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Ovarian Cyst

Ovarian cyst forms from accumulation of fluid within the ovary in a thin walled sac. The cyst can range from small pea-sized and big orange-sized cysts to rare enormous sizes that make the patient seem pregnant with a swollen belly.

Most ovarian cysts are known to be harmless (benign) in nature and mostly develop during the childbearing years in a woman’s life. However, ovarian cysts can develop at any age.

In some cases, the ovarian cyst may cause bleeding and pain and if the cyst is larger than 5 cm it will need to be removed using surgical methods.

Types of Ovarian Cysts

There are mainly two types of ovarian cysts commonly seen:

  • Functional ovarian cysts – This is a common and harmless type of ovarian cyst and is mostly temporary seen forming with the woman’s menstrual cycle. 

  • Pathological cysts – These are seen growing in the ovaries and can be benign (harmless) or malignant (cancerous) in nature.

What are the signs and symptoms of an ovarian cyst?

In most cases where the ovarian cyst is smaller in size and benign in nature there might not be any noticeable symptoms in the patient. However, in cases where the symptoms are seen, it is difficult to pinpoint the diagnosis at ovarian cyst as the same symptoms are seen in other disorders as well.

The signs and symptoms of an ovarian cyst may include:

  • Irregular menstruation – Periods become abnormal and painful.

  • Pelvic pain - A persistent pain or an intermittent dull ache that spreads to the lower back and thighs. Seen before or after menstruation.

  • Dyspareunia - Pelvic pain/abdominal ache during or after sexual intercourse.

  • Painful bowel movements - Pain when passing stool.

  • Pressure on the bowels

  • Pregnancy symptoms - Including breast tenderness and/or nausea, bloating, swelling, or heaviness in the abdomen.

  • Urinary problems - Problems fully emptying the bladder.

  • Rectal/bladder pressure - Patient may have frequent urge to urinate or pass stool.

  • Hormonal abnormalities - in some rare cases the body produces abnormal amounts of hormones, resulting in changes in the way the breasts and body hair grow.

What are the causes of ovarian cysts?

Functional ovarian cysts - there are two types:

  • Follicular cysts – This is a common type of ovarian cyst. The follicle where the egg is formed is filled with fluid to protect the growing egg. Normally, when the egg is released the follicle tends to discharge its fluid completely and shrink in size.

  • In certain cases, the follicle might not discharge its fluid completely or release the egg at all. This causes the fluid to accumulate in the follicle and form a ‘Follicular ovarian cyst’. However, this type of cyst is commonly seen in singular form and disappears on its own within a few weeks without the need for treatment.

  • Luteal ovarian cysts – These are seen in rare cases and develop when the remainder of the egg tissue (corpus luteum) after its release gets filled with blood. Although in most cases the cyst may disappear in some cases where the cyst may burst and cause bleeding the doctor may advise treatment.

  • Pathological cysts - Dermoid cysts are the most common type of pathological cyst for women under 30 years of age. This type of cyst develops from a totipotential germ cell which can give rise to the numerous cells necessary to form mature tissues. Dermoid cysts contain hair, skin, bone and other tissues (sometimes even teeth). A totipotential germ cell has the ability to develop in any direction. They are formed from cells that make eggs. These type of cysts need to be removed surgically. 

  • Cystadenomas - These ovarian cysts develop from cells that cover the outer part of the ovary. Some are filled with a thick, mucous substance, while others contain a watery liquid. Rather than growing inside the ovary itself, cystadenomas are usually attached to an ovary by a stalk. These can grow to larger sizes and need surgical removal.

How are ovarian cysts diagnosed?

As most ovarian cysts show no noticeable signs and symptoms these almost always go undetected. Most of the times, an ovarian cyst is detected during a pelvic exam or ultrasound scan for an unrelated condition.

