What is ovarian cyst?
There are two ovaries on either side of the uterus which produce eggs and female hormones like Estrogen and Progesterone. Normal size of each ovary is 4-6 cm in average.
Fluid filled sac or solid growth that occurs within the ovary or on the surface of ovary is known as Ovarian cyst. This is also known as Ovarian tumor or mass.
The functional unit of ovary is the “follicle”, which is very small cyst like structure, that grows in a menstrual cycle. It ruptures to release the egg and there after produces the hormones. After that it is decreased in size and disappears. If it still keep growing, it forms an ovarian cyst. This is known as functional cyst or Simple cyst, which is the commonest type of cyst.
Other than follicles, there are other structural components in ovary. Overgrowth from any other components is called Neoplastic ovarian tumour, which can be (non-cancerous) or malignant(cancerous).
Who can get ovarian cyst?
Anyone within the childbearing period may get a Simple cyst or Functional cyst. These cysts usually are asymptomatic and disappear on their own within few months.
Few cysts develop during pregnancy due to hormonal effect called Corpus Luteum cyst and Theca lutein cyst. They disappear in early months of pregnancy usually within 12 weeks.
Some times cyst may be found in very early prepubertal age or postmenopausal age.
What causes ovarian Cyst?
Hormonal imbalance is the main cause of ovarian cyst. Drugs used for producing eggs in infertility treatment can cause cyst.
Other risks may be previous history of ovarian cyst, severe pelvic infection, Endometriosis (bleeding inside the follicle during each menstrual bleed).
What are signs of ovarian Cyst?
Most of the ovarian cysts are symptomless. But when they grow in size they may cause discomfort, pain in abdomen, swelling in abdomen, feeling of pressure, bloating.
Painful periods, irregularities in periods and Pain during intercourse are additional signs of ovarian cyst.
What can be complications of ovarian cyst?
Torsion or Twisting of an ovarian cyst
The cyst has a pedicle (like neck of a balloon) through which it gets the blood supply and attached to the ovarian surface. When a cyst is twisted at this pedicle it causes sudden severe pain abdomen associated with vomiting. It is an emergency situation and needs immediate care. If delayed the blood supply to the ovary will be disturbed and it may cause permanent damage to the ovary.
Rupture of the cyst
When the cyst becomes large and tensed it may rupture which will cause bleeding inside the abdomen. This will cause sudden severe pain in abdomen. Patient may go into shock due to blood loss and this situation needs urgent surgery.
Some common Ovarian cysts
Follicular cyst
Every month one egg is prepared inside a follicle in any one of the ovaries. In the midway of the menstrual cycle follicle is ruptured and egg is released. Sometimes follicle doesn’t rupture and continues to grow, here it forms the follicular cyst. Most of the time the cyst disappears on its own within a period of 2 to 3 months. They are usually asymptomatic. Treatment is required if it becomes painful by enlargement or rupture or twisting.
Corpus luteum cyst
After the egg released, the follicle is called corpus luteum. It thereafter shrinks in size and gradually disappear. When it continued to stay back and enlarges in size, it is called corpus luteum cyst. It may often be associated with pregnancy and disappears during first 3 months of pregnancy. This kind of cyst is also harmless unless any complications occur.
Dermoid cyst
It is formed from the germ cells of ovary. It contains hair, skin, teeth and fluid. It is rarely cancer. This cyst could not be regressed on its own or by medications. Cystectomy is the treatment of choice.
Endometriotic cyst
When cells of the lining of uterus is found outside uterus, is called endometriosis. When these cells are in ovary, it causes ovarian cyst called Endometrioma. These could be unilateral or bilateral. Symptoms associated are painful periods, pain lower abdomen, painful intercourse, abnormal bleeding and infertility. Treatment modalities are hormonal medications or cystectomy.
Haemorrhagic cyst
Sometimes a lady can have unexplained sudden pain on one side of lower abdomen during or around the periods. This could be due to haemorrhagic cysts. Bleeding inside a follicular cyst is the cause. It needs only observation and analgesics.
Cystadenoma / Neoplastic cysts
These are neoplastic cells, can grow into very large size. Treatment is laparoscopic cystectomy.
Ovarian Cancer
These could be cystic or solid or may be mixed in consistency. Thorough evaluations, further imaging and surgery by an oncourse is the treatment.
Polycystic Ovarian Syndrome
People commonly called it as” cysts in ovary”, but they are not actual ovarian cysts. It’s a syndrome of one or both ovaries being enlarged, and multiple follicles present on their surface. This gives a cystic appearance to the ovary. Management of PCOS is medical and lifestyle modifications.
Diagnosis of ovarian cysts
Examination
Pelvic examination helps in identifying a cyst.
Ultrasonography of abdomen or lower abdomen
Ultrasonography will give information regarding location, size, nature of the cyst whether solid or fluid filled, clear fluid or blood or pus inside the cyst, presence of malignancy features. USG is used to diagnose as well as follow up of the ovarian cyst. TVS (transvaginal sonography) is done by introducing the transducer inside vagina. This is a very useful informative test to determine the malignancy nature of the cyst.
MRI or CT scan
These imaging modalities are used for further evaluation of the cysts.
Laparoscopy
Laparoscopy is used for both diagnosis and treatment. Direct visualization of cyst gives accurate information and on the same sitting cystectomy can be performed safely.
Tumour markers
These are substances found in blood. They are protein made by cancer cells and some healthy cells. The level of tumour markers is measured for diagnosis and follow up of tumours. It’s level help to plan further management of the cyst. Most commonly used tumour marker is CA 125.Raised CA 125 level with suspicious USG findings could be the sign of a malignant ovarian cyst. It may be increased in other benign conditions like endometriosis and pelvic infection.
How is the ovarian cyst treated?
Observation and follow up
Most of the cysts disappear on their own within few months. Small cysts (smaller than 8 cm), simple in nature, symptomless, without any malignancy features are the criteria for follow up for few months. Observation can be done with or without medicines. Serial USG and tumour markers are done at certain months interval. Large, symptomatic cysts and that with suspicious nature need surgical intervention.
Medications
Hormones in the form of progesterone or estrogen-progesterone combined pills are used for few months to decrease the size of the cysts. These birth controlling pills are also used for prevention of formation of further ovarian cyst.
Cystectomy
If cysts stay back or become symptomatic it needs surgery called Cystectomy. In cystectomy the cyst is removed and ovaries are preserved. Laparoscopic Cystectomy is the best option for this. Sometimes laparotomy or open cystectomy is also done if the cyst is suspicious of malignancy.
How can Ovarian Cyst be prevented?
Regular checkups and Birth control pills are helpful in preventing formation of ovarian cysts.
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