An ovarian cyst is a fluid filled sac within the ovary and does not in itself indicate a specific diagnosis.
In younger women by far the majority of ovarian cysts are related to ovarian function and known as physiological cysts. For example if ovulation does not occur, a small cyst may develop. Under these circumstances, if such an ovarian cyst is seen on ultrasound, a repeat examination in six weeks is advised to check for resolution. These cysts that relate to ovarian function can cause pain and on occasion treatment is required.
The ovary is made up of different types of cells that have different roles
There are many types of cysts that are benign growths, the different nature of these cysts reflect the cell type that they originate from. In young women probably the most common persistent ovarian cysts that we see are benign cystic teratomas (dermoid cysts) or endometriomas. Again, just because a cyst is present does not mean it has to be removed – however surgery is usually recommended in these cases unless the cyst is very small. These growths of the ovary can cause pain and occasionally they may cause the ovary to become twisted. The likelihood of these complications occurring is thought by some to depend on the size of the cyst. It is generally thought that complications are more likely if the cyst is more than 5 cm in largest diameter.
An ovarian cyst towards menopause and after
Towards the menopause and beyond the presence of an ovarian cyst is likely to cause more concern. Although ovarian cancer is in fact a relatively uncommon disease, it becomes more common with increasing age. Again benign cysts are more common. These are characterised by having a smooth internal wall and clear fluid contents. These cysts are called benign cystadenomas and they originate from the tissue that covers the ovary (called the epithelium). Unfortunately some ovarian cysts will turn out to be malignant (cancerous) although it must be emphasised that most ovarian cysts are benign.
Ultrasound is used as the main tool to diagnose ovarian cysts. However a scan should in most cases indicate not only that a cyst exists, but also give an opinion on the type of the cyst that is present. Many common cysts such as teratomas and endometriomas have a characteristic appearance. Nearly all cysts that have a smooth internal capsule and clear contents (called “simple”) are completely benign. Cancers tend to be associated with an irregular internal cyst wall and solid projections of tissue into the cyst cavity.
In young women many ovarian cysts will resolve spontaneously without intervention. For other cysts a “watch and wait” expectant policy may be adopted – with the cyst being monitored over a period of time.
If intervention is required then for most benign cysts laparoscopic (keyhole) surgery will be possible. Laparoscopic (keyhole) surgery has been shown to be associated with reduced post-operative pain and quicker recovery.
After the menopause, a less conservative approach is often taken and removal of an ovary, because of an ovarian cyst, is more likely. In the unlikely event that a cyst has features of cancer then surgery should be performed by a sub-specialist trained in Gynaecological Oncology and any further treatment planned with a multidisciplinary team of specialists.