Ovarian cysts are a common occurrence for many individuals, leading to understandable concerns about their potential connection to cancer. While the thought of any growth on an organ can be alarming, it is important to understand that the vast majority of ovarian cysts are benign. These fluid-filled sacs often resolve on their own without intervention. Although most cysts are harmless, a small percentage can be cancerous or indicate a higher risk, which is why medical evaluation is important.
Understanding Ovarian Cysts
Ovarian cysts are fluid-filled sacs that develop on or within an ovary. They are very common. Many cysts form as a normal part of the menstrual cycle, known as functional cysts.
Functional cysts occur when an egg-containing follicle either fails to release the egg and continues to grow, forming a follicular cyst, or when the follicle reseals and fills with fluid after releasing the egg, creating a corpus luteum cyst. These types of cysts are generally harmless, often cause no symptoms, and typically disappear within a few months. Other types of cysts, not directly related to the menstrual cycle, can also form, and while most are benign, some may require monitoring.
The Relationship Between Ovarian Cysts and Cancer
The vast majority of ovarian cysts are benign and do not develop into cancer. Simple cysts, which are fluid-filled sacs with thin walls, are typically not associated with an increased risk of ovarian cancer.
However, some types of ovarian cysts are considered more complex and may warrant closer attention. Complex cysts can contain solid areas, thicker fluid, internal divisions (septations), or a bump on their surface. While most complex cysts are also benign, they have a slightly higher chance of being cancerous compared to simple cysts. Specific types like dermoid cysts (which can contain various tissues like hair or teeth), endometriomas (cysts filled with menstrual blood from endometriosis), and cystadenomas (cysts on the ovary’s surface) are usually benign but may sometimes require removal. Malignant transformation of a cyst is rare, particularly before menopause.
Recognizing Symptoms and Risk Factors
Ovarian cysts often do not cause any symptoms and may only be discovered during a routine pelvic examination or imaging for another reason. When symptoms do occur, they can include pelvic pain, which may be a dull ache or a sharp sensation, bloating, or a feeling of fullness or pressure in the abdomen. Some individuals may experience pain during sexual activity, changes in bowel or bladder habits, or irregular menstrual periods. These symptoms are often vague and can be caused by many conditions, not just ovarian cysts or cancer.
Risk factors for ovarian cancer itself include increasing age, particularly after menopause, a family history of ovarian or breast cancer, and certain genetic mutations such as BRCA1 or BRCA2. Other factors can include never having been pregnant or having endometriosis. The presence of an ovarian cyst does not inherently increase the risk of ovarian cancer.
Diagnosis and Follow-Up
When an ovarian cyst is suspected or discovered, healthcare providers typically begin with a pelvic examination. The next step often involves imaging, most commonly a transvaginal ultrasound. This imaging helps determine the cyst’s size, its internal characteristics (whether it’s simple and fluid-filled or complex with solid components), and its location.
In some cases, especially for postmenopausal individuals or when a cyst appears complex, blood tests such as CA-125 may be ordered. CA-125 is a protein that can be elevated in ovarian cancer, but it can also be high due to other non-cancerous conditions like endometriosis, pelvic infections, or even menstruation, so it is not a definitive cancer marker. For most simple, functional cysts, a “watchful waiting” approach is common, with monitoring via repeat ultrasounds to see if it resolves. If a cyst is large, causing persistent symptoms, growing, or has features concerning for malignancy, surgical removal may be recommended for further evaluation and treatment.