Ovarian cysts are fluid-filled sacs that form in or on the ovaries. They are common, often forming as part of the menstrual cycle. While they can cause concern, most are benign and do not develop into cancer. However, a small percentage can be cancerous, making medical evaluation important.
Understanding Common Ovarian Cysts
Many ovarian cysts are functional, forming during the menstrual cycle. Follicular cysts develop when a follicle containing an egg grows larger than usual and does not release it. Corpus luteum cysts occur after an egg is released, when the remaining sac reseals and fills with fluid. These functional cysts are harmless, often resolving on their own within weeks or months.
Other common benign types include dermoid cysts, endometriomas, and cystadenomas. Dermoid cysts contain various tissues like hair, skin, or teeth, forming from embryonic cells. Endometriomas, often called “chocolate cysts,” are filled with dark, thick blood and are associated with endometriosis, a condition where uterine lining-like tissue grows outside the uterus. Cystadenomas are fluid-filled growths that develop from cells on the surface of the ovary.
When Ovarian Cysts Raise Concern for Cancer
While most ovarian cysts are benign, certain characteristics on imaging or specific types of ovarian masses may warrant closer investigation. Postmenopausal women, for example, have a slightly increased chance of developing cancerous cysts. Factors that make a cyst suspicious include its size, rapid growth, and appearance on imaging, such as solid components, internal partitions (septations), or abnormal blood flow within the cyst.
It is uncommon for a simple, functional ovarian cyst to transform into cancer. However, certain ovarian masses are cancerous from their inception. These include epithelial ovarian cancers, which arise from the outer surface of the ovary, and less common types like germ cell tumors and stromal tumors, which originate from different cell types within the ovary. If a cyst appears complex on imaging, with features like nodules or septations, it may be examined more closely. A 2019 study suggested that among women aged 50 or older, 6.5% of those with complex ovarian cysts might be diagnosed with ovarian cancer within three years.
Recognizing Symptoms and Diagnostic Steps
Ovarian cysts, whether benign or potentially concerning, can sometimes cause symptoms. These may include pelvic pain, abdominal bloating or pressure, and changes in bowel or bladder habits, such as a frequent urge to urinate. Some individuals may also experience abnormal bleeding or pain during intercourse. These symptoms can be similar to those of other conditions, so medical evaluation is important.
When an ovarian cyst is suspected, doctors employ several diagnostic methods to evaluate it. A physical examination, including a pelvic exam, is usually the first step. Imaging techniques like ultrasound are commonly used to visualize the cyst’s size, shape, and internal characteristics. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans may be used for more detailed evaluation, especially if ultrasound findings are unclear or suspicious. Blood tests, such as the CA-125 tumor marker, may also be performed, although CA-125 levels can be elevated due to benign conditions.
Medical Management and Monitoring
Once an ovarian cyst is diagnosed and evaluated, the management approach depends on its type, size, symptoms, and potential for malignancy. For many benign cysts, especially functional ones, expectant management or “watchful waiting” is often recommended. This involves monitoring the cyst over time with repeat imaging to see if it resolves on its own, which many do. Hormonal birth control may be prescribed in some cases to prevent the formation of new functional cysts.
If a cyst is large, persistent, causing significant symptoms, or has suspicious features, surgical intervention may be considered. Surgical options include a cystectomy, which involves removing only the cyst while preserving the ovary, or an oophorectomy, where the entire ovary is removed. The choice of procedure depends on factors like the cyst’s characteristics, the individual’s age, and their desire for future fertility. Regular follow-up with a healthcare provider is important to ensure appropriate monitoring and management of ovarian cysts.