Surgery For Suspicious Ovarian Cysts

Ovarian cysts, though a typical appearance among ovary-owners, might be suspicious and lead to ovarian cancer. Thus, they require removal through surgery.

What are the ovaries?

Your ovaries are small organs located deep within your pelvis. Eggs grow inside them, within a sac or follicle. During ovulation, ovaries release an egg its sac into one of your fallopian tubes. After that, the sac typically dissolves, but sometimes the sac can remain and fill with air or fluid to develop into a cyst. Cysts that form in or around your ovaries often go unnoticed. They may cause only mild symptoms or no noticeable symptoms at all.

What are ovarian cysts?

Cysts are fluid-filled sacs that can grow undetected on the ovaries. Many women have cysts on their ovaries that they cannot feel, which come and go with their menstrual cycle. Usually, you can’t feel a cyst unless the ovary twists or the cyst ruptures, or grows big enough that you can feel it.

Ovarian cysts occur commonly in women of all ages. Some women with ovarian cysts have pain or pelvic pressure, while others have no symptoms. Irregular menstrual periods are not usually related to an ovarian cyst.

Fortunately, most ovarian cysts do not require surgical removal. They are not caused by cancer. Cysts can vary in size from less than one centimeter (one-half inch) to greater than 10 centimeters (4 inches).

Ovarian cysts and cancer

It’s relatively rare, but some ovarian cysts are malignant, or cancerous. Fortunately, most are benign, or not cancerous. Your doctor’s recommended treatment plan will depend on the type of ovarian cyst or tumor that you have, as well as your symptoms. Oftentimes they won’t require any treatment.

Symptoms of ovarian cysts

Ovarian cysts may be either symptomatic or asymptomatic. Women with symptoms from ovarian cysts typically experience pain or pressure in the lower abdomen on the side of the cyst. This pain may be dull or sharp; it may be constant or come and go. Crampy lower abdominal pain is not usually related to ovarian cysts. If an ovarian cyst ruptures, a woman may experience a sudden sharp pain, which may be severe. Women with torsion (twisting) of an ovary may feel pain along with nausea and vomiting. Abnormal periods or vaginal bleeding are not usually related to ovarian cysts.

Benign or malignant ovarian cysts

Your doctor will examine the ultrasound to look for clues if the cyst is likely benign – non-cancerous – or if it has characteristics suspicious for cancer. Clues that tell if it is a benign cyst are:

• it is simple-looking and fluid-filled
• no solid growths
• and it has no extra blood flow to it.

Clues that make the doctor more suspicious of this mass would be that it appears more complex in the ultrasound image, there are areas that have a solid appearance and there is an increased blood supply flowing to it.

If the cyst looks benign, the doctor may advise you to watch your cyst through a series of ultrasound tests over a few months. Or, they may suggest the cyst be removed in surgery. A general gynecologist can remove a cyst. If there are clues that this mass could be cancer, you will be referred to a cancer surgeon (a gynecologic oncologist) for further examination and consultation. The cancer surgeon can remove the mass. If it is determined to be cancer, they can also remove lymph nodes. This is to see if the cancer has spread. If there is cancer in other areas that are found during surgery, it will be removed.

Getting referred to a gynecologic oncologist doesn’t mean you have ovarian cancer. It means your doctor saw something suspicious and wants to provide you the best care with an opinion from someone who can suggest the best plan of action. If it is determined that the cyst is likely benign, it may be suggested that you return to your general gynecologist for observation or removal.

Surgery for Suspicious Ovarian Cysts

In most cases, ovarian cysts disappear in a few months without the need for treatment.

The requirement of treatment depends on:

1. its size and appearance
2. whether you have any symptoms
3. whether you’ve had the menopause – if you are postmenopausal there is a slightly higher risk of ovarian cancer

Watchful waiting

In most cases, doctors recommend a policy of “watchful waiting”.

This means you will not receive immediate treatment, but you may have an ultrasound scan a few weeks or months later to check if the cyst has gone.

For instance, if you have been through menopause you may be advised to have ultrasound scans and blood tests every 4 months for a year. This is because you have a slightly higher risk of ovarian cancer.

If the scans show that the cyst has disappeared, further tests and treatment are not usually necessary. Surgery for suspicious ovarian cysts may be recommended if the cyst is still there.

Surgery

Large or persistent ovarian cysts, or cysts that are causing symptoms, usually need to be surgically removed.

Surgery is also normally recommended if there are concerns that the cyst could be cancerous or could become cancerous.

There are 2 types of surgery for suspicious ovarian cysts:

• a laparoscopy
• a laparotomy

These are usually carried out under general anesthetic.

Laparoscopy surgery for suspicious ovarian cysts

• This is a type of keyhole surgery. Small cuts are made in your tummy and gas is blown into the pelvis to allow the surgeon to access your ovaries.
• A laparoscope (a small, tube-shaped microscope with a light on the end) is passed into your abdomen so the surgeon can see your internal organs. The surgeon then removes the cyst through the small cuts in your skin.
• After the cyst has been removed, the surgeon closes the cuts using dissolvable stitches.
• Most people are able to go home on the same day or the following day.

Laparotomy surgery for suspicious ovarian cysts

• During a laparotomy, a single, larger cut is made in your tummy to give the surgeon better access to the cyst.
• The whole cyst and ovary may be removed and sent to a laboratory to check whether it’s cancerous. Stitches or staples will be used to close the incision.
• You may need to stay in the hospital for a few days after the procedure.

What happens after the surgery?

The time it takes to recover from surgery is different for everyone. After a laparoscopy or a laparotomy, it may take as long as 12 weeks before you can resume normal activities.

If the cyst is sent off for testing, the results should come back in a few weeks and your consultant will discuss with you whether you need any further treatment.

If your test results show that your cyst is cancerous, both of your ovaries, your womb (uterus), and some of the surrounding tissue may need to be removed.

This would trigger early menopause and mean that you’re no longer able to get pregnant.