WHAT IS AN OVARIAN CYST?

Ovarian cysts are sacs that can contain water, blood or fat.  They are very common in women and usually do not cause any symptoms. Most ovarian cysts form naturally and disappear within a few months without the need for any treatment. They are often the result of hormonal irregularities.

Normally, during each menstrual cycle, follicular cysts are formed in the ovaries, which contain reproductive cells called follicles, which carry egg cells and can reach 3 cm in size. These cysts are normal and necessary for reproduction. The cyst then ruptures and the egg is released. If the egg is fertilized with sperm, pregnancy occurs; if the egg is not fertilized, it is excreted in the form of menstruation after 14 days. As a result of hormonal imbalance, this cyst may not rupture and continue to grow. Sometimes the bleeding that occurs after rupture does not stop and it becomes a blood-filled cyst (hemorrhagic cyst).  Follicular cysts and hemorrhagic cysts often do not require treatment and disappear spontaneously within two months. Sometimes bleeding does not stop in blood cysts and surgical intervention may be required. The most common cysts seen in reproductive age are called simple cysts and are not dangerous.

WHICH CYSTS SHOULD BE TREATED SURGICALLY?

If the simple cysts mentioned above are very large, have not disappeared for a long time, if there is a suspicion that the cyst is a simple cyst, if it prevents ovulation, surgery should be considered.

Endometrioma (chocolate cyst), dermoid cyst, inflammatory cysts can also be seen in the ovaries.

Chocolate Cysts (Endometrioma): These cysts, popularly known as chocolate cysts, usually develop due to endometriosis. Endometriosis can prevent pregnancy because it is a condition that develops when the endometrium (uterine lining) tissue inside the uterus is found outside the uterus. If pregnancy is prevented due to chocolate cysts, these cysts may need to be surgically removed if they are very large.

 Dermoid Cysts: These cysts are cystic structures that cause suspicion of cancer due to their hard structure. These cysts begin to form when the patient is in her mother’s womb. They may contain fat, hair, bone and teeth. If they are cancerous or extremely large, surgical removal is recommended. Very small dermoid cysts cannot be removed surgically. Cysts that do not show cancerous features but are considered as dermoid cysts must be followed up regularly

Cysts should be evaluated according to the patient’s age and history. Ultrasound or other imaging methods cannot be used to determine whether the cyst is benign or malignant. An examination by a physician experienced in cancer can reveal the type of cyst with a higher probability. As the age of the patient increases, the likelihood that the cysts seen in the ovary are malignant increases. Cysts with suspected malignancy (malignant-cancer) should be operated on by a gynecooncologist if possible.

WHAT ARE THE SYMPTOMS OF OVARIAN CANCER?

Patients may suspect that they have ovarian cancer. Since the ovaries are organs in the abdomen, the presence of cysts can be understood by examination and ultrasound. Patients should suspect an ovarian cyst and consult a physician, especially in the presence of the following findings.

Severe abdominal and groin pain

Low back pain

Abdominal distension, indigestion

Mass in the hand in the groin area

HOW TO RECOGNIZE AN OVARIAN CYST

Ovarian cysts can be easily detected by ultrasound and examination. Contrast-enhanced MRI (MRI with medication) is useful to better understand the size of the cyst, whether it is benign or malignant, its spread, and the condition of the blood vessels. Blood tests such as CA-125, HE4, CA 15-3, CEA, CA 19-9, ß-hcg, AFP also provide information about the cyst. Especially in cysts that are thought to be malignant, these tests are necessary to evaluate the treatment response.

IS THERE A TREATMENT FOR OVARIAN CYSTS OTHER THAN SURGERY?

Follow-up: Most ovarian cysts do not require treatment. For these cysts, it is enough to see your doctor periodically. Your cyst may stay the same size, shrink or disappear completely. A sudden onset of pain during follow-up can be important. The cyst may have burst, turned around or bled. Contact your doctor in case of sudden onset of pain.

Birth control pills: This is actually a somewhat outdated treatment method that we do not use very often with our patients. It can be useful in the treatment of simple cysts. The aim is to suppress ovulation and suppress the development of new follicles. Thus, a new cyst will not confuse the existing cyst.