Minimal Invasive
Surgery
Ovarian Cysts
OVERVIEW
Ovarian cysts are fluid-filled sacs or pockets within or on the surface
of an ovary. The ovaries are two organs — each about the size and shape of
an almond — located on each side of a woman's uterus. Eggs (ova) develop
and mature in the ovaries and are released in monthly cycles during a
woman's childbearing years.
Many women have ovarian cysts at some time during their lives. Most
ovarian cysts present little or no discomfort and are harmless. The majority
of ovarian cysts disappear without treatment within a few months.
However, ovarian cysts — especially those that have ruptured —
sometimes produce serious symptoms that can be life-threatening. The best
way to protect your health is to know the symptoms and types of ovarian
cysts that may signal a more significant problem, and to schedule regular
pelvic examinations.
SIGNS AND SYMPTOMS
You can't depend on symptoms alone to tell you if you have an ovarian
cyst. In fact, you'll likely have no symptoms at all. Or if you do, the
symptoms may be similar to those of other conditions, such as endometriosis,
pelvic inflammatory disease, ectopic pregnancy or ovarian cancer. Even
appendicitis and diverticulitis can produce symptoms that mimic a ruptured
ovarian cyst.
Still, it's important to be watchful of any symptoms or changes in your
body and to know which symptoms are serious. If you have an ovarian cyst,
you may experience the following signs and symptoms:
Menstrual irregularities
Pelvic pain — a constant or intermittent dull ache that may radiate
to your lower back and thighs
Pelvic pain shortly before your period begins or just before it ends
Pelvic pain during intercourse
(dyspareunia)
Nausea, vomiting or breast tenderness similar to that experienced
during pregnancy
Fullness or heaviness in your abdomen
Pressure on your rectum or bladder — difficulty emptying your
bladder completely
The signs and symptoms that signal the need for immediate medical
attention include:
Sudden, severe abdominal or pelvic pain
Pain accompanied by fever or vomiting
CAUSES
Your ovaries normally grow cyst-like structures called follicles each
month. Follicles produce the hormones estrogen and progesterone and release
an egg when you ovulate.
Sometimes a normal monthly follicle just keeps growing. When that
happens, it becomes known as a functional cyst. This means it started during
the normal function of your menstrual cycle. There are two types of
functional cysts:
Follicular cyst. Around the
midpoint of your menstrual cycle, your brain's pituitary gland releases
a surge of luteinizing hormone (LH), which signals the follicle holding
your egg to release it. When everything goes according to plan, your egg
bursts out of its follicle and begins its journey down the fallopian
tube in search of fertilization. A follicular cyst begins when the LH
surge doesn't occur. The result is a follicle that doesn't rupture or
release its egg. Instead it grows and turns into a cyst. Follicular
cysts are usually harmless, rarely cause pain and often disappear on
their own within two or three menstrual cycles.
Corpus luteum cyst. When LH does
surge and your egg is released, the ruptured follicle begins producing
large quantities of estrogen and progesterone in preparation for
conception. This changed follicle is now called the corpus luteum.
Sometimes, however, the escape opening of the egg seals off and fluid
accumulates inside the follicle, causing the corpus luteum to expand
into a cyst. Although this cyst usually disappears on its own in a few
weeks, it can grow to almost 4 inches in diameter and has the potential
to bleed into itself or twist the ovary, causing pelvic or abdominal
pain. If it fills with blood, the cyst may rupture, causing internal
bleeding and sudden, sharp pain. The fertility drug clomiphene citrate (Clomid,
Serophene), used to induce ovulation, increases the risk of a corpus
luteum cyst developing after ovulation. These cysts don't prevent or
threaten a resulting pregnancy.
WHEN TO SEEK MEDICAL ADVICE
If you experience severe or spasmodic pain in your lower abdomen,
accompanied by fever and vomiting, see your doctor. These signs and symptoms
— or signs and symptoms of shock such as cold, clammy skin, rapid
breathing, and lightheadedness or weakness — indicate an emergency and
require immediate medical attention.
SCREENING AND DIAGNOSIS
A cyst on your ovary may be found during a pelvic exam, during which your
doctor feels (palpates) your ovaries. If a cyst is suspected, doctors often
advise further testing to determine its type and whether you need treatment.
Typically, doctors address several questions to determine a diagnosis and
to aid in management decisions:
Shape. Is your cyst irregularly shaped?
Size. What size is it?
Composition. Is it filled with fluid, solid or mixed?
