Ovarian Cysts (cont.)
What symptoms are caused by ovarian cysts?
Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. The pain can be caused from:
- rupture of the cyst,
- rapid growth and stretching,
- bleeding into the cyst, or
- twisting of the cyst around its blood supply (known as torsion).
How are ovarian cysts diagnosed?
Sometimes ovarian cysts may be noticed by a health care practitioner during a bimanual examination of the pelvis. If a cyst is suspected based upon the symptoms of physical examination, imaging techniques are used. Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting ovarian cysts. Ultrasound is an imaging method that uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and causes no harm.
Cysts can also be detected with other imaging methods, such as CT
scan or MRI
scan (magnetic resonance imaging).
How can the physician decide if an ovarian cyst is dangerous?
If a woman is in her 40's, or younger, and has regular menstrual periods, most ovarian masses are
"functioning ovarian cysts," which are not really abnormal. Examples include follicular cysts and corpus luteum cysts. These are related to the process of ovulation that happens with the menstrual cycle. They usually disappear on their own during a future menstrual cycle. Therefore, especially in women in their 20's and 30's, these cysts are watched for a few menstrual cycles to verify that they disappear.
Because oral contraceptives work in part by preventing ovulation, physicians will not
generally expect women who are taking oral contraceptives to have common "functioning ovarian cysts." Thus, women who develop ovarian cysts while taking oral contraceptives may be advised against simple observation; rather, they may receive closer monitoring with pelvic ultrasound or, less commonly, surgical exploration of the ovary.
Other factors are helpful in evaluating ovarian cysts (besides the woman's age, or whether she is taking oral contraceptives). A cyst that looks like it is just one simple sac of fluid on the ultrasound is more likely to be benign than a cyst with solid tissue in it. So the ultrasound appearance also plays a role in determining the level of suspicion regarding a serious ovarian growth.
Ovarian cancer is rare in women younger than age 40. After age 40, an ovarian cyst
has a higher chance of being cancerous than before age 40, although most ovarian
cysts are benign even after age 40. CA-125 blood testing can be used as a marker
of ovarian cancer, but it does not
always represent cancer when it is abnormal.
- First, many benign conditions in
women of childbearing age can cause the CA-125 level to be elevated, so CA-125
is not a specific test, especially in younger women. Pelvic infections,
uterine
fibroids, pregnancy, benign (hemorrhagic) ovarian cysts, and liver disease are
all conditions that may elevate blood CA-125 levels in the absence of ovarian cancer.
- Second,
even if the woman has an ovarian cancer, not all ovarian cancers will cause the
CA-125 level to be elevated. Furthermore, CA-125 levels can be abnormally high
in women with breast,
lung, and
pancreatic cancer.
Next: How are ovarian cysts treated? »
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