, such as:
  • Abdominal bloating or pressure
  • Menstrual irregularities
  • Constipation
  • Urinary incontinence
  • Urinary frequency
  • Pain during intercourse (dyspareunia)

Abdominal or transvaginal ultrasound or abdominal computed tomography (CT) scan help doctors confirm the diagnosis. When these imaging procedures are inconclusive, the doctor may perform a diagnostic laparoscopy to examine the cyst and take a tissue sample for biopsy

Ovarian cyst ultrasound

The main value of ultrasound in the treatment of ovarian cysts is to distinguish between a physiological cyst and a pathological cyst and the likelihood that any pathological tumor is malignant. Several studies have concluded that ultrasound is the best imaging technique for evaluating ovarian cysts. The following information should be obtained from an ultrasound examination of an ovarian tumor

• The side of the lesion unilateral/bilateral
• The size: if possible three dimensions
• Consistency: cystic/solid (size and regularity of solid components)
• Internal structures: unilocular, multilocular, complex. Nature of thin / thick septa
• Inner wall: smooth and irregular presence of papillary projections (solid projections into the cyst cavity from the cyst wall> 3 mm in height)
• Ecogenicity: compared to the myometrium

It is suggested that some features of ultrasound can be used to predict histological diagnosis. Dermoid cysts are a good example and are easily recognizable on ultrasound due to their fat and hair content. The most characteristic feature is the presence of a "white ball" in the corner of the cyst, this corresponds to hair and sebum. The free hair inside the cyst appears as long echoic lines. There are often significant shadows that make it difficult to accurately assess the size of the cyst

Ovarian cyst complications

Ruptured ovarian cyst

Ovarian cysts can rupture, twist, bleed, or become infected, causing severe pain, nausea, and vomiting. A ruptured cyst often occurs after exercise, intercourse, trauma, or even a pelvic exam. Torsion (twisting) and bleeding are more likely in right-sided ovarian cysts

Ruptured cysts, which are rare, can cause severe pain and internal bleeding. This complication increases the infection risk and can be life-threatening if left untreated

Ovarian Cyst Treatment

Treatment of an ovarian cyst depends on the type and size of the cyst and the age of the woman. If the ultrasound exam finds the cyst to be simple, a "wait and see" plan ("expectant management") may be appropriate, because many simple ovarian cysts resolve spontaneously. The woman should repeat the ultrasound 6 to 8 weeks after the simple diagnosis of a cyst. If the cyst persists, the patient is usually referred for a surgical evaluation, which is more likely to be done laparoscopically

Watchful waiting: Small cysts that are purely fluid-filled and smaller than 4-5 cm can be observed for 1-3 months and usually resolve without treatment

Medications: Women with a tendency to develop functional cysts are sometimes given medications that contain hormonal contraceptives, such as birth control pills, which can prevent new cysts from forming

Can contraceptives help with ovarian cysts?
Hormone management with a combination of estrogen and progesterone, such as oral contraceptives, transdermal patches, or vaginal rings, can help suppress ovarian function and help resolve functional cysts. They can also help reduce the risks of developing ovarian cysts

Surgery: In older women, a cyst usually requires surgical evaluation. Surgery may also be needed if a cyst is large, has solid components, is growing, or is causing pain

If any of these treatment regimens fail to control symptoms. The type of surgery performed can depend on factors such as the patient's age, size of the mass, or the desire to have children in the future. Several types of surgery may be considered, including ovarian cystectomy, unilateral or bilateral salpingo-oophorectomy, and hysterectomy in women over the age of 40 who are performed at childbearing age. Surgery can be performed laparoscopically, laparotomically, abdominally, or vaginally (usually only done if a hysterectomy is also performed)

When ovarian cysts require further evaluation, they can usually be evaluated and treated with laparoscopic surgery, in which a narrow telescope-like instrument is used to view the pelvic organs. Additional surgical instruments are inserted through small incisions to perform the surgery. This is usually done under general anesthesia. Very large cysts or cysts more suspected for cancer may require more extensive surgery

Ovarian cyst prevention

Ovarian cysts cannot be prevented. However, routine gynecological exams can detect ovarian cysts early. Ovarian cysts present in:
  • Menarche adolescents and adults
  • Postmenopausal women
  • Who uses the birth control pill
Benign ovarian cysts do not become cancerous. However, ovarian cancer symptoms can mimic the symptoms of an ovarian cyst. Therefore, tell your doctor about symptoms that may indicate a problem. It is important to visit the doctor and get a correct diagnosis

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