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WHAT ARE OVARIAN CYSTS ?

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Cysts are fluid-filled sacs that can form in the ovaries. There are several different types of ovarian cysts.The vast majority of ovarian cysts are harmless (benign), most are functional cysts.

  • Follicular cyst, the most common type of ovarian cyst. In menstruating women, a follicle containing the ovum (unfertilized egg) will rupture during ovulation. If this does not occur, a follicular cyst of more than 2.5 cm diameter may result.
  • Corpus luteum cysts appear after ovulation. The corpus luteum is the remnant of the follicle after the ovum has moved to the fallopian tubes. This normally degrades within 5–9 days. A corpus luteum that is more than 3 cm is defined as cystic.

It is not that all functional cysts require surgery. They can be observed upto 6-7 cm in size without any intervention . They can simply be followed up with a course of oral contraceptive pills( the hormones in the pills may regulate the menstrual cycle, and prevent the formation of follicles that can turn into cysts.(American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002).

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ovarian cyst on ultrasound

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ovarian cyst on laparoscopy

Some common Non-functional cysts include :

  • • Hemorrhagic ovarian cyst
  • •Polycystic ovaries. In polycystic ovary syndrome (PCOS), the follicles in which the eggs normally mature fail to open and cysts form.
  • •Cystadenomas. (Ovarian serous cystadenoma /Ovarian mucinous cystadenoma):These cysts form out of cells on the surface of the ovary. They are often fluid-filled.
  • • Endometriosis. In women with endometriosis, tissue from the lining of the uterus grows in other areas of the body. This includes the ovaries. It can be very painful and can affect fertility.Cysts caused by endometriosis, known as chocolate cysts.
  • • Dermoid cysts. This type of cyst contains tissue similar to that in other parts of the body. That includes skin, hair, and teeth.

If tumors are non-cancerous, they are said to be benign. If they are cancerous, they are called malignant.ovarian cysts may cause problems like bleeding and pain ( due to torsion ie twisting of the ovarian pedicle) or may raise concerns of malignancy.

What are the complaints of people with ovarian cysts ?

  • Abdominal pain. Dull aching pain within the abdomen or pelvis, especially on intercourse.
  • • Bleeding per vagina .
  • • Fullness, heaviness,of abdomen ESPECIALLY IF THE TUMOUR ASSUMES A BIG/ HUGE SIZE.
  • • When a cyst ruptures from the ovary, there may be sudden and sharp pain in the lower abdomen on one side.
  • • Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy.

What are the common tumour markers tested for ovarian cancer?

CA 125 ( Normally less than 35 miu/ mL)

AFP ( ALPHA FOETOPROTEIN)
LDH ( LACTATE DEHYDROGENASE)
BETA HCG ( HUMAN CHORIONIC GONADOTROPHIN)
CEA ( CARCINO EMBRYONIC ANTIGEN)

COMMON METHODS OF DIAGNOSIS

  • 1. USG
  • 2. CT SCAN
  • 3. MRI SCAN

Who need surgery?

Persistent complex ovarian cysts

  • • Persistent cysts that are causing symptoms
  • • Complex ovarian cysts larger than 5 cm
  • • Simple ovarian cysts larger 10 centimeters or larger than 5 cm in postmenopausal patients
  • • Women who are menopausal or perimenopausal

WHAT ARE THE SURGERIES DONE FOR OVARIAN CYSTS?

  • 1. OVARIAN CYSTECTOMY : In this case only the cyst is removed , preserving the ovary.If the patient is young and we need to preserve the ovaries, then this is the method of choice.
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    OVARIAN CYSTECTOMY

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    OVARIAN CYSTECTOMY

  • 2. SALPINGOOPHERECTOMY : Here the tube and ovary is removed if the patient has completed her family,over 40 years of age.
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    SALPINGOOPHERECTOMY

    Both the above methods can be done by laparoscopy (minimal invasive surgery) or laparotomy ( cutting open the abdomen ) though laparoscopy is preferred because it can put the patient back in action quickly because of less trauma, smaller incisions ( 0.5 cm), quicker recovery, lesser pain etc

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The above pictures are of a 15 kg ovarian tumour removed in 2010 by DR G S S MOHAPATRA for which he was awarded the ODIAR GOURAV SAMMAN 2010.