The initial reaction when a woman is informed that she has a cyst in the ovary is to panic and her immediate thought is “do I have cancer in the ovary?”. This reaction is completely reasonable and most of the times anticipated.
Nevertheless it is very important to mention here that most of ovarian cysts are benign especially in those women who belong to the reproductive age group.
Ovarian cysts are very common and during the reproductive years 10% of women will have an ovarian cyst at some point.
What is an ovarian cyst?
By saying ovarian cyst we mean a collection of fluid that grows inside the ovary. This fluid can vary in texture ranging from simple fluid or blood to more complex components like fat or hair. Let’s think of a balloon which is filled with water. This balloon with water inside represents the cyst whereas a second balloon outside the first one represents the tissue of the ovary.
Ovarian cysts can grow in different sizes and can occupy each time different space in the abdominal cavity.
Ovarian cysts should always be investigated thoroughly. They can result for example from endometriosis (see here) but also in rare occasions from cancer. Such investigation is crucial especially if the cyst is growing fast in size or the woman belongs in the menopausal group.
How is an ovarian developed?
There are many different kinds of ovarian cysts. All these cysts can be divided in two big subgroups: functional and non-functional cysts.
Functional cysts (like their name indicates) have to do with the function of the ovary. As long as the ovary functions (and this is during the reproductive age),there is a possibility that these cysts appear.
The following cysts belong to the group of functional cysts:
- Follicular cyst:This cyst is the result of non rupture of the dominant follicle in the mid-cycle. As a result, the follicle grows variably in size and turns into a follicular cyst.
- Hemorrhagic cyst:Usually after the ovulation and release of the egg, the empty follicle fills with blood. Sometimes (for various reasons) the blood inside the follicle is more than usual resulting in the so called hemorrhagic cyst.
The most important characteristic of functional cysts is that after 1 or 2 cycles they automatically regress or decrease in size. Thus, it is very crucial to recognize the nature of a cyst precisely so that an unnecessary surgical intervention is avoided.
The most frequent non functional cysts are:
- Endometriosic cysts:These cysts are also called chocolate cysts because of the texture and colour of their fluid. They appear as a result of advanced endometriosis and can cause intense pain. In case of bilateral endometriomas there is a 85% probability of endometriosis involving the lower part of recto-sigmoid colon.
- Dermoid cysts:These cysts are embryological remnants and very often contain strange material like teeth, hair, fat and even parts of thyroid gland.
- Malignant cysts:These cysts are fortunately rare and most of the times appear in women who belong to the menopausal age group. However, as an exception to the previous, there are some malignant cysts that appear in very young girls and usually come from embryological structures of the ovary. Cancer of the ovary has been given the name “ silent killer”since most of the times it doesn’t give any symptom at all in its initial stages and the diagnosis may be missed. Therefore it is very important that the clinician investigates every symptom and every complaint of the patient.
What symptoms does an ovarian cyst cause?
Usually, very small cysts (regardless of the type) don’t cause any symptoms at all with the exception of Endometriosis cysts which due to their inflammatory process, can be excruciatingly painful even when they are small in size.
Generally whether an ovarian cyst causes symptoms are not, this mainly depends on their size. If they are big enough to press upon adjacent organs this may cause severe pain. It can also cause a feeling of swelling or discomfort in the abdomen. If the cyst is big enough to press upon the bowel or bladder the patient may have constipation or increased urinary frequency respectively.
What can happen to an ovarian cyst?
An ovarian cyst can rupture, bleed or get twisted. All these are considered to be emergency situations and sometimes it is necessary for the patient to undergo surgical intervention in order to get stabilised and have her ovary salvaged.
How is the differential diagnosis between ovarian cysts made?
The gynaecology surgeon should address the patient to obtain a full medical history and examine her clinically in order to spot areas of increased tenderness.
The most efficient way to detect an ovarian cyst is by transvaginal ultrasound. During this process a small probe is inserted inside the vagina, thus enabling the examiner to investigate the pelvic cavity. This examination can cause mild discomfort but never cause pain. An alternative to the transvaginal ultrasound is the transabdominal ultrasound especially when the patient has never had sexual intercourse before.
Sometimes the clinician may ask for further investigations such as blood investigations and MRI or CT in case the diagnosis is doubtful.
Expert sonographic skills are required to differentiate between different types of ovarian cysts.
What is the treatment for ovarian cysts?
Functional ovarian cysts most of the times regress automatically. Other cysts (non-functional) may require surgical intervention and if this is the case laparoscopy is the preferred method instead of the classic open approach.
Dr Kyriakopoulos is an advanced laparoscopic surgeon who is extensively trained in treating pathologies via the laparoscopic route.He uses pioneering methods to excise the cyst out of the ovary,minimizing the damage to the ovarian tissue and retain fertility in the highest level.Dr Kyriakopoulos takes seriously into account his patients’ well being and considers laparoscopic surgery as the last resort.