Ovarian cysts are common fluid-filled sacs that develop on or within an ovary. They are a frequent finding in individuals with ovaries of all ages. While many are harmless and cause no symptoms, some can lead to discomfort or, rarely, more serious complications.
Understanding Septated Ovarian Cysts
The term “septated” refers to internal dividing walls, known as septa, within the cyst. These septa create multiple compartments, giving the cyst a complex appearance on imaging scans. Unlike simple cysts, which are typically uniform and fluid-filled without internal divisions, septated cysts have these internal structures. The characteristics of these septa, such as their thickness and the presence of blood flow, are important in distinguishing different types of cysts. While simple cysts often resolve on their own, septated cysts may require closer monitoring.
Assessing the Risks
Septated ovarian cysts can raise concerns due to their complex appearance, particularly regarding the possibility of malignancy. However, the majority of septated cysts are benign and do not pose a serious threat. Septated cystic ovarian tumors without solid areas or papillary projections have a very low risk of being cancerous, often less than 1%.
The risk of malignancy is influenced by factors such as the thickness of the septa and the presence of solid components within the cyst. Thicker septations, especially those exceeding 0.5 mm, can be a more concerning feature, particularly when combined with other suspicious characteristics. Conversely, thin septations, less than 2 mm, are generally associated with benign conditions. Age also plays a role, as cysts developing after menopause have a slightly higher chance of being cancerous compared to those in premenopausal individuals.
Beyond malignancy, septated ovarian cysts can lead to other complications. A cyst may rupture, which can cause sudden, sharp pelvic pain, sometimes accompanied by bleeding. Larger cysts carry a greater risk of rupture.
Another possible complication is ovarian torsion, where a large cyst causes the ovary to twist, potentially cutting off its blood supply. This condition can result in severe pain, nausea, and vomiting, and requires immediate medical attention. The risk of torsion or rupture for benign-appearing septated cysts is low, between 0.2% and 0.4%.
Diagnosis and Treatment Approaches
The diagnosis of septated ovarian cysts typically begins with a pelvic examination, where a healthcare provider may feel for any lumps or changes. The primary diagnostic tool is an ultrasound, which uses sound waves to create images of the ovaries and can determine the cyst’s size, location, and internal characteristics, including the presence and nature of septations. Magnetic Resonance Imaging (MRI) may also be used for more detailed characterization, especially if there are concerns that cannot be fully addressed by ultrasound.
Blood tests, such as the CA-125 test, might be ordered, particularly if there is a concern about malignancy or if the individual is postmenopausal. It is important to note that CA-125 levels can be elevated due to various non-cancerous conditions, including endometriosis or pelvic inflammatory disease, so this test alone is not definitive for cancer. Pregnancy tests are also common to rule out conception-related cysts.
Treatment approaches for septated ovarian cysts vary depending on factors such as the individual’s age, symptoms, cyst size, and features observed on imaging. For many small, asymptomatic septated cysts, particularly in premenopausal individuals, a “watchful waiting” approach is often recommended. This involves monitoring the cyst with follow-up ultrasounds over several weeks or months to see if it resolves on its own or changes in size or appearance. Many septated cysts, around 38.8%, resolve spontaneously within a year.
If a cyst is large, causes persistent symptoms, or shows concerning features suggestive of malignancy, surgical intervention may be considered. Surgery can often be performed using minimally invasive laparoscopic techniques, where the cyst is removed through small incisions. In some cases, if the cyst is very large or cancer is suspected, a larger open surgical procedure might be necessary. The goal of surgery is often to remove only the cyst while preserving the ovary, especially in individuals who wish to maintain fertility. However, if there is a high suspicion of cancer or significant damage to the ovary, removal of the entire ovary might be necessary.