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Ovarian Cysts and Ovarian Cancer

What are ovarian cysts?
A cyst is a fluid-filled sac, and can be located anywhere in the body.
The most common type of ovarian cyst is called a functional cyst,  (either follicular or corpus luteal cyst) which often forms during the normal menstrual cycle.
Each month the ovaries grow tiny cysts that hold the eggs. When the egg is ready the sac opens to release the egg.  Usually the sac then dissolves.  Sometimes the sac does not open to release the egg and the sac continues to grow  (this is a follicular cyst).   This usually goes away on it's own over a couple of months.
Sometimes the sac does not dissolve and continues to grow.  This is a corpeus luteal cyst and can cause problems if it twists or bleeds.

There are also other types of cysts:
Endometriomas:  These develop in women who have endometriosis.  They are often called chocolate cysts because of their colour.
Cystadenomas: These develop from cells on the outer surface of the ovary and are contain sticky gel or fluid
Dermoid cysts: These are strange cysts that sometimes contain hair, teeth or cartilage. Early in the development of the embryo, cells become specialized.  Eg into skin cells, or cartilage or bone etc.   Sometimes cells in the ovary do not do this and instead can develop into a range of structures including teeth or hair.  Treatment is by removal.
Polycystic ovaries:  Sometimes a woman may have multiple cysts in her ovaries.  The eggs mature within the follicles, or sacs, but the sac doesn't break open to release the egg. The cycle repeats, follicles continue to grow inside the ovary, and cysts form. There are hormonal problems with  polycystic ovaries.

What are the symptoms of ovarian cysts?
Many women have ovarian cysts without having any symptoms. Sometimes, though, a cyst will cause these problems:
� pressure, fullness, or pain in the abdomen
� dull ache in the lower back and thighs
� problems passing urine completely
� pain during sexual intercourse
� weight gain
� painful menstrual periods and abnormal bleeding
� nausea or vomiting
� breast tenderness

How are cysts found?
Sometimes ovarian cysts do not cause symptoms and are found when the doctor does a vaginal examination.  Then an ultrasound can be performed along with blood tests to check hormone levels.  The ultrasound will let you know if the cyst is solid or fluid filled.  Also there is a test called CA 125 which can give more information about what kind of cyst this can be.  It is used to check for ovarian cancer. 
How are cysts treated?
Watchful waiting.   A lot of cysts will go away on their own and if the woman is young and it is a fluid filled cyst then this is a good option. 

Surgery. If the cyst doesn't go away after several menstrual periods, has gotten larger, looks unusual on the ultrasound, causes pain, or you're postmenopausal, the doctor may want to remove it. There are two main surgical procedures:

 Laparoscopy:  This is when a very small cut is made on the abdomen and a telescope like instrument is inserted into the abdomen.  If the cyst is small and non cancerous it can be removed.

 Laparotomy:  If the cyst is large or suspicious then a bigger cut is made and the cyst is removed and checked for cancer.

Prevention
Birth control pills can help to prevent functional cysts.

Ovarian Cancer
This is a relatively uncommon kind of cancer but it is often diagnosed late in the disease so can cause a high death rate.

It is often diagnosed late because the symptoms may be non specific and include:
� Pelvic discomfort
� Pain on intercourse
� Increase in abdominal girth, i.e. seems like the woman is getting fat
� Irregular bleeding
� Bowel and bladder problems
� Weight gain or loss

Risk factors
� If there is a history in the family of ovarian cancer.  Also family or personal history of bowel, prostate, breast cancer also can increase the risk.
� Increasing age
� Use of fertility drugs

How can it be Found?

� Sometimes it can be detected with a vaginal examination.  It is not detected with a cervical smear.  I suggest you always ask your doctor to do a vaginal exam when you are having a cervical smear as this is the only time that someone will have a feel of your ovaries.  It is also a chance to pick up other things such as fibroids.

� Ultrasound
� Blood test. There is a blood test called CA125 which can be elevated with ovarian cancer.  Although it is not an approved screening test, it can be helpful along with ultrasound.  It is also elevated with other conditions eg endometriosis.

Main message:
Ask your doctor or nurse to do a vaginal exam when you are having a smear as sometimes these are not routinely done.  This is especially important as you get to be over 40 years of age.
If you have symptoms, get them checked.

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