Management of ovarian cysts
Dr Matt Hewitt
Benign• e.g functional cysts, serous cystademonas, dermoid (teratoma)
Non ovarian
Malignant• Epithelial tumours 90% - e.g serous cystadenoacrcinomas• Sex cord tumours• Germ cell tumours• Metastatic
• e.g Hydrosalpinx, tubovarian abcess
Ovarian cysts
Ovarian cancer
• Lifetime risk 1 in 70• 90% are epithelial tumours• 75% present at late stage III/IV• 5 – 10 % Hereditary predisposition BRCA I and
II HNPCC
0
20
40
60
80
100
1 2 3 4
Stage at diagnosis and 5 year survival
Uterus
Cervix
Ovary
FIGO Staging
Pre menopausal ovarian cysts• 10% of women will undergo ovarian
surgery at some point• Symptomatic cysts 1 to 3 1000 population• Simple cysts < 5cm usually resolve, do not
require follow up • PCO on scan do not require follow up scan
Post menopausal cysts• Increasing detection of ovarian cysts
• 21% have abnormal ovarian pathology
• Simple Cysts <5cm – low risk of malignancy
Clinical examination
• If its palpable it needs surgery
• Ascites
• Tenderness
• Fixed
• Differentiating between uterus and ovarian mass
ImagingUltrasound
– good assessment of the ovary and presence of ascites
MRI
– good but expensive assessment of ovary
– Rarely gives additional information on nature of cyst
– Is good in
CT scan
– not good at evaluating cyst
- good in presence of ascites
Ultrasound• Trans abdominal and transvaginal (TVS)• Size• Simple – unilocular, no blood flow• Complex – Multilocular, solid elements, irregular,
papillary projections, blood low• Ascites
Tumour markers
• Ca 125– not sensitive and not specific– Should not be used in assessment of abdominal
pain
• hCG, α-FP, LDH– Should not routinely be used– Secondary care assessment germ cell tumours
Surgical management • Laparoscopy – up to 12cm• Laparotomy• Cystectomy – if confident not malignant• Unilateral oophorectomy• Bilateral oophorectomy
Disease
• serious• high prevalence of preclinical stage• natural history understood• lead time bias, length bias
Diagnostic test• sensitive and specific• simple and cheap• safe and acceptable• reliable
Diagnosis & Treatment• facilities are adequate• effective, acceptable, safe treatment available
WHO Principles of Screening
Premenopausal Asymptomatic
Post Menopausal Asymptomatic
Thank you