In case the doctor (or gynecologist) suspects the development of ovarian cyst, the initial diagnosis usually involves a through physical examination. This helps the doctor to determine:

  • Shape of cyst

  • Size of cyst

  • Composition of cyst (fluid/solid/mixed)

Apart from this, the doctor might also advise on the following diagnostic methods, including:

  • Ultrasound scan – This helps to view the inside of the vagina and ovaries to determine the nature of the suspected ovarian cyst.

  • Blood test – This helps to determine whether the cyst is a tumor by checking the levels of CA125 protein. Higher CA125 levels indicate towards risk of ovarian cancer as well.

  • Pregnancy test – This test helps to determine whether the cyst is a Luteun ovarian cyst.

  • Laparoscopy – A thin, hand held device (laparoscope) is inserted in the abdomen using minimally invasive surgical methods. This helps to directly view the ovaries and determine the presence and the type of ovarian cyst as well.

What are the treatment options for ovarian cysts?

The doctor/gynecologist will take into consideration several factors before deciding on the best type of treatment in individual cases of ovarian cysts.
The patient’s age, menopausal stage, size and shape of cyst along with the absence or presence of certain symptoms help to determine the best-suited treatment for ovarian cysts.

These are the types of treatments that are available to treat ovarian cysts:

Birth control pills – These help to reduce the risk of new cysts developing in future menstrual cycles. Oral contraceptives also reduce the risk of developing ovarian cancer. 

  • Surgery – In case there are symptoms, the cyst is large, does not look like a functional cyst, is growing, or persists through two or three menstrual cycles the doctor may recommend surgical removal.

  • In some cases if a cyst is found and no symptoms are present, surgical removal is still recommended - this is because it is not possible to know what type of cyst it is without examining it under a microscope. Removing it addresses the risk of the cyst eventually becoming cancerous.

  • Laparoscopy (key hole surgery) - two small cuts are made in the lower abdomen and one in the belly button. Gas is blown into the pelvis to raise the wall of the abdomen, away from the internal organs. A small tube with a light on the end (a laparoscope) is inserted into the abdomen. The surgeon can see the internal organs. With very small tools the surgeon is able to remove the cyst through the small incisions. In some cases a sample (biopsy) of the cyst is taken to determine what type it is. 

    In most cases the patient can go home the same day. This type of surgery does not usually affect a woman's fertility, and recovery times are much faster. 

  • Laparotomy - this is a more serious operation and may be recommended if the cyst is cancerous. A longer cut is made across the top of the pubic hairline, giving the surgeon better access to the cyst. The cyst is removed and sent to the lab. The patient usually has to remain in hospital for at least a couple of days.

  • Cancer treatment - if the cyst is cancerous the patient may need to have more organs and tissue removed, including the ovaries, uterus, the omentum and some lymph nodes.

What is recovery like after Ovarian Cyst treatment?

Once the surgical treatment is completed, the patient is usually discharged once the anesthetic effects wear off completely and there are no visible signs of complications.

The doctor will advise you on the precautions to be taken and any post-operative instructions that need to be followed.
It usually takes about one to two weeks to recover from ovarian cyst removal, but this varies between individuals, so it's important to follow your surgeon's advice

What are the risks of Ovarian Cyst treatments?

Ovarian cyst removal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects – In case of laparoscopic (keyhole) surgical treatment there might be pain in abdomen or shoulder’s tips which usually gets relieved in 48 hours.
Complications - The possible complications of any operation include an unexpected reaction to the anesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis or DVT).

Specific complications of ovarian cyst removal are rare but can include:

  • Removal of one or both of your ovaries (a procedure known as oophorectomy), if the cysts are malignant or have caused irreversible damage

  • Accidental damage to other organs in your abdomen (such as your bowel, bladder or major blood vessels)

  • Damage to your fallopian tube, or tubes - this may increase your risk of ectopic pregnancy or infertility

  • Damage to your womb - this can lead to bleeding and infection, and may require further surgery or, extremely rarely, a hysterectomy

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