Obstetric & Gynaecology Malaysia

OBSTERIC & GYNAECOLOGY IN MALAYSIA

Ovarian cyst ia a sac filled with fluid or other tissues in an ovary. Ovarian cyst are very common.

Ovarian cysts do not always require treatment

In premenopausal women, ovarian cysts often resolve on their own within one to two months, without treatment. In postmenopausal women, ovarian cysts are less likely to resolve. Most ovarian cyst are benign (not cancer). Rarely, a cyst may be malignant (cancer)

If a cyst is large, causing pain, or appears suspicious for cancer, treatment usually involves surgery to remove the cyst or the entire ovary.







Different Types of Ovarian Cyst

Functional cyst-occur due to ovulatory process and usually cause no symptoms. It often goes away without treatment within 6-8 weeks.

Teratoma or Dermoid cyst-type of cyst that contain different kind of tissues that make up the body. These cyst may be present from birth but can grow during a woman's reproductive years.

Cystadenoma-type of cyst that form on the outer surface of the ovary. They can grow very large but usually are benign.

Endometrioma-type of cyst as a result from endometriosis, which are collection of chocolate like content from altered menstrual blood


Watchful waiting


Premenopausal women

In premenopausal women, watchful waiting usually involves monitoring for symptoms (pelvic pain or pressure) and repeating the pelvic ultrasound after 6-8 weeks. If the ovarian cyst does not enlarge or if it resolves during the period of watchful waiting, it does not usually require surgical removal. Some premenopausal women will be advised to take a birth control pill during this time to help prevent new ovarian cysts from developing.

If a cyst decreases in size or does not change, the ultrasound is often repeated at regular intervals until your health care provider is certain that the cyst is not growing. If the cyst resolves, no further testing or follow-up is required.


Postmenopausal women

In postmenopausal women, the decision to undergo watchful waiting depends upon the initial testing (ultrasound and cancer antigen 125(CA 125). If the cyst does not appear to be cancerous, watchful waiting may be an option, and includes a pelvic ultrasound and measurement of CA 125 every 3-6 months for one year, or until the cyst resolves. However, ovarian cysts do not always resolve in postmenopausal women.

If the CA 125 levels increase or the cyst grows or changes in appearance, then surgery to remove the cyst may be recommended.


Surgery — Surgery may be recommended in the following situations:

●A cyst is causing persistent pain or pressure, or may rupture or twist.

●A cyst appears on ultrasound to be caused by endometriosis and is removed for fertility reasons.

●Large cysts (>5 to 10 cm) are more likely to require surgical removal compared with smaller cysts. However, a large size does not predict whether a cyst is cancerous.

●If the cyst appears suspicious for cancer. If you have risk factors for ovarian cancer or the cyst looks potentially cancerous on imaging studies, your health care provider may recommend surgery.

●If the suspicion for ovarian cancer is low but the cyst does not resolve after several ultrasounds, you may choose to have it removed after a discussion with your health care provider. However, surgical removal is not usually necessary in this case.


Surgery to remove ovarian cyst —

If surgery is needed to remove an ovarian cyst, the procedure is usually done in a hospital or surgical center. Whether the surgery involves removing only the cyst, ovarian cystectomy or the entire ovary, oophorectomy depends upon your age and what is found during the procedure.


For example:

●If there is suspicion of cancer, the whole ovary must be removed since cutting into a cancerous cyst may lead to cancer spread. In some cases, the whole ovary is removed and the cyst turns out to be benign. Having one ovary removed will not cause you to go through menopause and will not cause you to be infertile.

●If the cyst appears noncancerous and is able to be removed through small incisions, it may be removed laparoscopically (through several small incisions) and you may be able to go home the same day.

●If the cyst is large or appears suspicious for cancer, it may be necessary to have an open incision called a laparotomy and the surgeon may need to remove the entire ovary and surrounding tissues. You will need to stay in the hospital for one or more nights after a laparotomy.


OVARIAN CYST FOLLOW-UP

After an ovarian cyst resolves, you will not need further imaging tests if you do not have symptoms.

Some types of ovarian cysts are more likely to recur than others. This includes endometriomas and functional ovarian cysts. If you are premenopausal and are concerned about recurrent cysts, taking a birth control pill or other hormonal form of birth control may help to prevent ovarian cysts from developing

A disadvantage of an MIS oophorectomy/cystectomy is the potential for spill of cancer cells if the mass is malignant. Neither preoperative clinical and sonographic evaluation nor the laparoscopic appearance of the ovary can reliably predict which masses are malignant. However, with appropriate patient selection, these risks can be minimized. 

A survey by the American Association of Gynecologic Laparoscopists reported unsuspected ovarian cancer was found in only 0.04 % of 13,739 cases of laparoscopic ovarian cyst surgery. IOTA - ADNEX model