When we looked at the ultrasound results closely however, it said that the ovarian cyst was at the right side, about 3 cm. in its widest diameter, thin-walled, and was signed out as a follicular cyst. I assured her this was one of the functional or physiologic cysts of the ovary. It was benign, and there was no need for any surgery; we would simply repeat the ultrasound after three to six months and see.
The ovaries are two structures (right and left) attached to the fallopian tubes and the uterus at the lower abdomen. Each month, from among the many unripe eggs inside it, one egg (the primary follicle) matures and is extruded out during ovulation. Sometimes the egg does not come out, and after a time the follicle becomes filled with fluid, and becomes a follicular cyst. These are benign growths that most of the time disappears spontaneously. The area from which the egg comes out is called the corpus luteum, and sometimes fluid also fills this area after ovulation and this becomes a corpus luteum cyst, another benign condition.
Many other non-malignant cysts can occur in the ovaries, like the dermoid cyst, which can grow to large sizes, carrying inside it skin, hair, neural tissues and sometimes even teeth and muscles; or, the so-called chocolate (endometrial) cyst, containing dark brown fluid. Many times too, numerous, very small (less than 1 cm) cysts grow at the edges of the ovaries, and the ovaries are considered polycystic.
We do not exactly know why ovarian cysts form. They occur very commonly in women during their reproductive age, probably because at this time the ovaries are actively involved in the menstrual cycle. Mature eggs come out every month, and hormones are produced in a recurring fashion. This is also a reason why ovarian cysts in post-menopausic women should be regarded with more caution, especially when there is sudden enlargement.
Symptoms
When cysts are small they are usually asymptomatic. This is when an accidental finding of an ovarian cyst surprises the woman the most. The request for a pelvic ultrasound (or sometimes, a whole abdomen ultrasound) for another ailment could provide a surprise finding.
However, the usual symptoms include dull abdominal pain, many times described simply as heaviness; or something vague like low back pains. Doctors agree that cysts are worrisome when they grow to more than 6 cm. in size; some would call growths that are less than this as simply “cystic ovaries.” When these cysts grow large they could even be felt by the woman herself, or her partner.
When the ovarian growth is large enough it could cause pressure on the bladder, so the woman urinates more frequently. Painful sexual intercourse too, could occur. At times there will be menstrual changes, or, dysmenorrhea. This usually occurs in endometrial cysts, where the endometrial glands inside the ovaries also bleed and the cysts grow every time the woman menstruates.
Dresses and pants too could become tighter as the cyst grows. Because of the space that the cyst occupies, nausea and vomiting occur, as the woman feels full easily after eating.
Complications
Ovarian cysts sometimes have pedicles (or long, thin attachments) and these could twist. The blood supply and nerves are affected by this torsion, and can cause severe pain. The ovarian cyst itself could also become infected, and the contents become an abscess, again, leading to pain and other signs of infection.
When the intra-cystic pressure increases to such an extent that the walls could no longer hold, there could be rupture, spilling out the contents of the cyst into the peritoneum. Again, pain ensues, and with time, infection (peritonitis) follows.
Hemorrhage too, is another feared sequel of an unattended ovarian cyst. Needless to say, there will be pain, and loss of blood inside the abdomen.
Treatment
As mentioned in Dolores’ case, when the ovarian cyst is deemed physiologic and small, there is room for observation, and watchful waiting. These functional cysts could resorb by themselves, or sometimes spill out their small contents, collapse and disappear.
Larger and symptomatic cysts (regardless of size) are managed by surgery. Many gynecologic surgeons now employ laparoscopy, which entails passing a thin, lighted instrument through the abdominal wall to remove the cyst. This is the best management for cysts that are free (no adhesions), and when ovarian cancer has been ruled out. Many times the surgeon will opt to do a laparotomy, which means opening up the abdomen to remove a large and adherent cyst.
Some gynecologists too, while observing an ovarian cyst over several cycles, will prescribe an oral contraceptive to prevent further ovulation while observing the existing growth.
Fear of malignancy
Dolores’ worry about malignancy then could be allayed, as hers was a functional cyst. Clinically though we could suspect malignancy in ovarian growths when the following occurs: sudden enlargement of the cyst, plus constitutional signs of malignancy that includes weight loss, anemia, and loss of appetite. There are ultrasound findings too that could make us suspect that the cyst is no longer benign: fluid in the abdomen (called ascitis), or seeing both cystic and solid structures in the same ovarian growth. In this case, a gynaecologic oncologist would need to do surgery for a debulking procedure (removal as much malignant tissue), sample the lymph nodes, and decide post-surgery therapies. We do not know why ovarian cancer develops. But studies show that this disease is associated with: age, obesity, smoking, infertility (and the taking of ovulation medications), and a positive family history of ovarian, breast, or colon cancer.
For Dolores, she went home that day relieved and at peace, finding resolution for her many questions and worries. — BM, GMA News
source: gmanetwork.com
