What is an ovarian cyst?Ultrasound found ovarian cysts, what to do? What can I do?”
First of all, we need to understand what cysts are! Cysts are actually like buns, the outside is the skin and the inside is the filling!
But ovarian cysts are more complicated than buns, the skin of the bun is all dough, only the filling is different. Ovarian cysts can have different skins and different fillings! This combination is much more! It’s not a problem to list a dozen varieties at random! Follicular cysts, corpus luteum cysts, teratomas, chocolate cysts, tubo-ovarian tract cysts, inflammatory cysts, plasmacytoma, mucinous cystadenoma, endodermal sinus tumors, granulosa cell tumors, fibromas, plasmacytoma, mucinous cystadenoma ……
Therefore, the term “cyst” is only a morphological description and is not a diagnosis yet. There are physiological and pathological cysts, benign and malignant; some require surgery, some do not, some will recur and some are not prone to recurrence. Ovarian cancer is malignant and there are many varieties of ovarian cancer. Ovarian cancer is like a bomb buried in our body. It is generally more malignant and has few symptoms, so it can only be detected by ultrasound examination, or when there are symptoms, it is found at an advanced stage. Therefore, when many people see ovarian cysts on the ultrasound, they are mainly worried about cancer.
In fact, the majority of cysts on the ovaries are benign. It can be said that the majority of them are benign.
Classification of ovarian cysts
1. Physiological cysts
This is not a disease in most cases and does not require surgery and can disappear on its own.
In women of childbearing age, ovulation occurs every month. Before ovulation, the ovaries develop to a certain size and the eggs come out due to changes in hormone levels. The structure of the ovary also conforms to the morphological characteristics of a “cyst”, with a follicular membrane on the outside and follicular fluid inside, which can reach 3-4 cm in size when it grows large. This is called a “follicular cyst”. After ovulation, the follicle collapses and forms the corpus luteum, which also has the morphological characteristics of a “cyst”, with a membrane outside and corpus luteum tissue inside (similar to the structure of a bun). The menstrual corpus luteum can be as large as 3cm in size. Sometimes, for various reasons, the corpus luteum does not develop normally, and during the process of receding, cystic changes may occur, liquefying inside, accumulating fluid, and the outer layer of skin being stretched larger and larger, forming a “water sac”-like structure, which can be seen on ultrasound as a typical cyst, which is a typical “luteal cyst This is a typical “luteal cyst”. These two kinds of cysts will generally disappear when the ultrasound is repeated every other month.
2. Inflammatory cysts
Sometimes women who have had pelvic inflammatory disease have formed adhesions in the pelvis, and some membranous adhesions surround each other and form a spherical shape with inflammatory fluid gathered inside, and the ultrasound will also tell you that this is a “cyst”, which clinically we call an “inflammatory mass”. In this type of “cyst”, the first consideration is usually active anti-inflammatory, and only if anti-inflammatory treatment is ineffective is surgery considered. The patient needs to accept the reality that inflammatory masses can recur after treatment, whether medication or surgery. But no cancer has been heard of.
3.Neoplastic cysts
This type of cyst is the most classical explanation of cysts that we deal with clinically. It is formed due to the lesion of ovarian cells, and the pathogenesis is the same as that of tumor. Because of the complex tissue composition of the ovary, there are many types of these cysts, most of which are benign and a few are malignant (cancer).
Ovarian tumor masses are either cystic (fluid inside) or cystic solid (fluid and solid), and are indicated by ultrasound as “cyst” or “cystic solid occupancy”. Some of them are solid (no liquid inside), and the ultrasound indicates “pelvic mass” or “adnexal mass” or “occupancy”.
4. Hemorrhagic cysts
It is usually secondary to follicular cyst or corpus luteum cyst, which is clinically known as follicular rupture or corpus luteum rupture. The mass may appear as a “mixed” mass on ultrasound because of the possible formation of blood clots inside.
5. Chocolate cysts
This one must be mentioned separately because it is special and very common. It is one of the main causes of dysmenorrhea and female infertility. It is caused by the presence of endometrial cells on the ovaries, which bleed every month during menstruation, and the bleeding collects in the cyst, forming a cyst. With repeated bleeding, the cyst gets bigger and bigger, and the blood inside becomes old, mixed with some endometrial glandular epithelial secretions, forming a thick chocolate colored fluid, so we call it “chocolate cyst”. But its real name should be “endometriosis cyst”. Because the cyst contains iron-containing heme and the fluid is viscous, the ultrasound usually indicates that the cyst is “filled with dotted fine echoes”.
See how complicated ovarian cysts can be! Therefore, for doctors and patients, just an ultrasound sheet that indicates “ovarian cyst”, we don’t know anything, we don’t know if it is a disease, we don’t know what it is, we don’t know if it is benign or malignant, and we don’t know if it will recur after surgery.
What should I do if I find a cyst?
With so many kinds of cysts, a head of questions, what exactly should we do when we find a cyst?
If an ovarian cyst is found by chance ultrasound, don’t be nervous first, if there are no symptoms and the ultrasound suggests pure cystic with good sound transmission inside – first advice: review! It is possible to review immediately in a different place, but more importantly, a month later, when your period is clean. The review can minimize the physiological cysts from being operated innocently.
If the ultrasound suggests that the cyst is mixed and cystic solid. Check the tumor markers first, or review next! It is very important to review the ultrasound. A ruptured follicle with a blood clot forming inside is also cystic solid (mixed). If the tumor markers are found to be elevated, it is good to be alert to the possibility of malignant tumors. But don’t be too nervous, because inflammation, endometriosis, adenomyosis, tumor markers may also be elevated.
For repeated ultrasound suggesting a cyst in a certain area, it is necessary to consider surgery because the possibility of tumor is very high. Most benign ovarian tumors are negative for tumor markers. Laparoscopy is also the preferred surgical approach.
If the tumor markers are violently high, then ovarian cancer is more likely and will require open abdominal exploration.
The core word you need to remember in this article is: “review”! “Review”! “Review”! Remember to review if you find a cyst!