Ovarian cysts Flashcards
How are ovarian masses normally detected?
They are often silent.
Detected when they are very large and cause abdominal distension or on US scan
Acute presentation is with ‘accidents’
Name some ovarian ‘accidents’
- Rupture of an ovarian cyst into the peritoneal cavity
- Haemorrhage into a cyst
- Torsion of the pedicle
Sx of a ruptured cyst?
Intense pain, particularly with an endometrioma or dermoid cyst
Where can a cyst haemorrhage into?
Into the cyst itself, or into the peritoneal cavity
Sx of a cyst haemorrhage?
Pain
What can severe haemorrhage into the peritoneal cavity cause?
Hypovolaemic shock
What does pedicle torsion cause?
Infarction of the ovary and/or fallopian tube
This is v painful
What is the Mx/Tx of torsion?
Urgent surgery and detorsion to save the ovary
What can a cyst be?
Anything from the malignant to the physiological
Common ovarian cysts in premenopausal women?
- Follicular / luteal cysts
- Dermoid cysts
- Endometriomas
- Benign epithelial tumours
Common ovarian cysts in postmenopausal women?
- Benign epithelial tumour
2. Malignancy
What is a follicular or luteal cyst?
Enlarged follicles or corpora lutea respectively.
What can prevent folliuclar or luteal cysts?
The combined pill
Do follicular or luteal cysts cause more Sx?
Luteal
How are cysts managed if no Sx present?
Tx not required and the cyst is observed using serial US scans and CA125
What is done if a cyst appears >5cm for more than 2 months?
There is a remote possibility of malignancy, so the serum cancer antigen 125 (CA 125) level is measured and a laparoscopy considered to remove or drain the cyst
Chronic Sx from ovarian cysts?
- Chronic pain (dull ache)
- Pressure on other organs (urinary frequency or bowel disturbance)
- Dyspareunia (endometrioma)
- Cyclical pain (endometrioma)
- Abnormal uterine bleeding
- Hormonal effects
What is a dermoid cyst?
A common benign tumour usually arising in young premenopausal women. May contain fully differentiated tissue of all cell lines, commonly hair and teeth. Commonly bilateral, seldom painful and often ASx. However, rupture is painful.
Malignant form, solid teratoma, do exist but rare
What is an endometrioma?
Endometriosis commonly causes altered blood to accumulate in ‘chocolate cysts’. In the ovary, they are called endometriomas. Rupture is very painful but uncommon
What haematological tests should be done?
- FBC
2. Tumour markers (CA125 and in younger women (<40) with a solid mass; AFP, hCG, LDH, inhibin and oestradiol)
What imaging should be done?
Abdominal and pelvic USS; presence and appearance of pelvic mass and ascites
