Ovarian cyst is a broad name for ovarian tumors, including benign, malignant, and physiologic ovarian masses. Most ovarian cysts refer to benign ovarian masses, which are common diseases of the female reproductive organs and are most common in women between the ages of 20 and 50. The medical classification of ovarian cysts is complex because of their cytologic and histologic complexity, and there are many variables involved in ovarian cysts. Despite the complexity of ovarian cysts, it is important for patients to clarify the following 4 questions
First, benign or malignant?
The most worrying issue for ovarian cyst patients is the nature of the tumor, benign or malignant. Clinically, early diagnosis of ovarian cancer is very difficult, and about 70% of patients are already in advanced stage when they are diagnosed, with a 5-year survival rate of only 30% after treatment. Clinically, it is also difficult for physicians to identify the nature of ovarian cysts. Physicians mainly identify the nature of ovarian cysts based on the patient’s symptoms, signs, and ancillary examinations. The following points are personal experiences for reference.
1. Symptoms (as reported by the patient himself)
(1) Age: before the age of 18, and after the age of 50, ovarian cysts should be noted for malignancy. Typical cases: germ cell tumors in young people and epithelial ovarian cancer in older people.
(2) Menstruation: ovarian cysts in women of childbearing age with menstrual abnormalities are mostly benign. Typical examples: functional (physiologic) ovarian cysts, chocolate cysts.
(3) Abdominal pain: most ovarian cancers do not have abdominal pain and come “quietly”, except for patients with advanced stages (which do not need to be identified); on the contrary, most ovarian cysts with abdominal pain are benign. Typical examples: adnexal abscesses, chocolate cysts, cyst torsion (most patients capable of torsion with acute abdominal symptoms are benign).
(4) Gastrointestinal symptoms: clinically, there is a very strange phenomenon that the earliest and most common symptom of ovarian cancer patients is often gastrointestinal symptoms (similar to chronic gastritis and chronic cholecystitis), and patients often undergo gastroscopy (the test results are chronic atrophic gastritis, sinus gastritis, superficial gastritis, etc.) and receive treatment for “gastritis”, but the medication is often ineffective. However, the medication is often ineffective. Therefore, if you are over 50 years old and have unexplained and unexplained “stomach problems”, you should be highly alert to “ovarian cancer” and have an ultrasound examination of the pelvic cavity.
2. Physical signs (evidence obtained from physical examination and gynecological examination by physicians)
(1) Benign signs: ovarian cyst 5-10cm, unilateral, clear border, cystic, active, no tenderness, no nodules in pelvic floor.
(2) Malignant signs: 10 cm or more, bilateral, indistinct borders, substantial, immobile, painful to palpation, nodules in the pelvic floor.
(3) Note: Adnexal abscess, chocolate cyst, physical examination is similar to malignant signs, but of course experienced physicians can still identify them.
3. Auxiliary examination
(1) Ultrasound: Ultrasound is the easiest and most effective weapon to check ovarian cysts. Benign sonogram: unilateral, cystic, dark areas with few separations and clear borders. Malignant sonogram: bilateral, cystic solid (mixed), indistinct borders, multiple segregations, ascites. Note: Chocolate cysts and adnexal abscess sonograms are easily confused.
(2) Blood tumor related indexes: CA125, CA199, AFP, CEA, hCG, etc. CA125 is the most valuable, elevation indicates malignant possibility. Chocolate cysts and adnexal abscesses can also be elevated, but generally do not exceed 200 IU/L.
(3) CT and MR: can help identify the nature of ovarian cysts, especially valuable for the identification of adnexal abscesses and chocolate cysts.
(2) What type of benign ovarian cysts are they?
1. Functional cysts: also known as physiological cysts, are common cysts. They occur in women of childbearing age during the ovulation cycle, when fluid collects in the follicles or within the corpus luteum to form follicular cysts or corpus luteum cysts (lutein cysts).
Main features.
(1) Purely cystic in nature.
(2) Generally not exceeding 5 cm.
(3) Most and have menstrual abnormalities.
(4) Usually disappear on their own within three months and do not require drug treatment.
2, epithelial cysts: epithelial cysts are the most common benign tumors of the ovary, and there are plasmacytosis and mucinosis. When the epithelial cells of the cyst change to resemble the epithelium of the cervical canal, they can secrete mucus, i.e. mucinous cysts; when they change to resemble the epithelium of the fallopian tube, they can secrete plasma, i.e. plasmacytic cysts.
Main features.
(1) Most are asymptomatic.
(2) Cysts that grow gradually during follow-up and do not disappear.
(3) Single or multiple chambers (internal separation of cysts).
(4) They are benign tumors and require surgery.
