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Serous and mucinous cysts: These are benign cysts which can grow to be massive in size. They can be unilocular, having only one chamber, or can be multilocular, where the tumour is an amalgamation of several pockets of fluid. Serous cysts consist of watery fluid, usually clear or straw-coloured. Mucinous cysts contain gel type fluid, almost always clear. Serous and mucinous cysts have got more deadly cousins, the malignant serous and mucinous cystadenocarcinomas.

Endometriotic cysts:

Endometriosis is a condition which causes pelvic pain especially during menstruation and can cause painful sexual intercourse. It is a benign condition. Sometimes the endometriotic lesions are within the ovary. Because the nature of endometriosis is that the lesions bleed every time the woman is menstruating, the lesions that are within the ovary will bleed within thereby forming blood filled ‘cysts’. These are known as endometriotic cysts. Since the blood accumulates over time, it is usually found to be thick and dark. This is why endometriotic cysts are also called ‘chocolate’ cysts. An endometriotic cyst is also known by the term ‘endometrioma’

Endometriotic cysts are almost always surgically removed, usually via ‘keyhole’ (laparoscopic) surgery.

Malignant ovarian cysts

Whilst the majority of ovarian cysts are benign, some will be found to be malignant. Benign and malignant cysts have one thing in common. Both tend to be symptom-less. When symptoms start to appear with malignant cysts, the disease is usually fairly advanced. The symptoms will therefore be due to the spread of the disease elsewhere rather than the primary cyst.

The incidence of ovarian cancer is estimated at 10 -15 per 100,000 women per year. It is the second commonest gynaecological cancer after cancer of the lining of the womb. In UK, around 4,400 women die of the disease every year. The figure in the United States is 16.000. Worldwide, annual mortality is estimated at 125,000. Ovarian cancer is deadly mainly because of late presentation and absence of symptoms in the early stages.

Malignant ovarian cysts tend to be complex on ultrasound scan. This prompts investigations which will include blood tests for levels of bio-markers such as CA-125 and others, hormone profile and, where still unclear, a surgical diagnostic procedure, usually laparoscopy.

Treatment for ovarian cysts:

As mentioned earlier, benign cysts can and are usually managed conservatively with observation alone. The vast majority will resolve spontaneously. When very large in size, benign cysts pose a different type of problem. They can twist on their stalk. If this happens, it is an emergency requiring immediate surgical intervention. It is therefore common practise to advise surgical removal of large cysts, especially when more than 10 cm diameter. Aspiration of the cyst can be done but this tends to have unsatisfactory results since the majority of them tend to fill up again quite rapidly.

Surgical excision of the cyst is usually done via keyhole (laparoscopy) surgery. However, this is not always feasible or desirable and therefore, in some cases, an open procedure (laparotomy) is done.

Ovarian cysts before puberty

For children who have not reached puberty, it is unusual for ovarian cysts to develop. Cysts have been occasionally found in infants and rarely even in fetuses yet to be born. Pre-puberty ovarian cysts have always got to be actively investigated. In many cases, these will be innocuous and conservative management is sufficient. However, in some cases, presence of ovarian cysts could be a manifestation of a hormonal disorder requiring medical or surgical intervention.

Ovarian cysts after the menopause

Post-menopausal ovarian cysts are also uncommon. Whilst the majority of women in the reproductive age will be found to have ovarian cysts at any time, cysts are found in under 15% of post-menopausal women. These are usually persistent cysts from before menopause. However, all cysts found after the menopause need to be actively investigated. Even in this age group, the majority of cysts will be found to be benign. Usually a detailed ultrasound scan and blood tests for specific bio-markers and hormones will help distinguish benign from potentially malignant cysts. When scan findings show a simple-looking cysts and bio-marker and hormone blood test results are normal, management is usually conservative. Surgical removal will be advised if the cyst is increasing in size or changing in character (developing solid components), bio-marker (CA-125) level are rising or the person is becoming symptomatic.

Last update: October 07, 2012

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A fairly large endometriotic ovarian cyst or ‘endometrioma’. It is seen to dwarf even the womb (partially seen top right)

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