What are ovarian cysts?
Ovarian cysts are fluid-filled, sac-like structures within an ovary. The term cyst refers to a fluid-filled structure. Therefore, all ovarian cysts contain at least some fluid.
What causes ovarian cysts?
Ovarian cysts form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve on their own over the course of days to months. Cysts can contain blood (hemorrhagic or endometrioid cysts) from injury or leakage of tiny blood vessels into the egg sac. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are called dermoid cysts.
What symptoms are caused by ovarian cysts?
Most cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. The pain can be caused from rupture of the cyst, rapid growth and stretching, bleeding into the cyst, or twisting of the cyst around its blood supply.
How are ovarian cysts diagnosed?
Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting ovarian cysts. Ultrasound is an imaging method that uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and causes no harm.
Cysts can also be detected with other imaging methods, such as CAT scan or MRI scan (magnetic resonance imaging).
How can the physician decide if an ovarian cyst is dangerous? If a woman is in her 40's, or younger, and has regular menstrual periods, most ovarian masses are "functioning ovarian cysts," which are not really abnormal. They are related to the process of ovulation that happens with the menstrual cycle. They usually disappear on their own during a future menstrual cycle. Therefore, especially in women in their 20's and 30's, these cysts are watched for a few menstrual cycles to verify that they disappear. Because oral contraceptives work in part by preventing ovulation, physicians will not really expect women who are taking oral contraceptives to have common "functioning ovarian cysts." Thus, women who develop ovarian cysts while taking oral contraceptives may be advised against simple observation; rather, they may receive closer monitoring with pelvic ultrasound or, less commonly, surgical exploration of the ovary.
Other factors are helpful in evaluating ovarian cysts (besides the woman's age, or whether she is taking oral contraceptives). A cyst that looks like it's just one simple sac of fluid on the ultrasound is more likely to be benign, than a cyst with solid tissue in it. So the ultrasound appearance also plays a role in determining the level of suspicion regarding a serious ovarian growth.
Ovarian cancer is rare in women younger than age 40. After age 40, an ovarian cyst has a higher chance of being cancerous than before age 40, although most ovarian cysts are benign even after age 40. CA-125 blood testing can be used as a marker of ovarian cancer, but it does not always represent cancer when it is abnormal. , First, many benign conditions in women of childbearing age can cause the CA-125 level to be elevated, so CA-125 is not a specific test, especially in younger women. Pelvic infections, uterine fibroids, pregnancy, benign (hemorrhagic) ovarian cysts, and liver disease are all conditions that may elevate CA-125 in the absence of ovarian cancer. Second, even if the woman has an ovarian cancer, not all ovarian cancers will cause the CA-125 level to be elevated. Furthermore, CA-125 levels can be abnormally high in women with breast, lung, and pancreatic cancer.
How are ovarian cysts...