Fluid-filled cysts aren't likely to be cancerous. Those that are solid
or mixed — filled with fluid and solid — may require further
evaluation to determine if cancer is present.
To identify the type of cyst, your doctor may perform the following
procedures:
Pregnancy test. A positive
pregnancy test may suggest that your cyst is a corpus luteum cyst, which
can develop when the ruptured follicle that released your egg reseals
and fills with fluid.
Pelvic ultrasound. In this
painless procedure, a wand-like device (transducer) is used to send and
receive high-frequency sound waves (ultrasound) through your pelvic
area, creating an image of your uterus and ovaries on a video screen.
This image can then be photographed and analyzed by your doctor to
confirm the presence of a cyst, help identify its location and determine
whether it's solid, filled with fluid or mixed.
Laparoscopy. Using a laparoscope
— a slim, lighted instrument inserted into your abdomen through a
small incision — your doctor can see your ovaries and remove the
ovarian cyst.
CA 125 blood test. Blood levels
of a protein called cancer antigen 125 (CA 125) often are elevated in
women with ovarian cancer. If you develop an ovarian cyst that is
partially solid and you are at high risk of ovarian cancer, your doctor
may test the level of CA 125 in your blood to determine whether your
cyst could be cancerous. Elevated CA 125 levels can also indicate non-cancerous
conditions such as endometriosis, uterine fibroids and pelvic
inflammatory disease.
COMPLICATIONS
A large ovarian cyst can cause abdominal discomfort. If a large cyst
presses on your bladder, you may need to urinate more frequently because its
capacity is reduced.
Some women develop less common types of cysts that may not produce
symptoms, but that your doctor may find during a pelvic examination. Cystic
ovarian masses that develop after menopause may be cancerous (malignant).
These factors make regular pelvic examinations important.
The following types of cysts are much less common than functional cysts:
Dermoid cysts. These cysts may
contain tissue such as hair, skin or teeth because they form from cells
that produce human eggs. They are rarely cancerous, but they can become
large and cause painful twisting of your ovary.
Endometriomas. These cysts
develop as a result of endometriosis, a condition in which uterine cells
grow outside your uterus. Some of that tissue may attach to your ovary
and form a growth.
Cystadenomas. These cysts develop
from ovarian tissue and may be filled with a watery liquid or a mucous
material. They can become large — 12 inches or more in diameter —
and cause twisting of your ovary.
TREATMENT
Treatment depends on your age, the type and size of your cyst, and your
symptoms. Your doctor may suggest:
Watchful waiting. You can wait
and be re-examined in one to three months if you're in your reproductive
years, you have no symptoms and an ultrasound shows you have a simple,
fluid-filled cyst. Your doctor will likely recommend that you get
follow-up pelvic ultrasounds at periodic intervals to see if your cyst
has changed in size. Watchful waiting, including regular monitoring with
ultrasound, is also a common treatment option recommended for
postmenopausal women if a cyst is filled with fluid and less than 2
inches in diameter.
Birth control pills. Your doctor
may recommend birth control pills to reduce the chance of new cysts
developing in future menstrual cycles. Oral contraceptives offer the
added benefit of significantly reducing your risk of ovarian cancer —
the risk decreases the longer you take birth control pills.
Surgery. Your doctor may suggest
removal of a cyst if it is large, doesn't look like a functional cyst,
is growing or persists through two or three menstrual cycles. Cysts that
cause pain or other symptoms may be removed. Some cysts can be removed
without removing the ovary in a procedure known as a cystectomy. Your
doctor may also suggest removal of the one affected ovary and leaving
the other intact in a procedure known as oophorectomy (or ovariotomy).
Both procedures may allow you to maintain your fertility if you're still
in your childbearing years. Leaving at least one ovary intact also has
the benefit of maintaining a source of estrogen production. If a cystic
mass is cancerous, however, your doctor will advise a hysterectomy to
remove both ovaries and your uterus. After menopause, the risk of a
newly found cystic ovarian mass being cancerous increases. As a result,
doctors more commonly recommend surgery when a cystic mass develops on
the ovaries after menopause.
PREVENTION
Although there's no definite way to prevent the growth of ovarian cysts,
regular pelvic examinations are a way to help ensure that changes in your
ovaries are diagnosed as early as possible. In addition, be alert to changes
in your monthly cycle, including symptoms that may accompany menstruation
that aren't typical for you or that persist over more than a few cycles. Be
sure to talk with your doctor about any concerns relating to menstruation.
