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All about ovarian cysts





What are ovarian cysts and how can they be treated?

Shereen has had a nagging pain on the left side of her lower abdomen for the past three months. She was asked to have an ultrasound scan to make sure that there was no problem in the uterus or ovaries. She was found to have a 4 cm cyst in the left ovary. She is apprehensive. She is 28 years old. Will she require a surgery? The ovaries are two small organs, one on each side of a woman's uterus. It is common for a small cyst (a fluid-filled sac) to develop on the ovaries. In most cases, these cysts are harmless and disappear on their own. In other cases, cysts may cause problems and may need treatment.

Types of ovarian cysts

Ovarian cysts are quite common in women during their childbearing years. Ovarian cysts can vary in size. There are different types of ovarian cysts. Functional cysts: It is the most common type of ovarian cyst. It occasionally develops during the normal process of ovulation. There are two types of functional cysts. A follicular cyst can form in any cycle when the fluid which normally forms around the egg, is more than usual. A corpus luteum cyst can form after the egg is released. Both these kinds of cysts usually have no symptoms or only minor ones when they occur. They disappear within 6-8 weeks, without any treatment. Dermoid cysts: A dermoid cyst is present in the ovary from birth and is made up of different kinds of tissue such as skin, hair, fat and teeth. It may be found on one or both ovaries. Dermoid cysts often are small and may not cause symptoms unless they become large. They are most often found on a routine ultrasound scan. Occasionally they may twist and cause severe pain. In that situation emergency surgery may be required. Cystadenomas: Cystadenomas (serous or mucinous) are cysts that develop from cells on the outer surface of the ovary. They usually are benign, but they can grow large and cause pain. These can occasionally become cancerous. Endometriomas: Endometriomas are cysts that form when tissue resembling the lining of the uterus grows in the ovaries. This tissue bleeds monthly, which may cause it to form a cyst that slowly grows in the ovary. An endometrioma also is known as a "chocolate cyst" because it is filled with dark, reddish-brown blood. `Polycystic ovaries' is a misleading term. Women diagnosed with this condition panic because they think they have multiple cysts in the ovary. These ovaries contain tiny immature eggs (`cysts') and occur in women who do not ovulate regularly. It does not require surgery.

Symptoms

Most ovarian cysts are small, do not cause symptoms, and may disappear spontaneously. Some may cause symptoms because of twisting, bleeding or rupture. They may cause a dull or sharp pain in the abdomen. It is important to remember that most ovarian cysts are non-cancerous. Although rare in young women, the risk of ovarian cancer increases with age. Ovarian cancer usually has no symptoms in its early stages. The ultrasound scan can indicate if the cyst has the possibility of being cancerous. Usually, a cancerous cyst will have solid areas or will have a complex appearance with both cystic and solid areas.

Warnings signs of cancer of the ovary

* Enlargement or swelling of the abdomen * Persistent nausea or heartburn * Loss of appetite * Pelvic pain If a cyst is suspected to be cancerous, the doctor will order a blood test for the presence of CA-125 and sometimes other substances. These are tumour markers and if elevated, may indicate malignancy.

Diagnosis

An ovarian cyst is often found during a routine pelvic examination. When the doctor detects an enlarged ovary, further tests may be required to confirm the diagnosis. Some of these tests provide further information that is helpful in planning treatment. Ultrasound scan: This is the most useful test to visualise the ovaries and can give accurate information on the size and type of cyst. Laparoscopy: This is a surgical procedure that allows the gynaecologist to look directly inside the abdomen and view the pelvic organs. Laparoscopy also can be used to operate on a cyst.

Treatment

If the cyst is not causing any symptoms, it may simply be monitored for 1-2 months. Most functional cysts disappear spontaneously after one or two menstrual cycles. If a cyst is large or causing symptoms, surgery may be required. Most benign cysts, especially in younger women, can be removed by laparoscopic surgery. In younger women, it is important not to remove the ovary, if possible. All efforts must be made to retain the ovary because the hormones produced by it are essential for health. GITA ARJUN

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)



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