Post-Menopausal Disorders - Ovarian Cysts

Question 1

What is a cyst?

Answer 1

Fluid-filled sac.

Question 2

What are Functional Ovarian Cysts related to?

Answer 2

Fluctuating hormones of the menstrual cycle.

Question 3

Epidemiology of Ovarian Cysts.

Answer 3

1. Majority - Premenopausal Women : Benign.

2. Postmenopausal : Malignancy Concern - INVESTIGATE.

Question 4

Types of Ovarian Cysts (2).

Answer 4

1. Follicular Cyst (commonest).

2. Corpus Luteum Cyst.

Question 5

What are Follicular Cysts? (3)

Answer 5

1. Developing follicle fails to rupture and release the egg.
2. Thin Walls and No Internal Structures.
3. Disappear after a few internal structures.

Question 6

What are Corpus Luteum Cysts? (3)

Answer 6

1. Corpus Luteum fails to break down and fills with fluid instead.
2. Often : Early Pregnancy.
3. Symptoms : Pelvic Discomfort, Pain, Delayed Menstruation.

Question 7

Give 5 other types of Ovarian Cysts.

Answer 7

1. Endometrioma.
2. Serous Cystadenoma (Benign tumour of epithelial cells).
3. Mucinous Cystadenoma (big version of Serous Cystadenoma).
4. Dermoid Cysts / Germ-Cell Tumours (benign teratomas associated with Ovarian Torsion).
5. Sex Cord Stromal Tumours (arising from storm or sex cords).

Question 8

What is Meig’s Syndrome? (3)

Answer 8

Triad of  (OAP):
1. Ovarian Fibroma.
2. Ascites.
3. Pleural Effusion.
Older Women.

Question 9

Investigations of Complex Ovarian Cysts (Multi-Loculated).

Answer 9

BIOPSY : Exclude malignancy.

Question 10

Investigations of Ovarian Cysts.

Answer 10

1. Premenopausal + Simple (<5cm) Ovarian Cyst - No US or Investigations.
2. Risk of Malignancy Index.
3. Women Under 40 + Complex Ovarian Mass : Germ-Cell Tumours (LDH, aFP, hCG).

Question 11

What is the Risk Malignancy Index? (3)

Answer 11

Estimate of the risk of an ovarian mass being malignant based on :

1. Menopausal Status.
2. US Findings.
3. CA-125 Level.

Question 12

Referrals with Ovarian Masses.

Answer 12

1. Possible Cancer - 2 Week Wait.

2. Possible Dermoid Cyst - Gynaecology Referral.

Question 13

Management of Simple Ovarian Cysts in Premenopausal Women (3).

Answer 13

1. <5cm : Resolve within 3 cycles + no follow-up.
2. 5-7cm : Routine referral to Gynaecology and annual US monitoring.
3. 7+cm : MRI Scan or Surgical Evaluation.

Question 14

Management of Ovarian Cysts in Postmenopausal Women (2).

Answer 14

1. Raised CA-125 : 2 Week Wait.

2. <5cm + Normal CA-125 : US every 4-6 Months.

Question 15

Surgical Management of Ovarian Cysts (2).

Answer 15

1. Persistent/Enlarging - Laparoscopy.

2. Ovarian Cystectomy +/- Oophorectomy.

Question 16

Complications of Ovarian Cysts (3).

Answer 16

1. Torsion.
2. Haemorrhage (into Cyst).
3. Rupture (into Peritoneum).

Question 17

When is an Ovarian Cyst most likely to rupture?

Answer 17

Physical activity e.g. sex, exercise.