“ I had never had a Cervical Smear before so I was quite nervous. Mr McIndoe was very professional and courteous. He took the time to answer all of my questions and alleviate any doubts I had. He made sure that he understood what I was asking and that I understood what he explained."
TREATMENT OF OVARIAN CYSTS
With most ovarian cysts diagnosed, the suspicion of malignancy is very low and therefore women can be reassured. The treatment of an ovarian cyst depends on what type of cyst is present. Unfortunately, even with the very best imaging and assessment it is not possible to be certain about the nature of an ovarian cyst. The treatment has to be decided on the basis of probability of various cyst types rather than certainty. One of the key issues is the possibility that the cyst is cancerous. With most simple cysts this is very unlikely, but often the possibility cannot be completely excluded.
Ovarian Cyst Symptoms
Most ovarian cysts cause no symptoms at all
Ovarian cysts may cause bleeding between periods
Ovarian cysts may cause pelvic pain
Ovarian cysts may twist to cause severe pelvic pain
Ovarian cyst rupture is very uncommon and rarely causes pain
Assessing an ovarian cyst
A simple “Risk of Malignancy Index” has been developed which takes into account the CA125 level, menopausal status and ultrasound findings. This is a guide that can be useful in raising suspicion of malignancy in some cases, although it is not very helpful with endometriosis as the ultrasound appearances are often complex and CA125 may be raised significantly. Other risk scores have been developed which perform better than the RMI.
When is surgery necessary?
Functional cysts usually resolve spontaneously over several weeks or months. If a cyst is thought to be functional a repeat scan in 4 to 6 weeks is usually arranged. It is only necessary to remove a simple cyst if it persists over several months or causes symptoms.
The factors that determine whether a cyst should be removed are:
Complexity. If an ovarian cyst has septae, solid areas, an irregular wall or increased blood flow.
Size. Over 5 cm is considered more significant.
Symptoms attributable to the cyst
The nature of the cyst suggesting whether it will resolve spontaneously or not.
Risk that the cyst is cancerous
Types of Surgery for Ovarian Cysts
Laparoscopic (Keyhole) surgery
Many cysts can be removed using keyhole surgery. This allows dissection and removal of the cyst without an abdominal incision with a quicker return to normal activities. The operation is performed using a telescope in an incision in the umbilicus and usually two other ports lower down on the abdomen. The cyst is placed in a bag and the fluid removed before the cyst wall is removed through one of the ports.
Recently robotic surgery has been used to improve keyhole surgery. This approach allows very much more precise surgery with even quicker recovery. Robotic surgery can be performed through a single port in the umbilicus making it virtually “scarless”.
If the cyst is possibly a cancer, even if that risk is low, an open operation is usually better, as laparoscopic surgery is more likely to spread the tumour than an open operation. Often this can be performed through a small incision and return to normal activities is almost as quick as with keyhole surgery.
Ovarian Cyst Assessment
Expert pelvic ultrasound scan with IOTA risk assessment
Consultation with a Gynaecological Oncologist
Full discussion of options for management
Expert Ultrasound only