3. Chocolate cysts (endometriosis): endometriosis grows ectopically on the ovaries, forming a coffee-colored, chocolate-like liquid, hence the name “chocolate cysts”.
Main features.
(1) Typical symptoms are dysmenorrhea and infertility.
(2) Young age.
(3) Variable cysts that increase in size over time.
(4) Adhesions and fixation to surrounding tissues, partially bilateral, with pelvic floor nodules.
(5) Common ultrasound terminology: fine dots of light within cysts, segregation, mixed (cystic solidity).
(6) Elevated CA125.
(6) CT/MR examination to aid in diagnosis.
(7) Treatment options are determined by a variety of factors, including patient age, fertility, and symptoms.
(8) Need for open treatment.
(4) Growth cell tumor: Teratoma is a common germ cell tumor. Some patients often think that the tumor is inherited based on the name, which is a misconception. Teratoma comes from ovarian germ cells and may be a result of a problem in cell differentiation during the embryonic period.
(1) Ultrasound terminology: cystic solidity with intense light masses.
(2) Partially bilateral.
(3) Cysts with hair, teeth, sebum and other tissues.
(4) 15% chance of ovarian torsion as teratoma itself does not disappear on its own and may keep growing.
(5) Surgical treatment is required.
(3) How to choose the treatment plan for ovarian cysts and do they need surgery?
1. Treatment principles.
(1) Ovarian cyst is a generic term for a cystic mass of the ovary, and the nature of the cyst must be identified before treatment (benign? malignant?). (1) Ovarian cysts are a generic term for cystic ovarian masses.
(2) Benign cysts less than 5 cm in diameter can be followed up regularly, and the cysts become smaller or disappear within 2-3 months, suggesting physiological cysts (functional). The time to review ultrasound is chosen at the next clean menstrual period. Oral contraceptive pills can accelerate the shrinkage of physiological cysts. Experience: Simple cysts, less than 5 cm in diameter, accompanied by menstrual disorders, are mostly physiological cysts.
(3) Cysts larger than 5 cm in diameter are mostly of tumor nature and usually require surgery.
(4) Ovarian cysts that are clearly tumorigenic in nature, even if they are less than 5 cm in diameter, are mainly treated surgically because of the complexity, and variability of ovarian cysts.
(5) Early surgery for those at high risk of malignancy.
(6) Emergency surgery should be performed when complications of ovarian cysts (torsion, rupture, infection) are presented.
2. Surgical treatment of benign ovarian cysts
(1) Laparoscopic surgery has replaced traditional cesarean surgery as the preferred surgical procedure for ovarian cysts.
(2) Ovarian cystectomy (cyst debridement) is feasible in young patients (under 45 years old), preserving part of the normal ovarian tissue.
(3) Older patients (over 45 years old) can opt for adnexal resection (en bloc ovarian cyst and fallopian tube) on one side.
(4) Combination of other diseases of reproductive organs and older age (near menopause) can choose adnexal and total hysterectomy.
(5) Most patients with ovarian complications have unilateral adnexal resection.
(6) See other articles for surgical approaches to ovarian chocolate cysts, adnexal abscesses, and hydrocele in the fallopian tubes.
(7) Ultrasound intervention for cysts: this is a non-mainstream surgical procedure. Ultrasound-guided ovarian cyst puncture is performed, the cyst fluid is aspirated, and after the cyst fluid is removed, a sclerosing drug (e.g. 95% alcohol) is injected and kept for 10 minutes before the alcohol is withdrawn. This will coagulate all the cells that secrete cystic fluid, so that no more cystic fluid is produced and the cystic cavity is closed. Advantages: minimally invasive surgery, short treatment time (10-20 minutes), no hospitalization, and on-the-go treatment. Disadvantages: lack of pathological diagnosis, inability to understand the pelvic cavity in detail, risk of mistreatment. Recurrence after surgery.
What are the dangers of ovarian cysts?
1, affect ovarian function: ovary is the main gland of female hormone secretion, ovarian cysts can affect the endocrine function of the ovary, manifested as menstrual disorders.
2, leading to infertility: the ovary is the place where eggs are developed, matured and discharged, and follicles at different stages are in the ovarian cortex. If the ovary suffers damage to the development, maturation and discharge of eggs, it will lead to infertility. Endometriosis (chocolate cysts), pelvic inflammatory disease (adnexal abscesses, fluid in the fallopian tubes) can also involve other complex mechanisms leading to infertility.
3. Complications.
(1) Torticollis of ovarian cysts.
(2) Rupture of ovarian cysts.
(3) Ovarian cyst co-infection.
(4) Malignant transformation. Ovarian cysts with complications require emergency surgery.