Last month we discussed when to save and when to remove ovaries. With the
frequent use of CT scans, MRIs, and sonograms, an asymptomatic ovarian
cyst (a fluid filled growth, imagine a water balloon) is commonly found.
It is present but the person is unaware of it. Each menstrual cycle a
woman ovulates creating a small cyst on her ovary, which we call a follicle
that is < 3cm, approximately 1 inch, in diameter. The follicle pops,
releases an egg, then collapses. Sometimes the follicle fails to pop open
or collapse, resulting in formation of a cyst. The cyst can grow by filling
with fluid or blood. However, over time (usually 1-3 months) it gradually
collapses. This often happens without any awareness by the person. Rarely
a cyst will rupture or twist which will cause severe pain prompting a
visit to her gynecologist.
Multiple studies have demonstrated that observation of a painless cyst,
even in menopausal women, is the prudent course. In one study of women
over 50, 70% of “simple” cysts resolved spontaneously within
6 weeks, and of the 220 women with persistent ones, none developed cancer
after an average follow-up of nearly 7 years. This information should
help allay fears and decrease the need for unnecessary surgery. For those
with persistent cysts annual surveillance with repeat testing is appropriate,
or sooner if worrisome symptoms, like persistent pain or bloating appear.
Sometimes to help us decide on the clinical course, we obtain a blood test
called CA 125. When the level is in the normal range, it adds reassurance
that it is wise to wait, especially in older women. Unfortunately, the
CA 125 is falsely elevated in about 70% of premenopausal women with cysts
because of confounding benign pathology such as fibroids or endometriosis.
Conversely, about 50% of women with stage I ovarian cancer have a negative
test. Therefore, it is far from the perfect tumor marker.
ovaries make cysts for a living. Most cysts can be watched and resolve without
surgery. And even when surgery is necessary, it can often be performed
using a minimally invasive approach called laparoscopy with button hole
sized incisions and less than a week of recovery.