Ovarian Cysts

Ovarian cysts are very common, particularly during the reproductive years. Most women will develop at least one ovarian cyst during their lifetime, often without any symptoms. Many cysts are harmless and resolve on their own without treatment.

There are three common types of ovarian cysts:

• Functional ovarian cysts: These cysts are also known as follicular cysts and are common in young women. Function of ovaries is to produce eggs every month and it is not uncommon for these eggs to be retained and enlarge in size. These cysts are often self-limiting and can be monitored. Usually, these cysts will resolve spontaneously without any treatment.
• Benign ovarian cysts: These cysts are not cancerous but do not resolve spontaneously. Tumour marker (CA125) levels are often normal and surgery can be performed as a key-hole (laparoscopic) procedure. Dermoid cyst or teratoma is a common benign ovarian cyst.
• Malignant ovarian cysts (ovarian cancer): These cysts are often seen in older women and the tumour marker (CA125) level may be raised. Even though ovarian cancer may be suspected on tests, it is confirmed after removal and histological analysis. Treatment is often (but not always) by open surgery. In some cases of advanced ovarian cancer, further treatment may be required after surgery in the form of chemotherapy.

Many ovarian cysts do not cause any symptoms and are often found incidentally during routine scans. However, some may lead to:

• Lower abdominal or pelvic pain

• A feeling of fullness or bloating

• A noticeable lump or swelling

• Sudden, sharp pain – which may suggest a complication such as torsion, bleeding, or rupture

In rare cases, ovarian cysts may be cancerous. Early-stage ovarian cancer often causes no symptoms or only vague signs that may be mistaken for other conditions. In addition to the symptoms listed above, possible signs of a malignant ovarian cyst include:

• Persistent abdominal distension

• Indigestion or bloating

• Changes in bowel habits

• New onset of pelvic pain, particularly after the age of 50

These symptoms can mimic irritable bowel syndrome (IBS), which is why it’s important to see your GP promptly—especially if you are over 50 and develop these symptoms.

For more information regarding ovarian cancer symptoms please read the Early Recognition of Ovarian Cancer leaflet published by NICE.

Ovarian cysts are typically diagnosed using an ultrasound scan. In some cases, an MRI scan is recommended to provide more detailed information about the nature and characteristics of the cyst.

A blood test called CA125 (a tumour marker) may also be carried out. While elevated CA125 levels can be associated with ovarian cancer, they can also rise in several benign conditions such as endometriosis, fibroids, pelvic infections, during menstruation, or following surgery.

This test is often raised in cancerous cysts but may also be raised in other benign conditions such as endometriosis, fibroids, infection, during monthly periods and after surgery.

Not all ovarian cysts need removal. Functional (follicular) cysts often will resolve spontaneously. Surgery may be needed if the cysts are persistent or if there are symptoms (see above). If there is a suspicion of cancer, urgent surgery is indicated to make a diagnosis and also as treatment.

Most of the ovarian cysts can be removed as a key-hole (laparoscopic procedure). Three or four small (5-10mm) incisions are made on the tummy wall. Camera and special surgical instruments are then inserted to remove the cyst and healthy ovarian tissue is conserved. The cyst is then put in a plastic bag, decompressed and removed with no spillage inside the tummy. Key-hole surgery avoids the need for a big cut and has the advantage of reduced hospital stay and quick recovery and return to normal life.

The ovary containing the cyst does not need to be removed unless the cyst is suspected to be cancerous or too large. If the cyst is suspected to be cancerous, the ovary may be removed to avoid inadvertent rupture and spillage of contents. In other situations the ovary can almost always be conserved.

It may not be always possible to prevent ovarian cysts, but going on the contraceptive pill may prevent cyst-formation to some degree.