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