eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Ovarian Cysts: Follow-up

Author: C William Helm, MB, BCh, MA, FRCS(Edin), FRCSE, Associate Professor, Division of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville
Contributor Information and Disclosures

Updated: Mar 19, 2008

Follow-up

Deterrence/Prevention

  • Current use of oral contraceptive pills protects against the development of functional ovarian cysts. Current and previous use within 15 years reduces the risk of epithelial ovarian cystadenocarcinoma.
  • All women should undergo an annual gynecologic examination. No generalized screening test is available for ovarian cystadenocarcinoma, but women at high risk based on family history or previous history of breast cancer should undergo an annual ultrasonographic examination and CA125 test. Referral for genetic counseling should be considered.
  • Women at high risk for ovarian cystadenocarcinoma may be offered prophylactic oophorectomy, which will prevent the development of ovarian cancer but not peritoneal carcinoma.

Complications

  • Torsion
  • Rupture
  • Hemorrhage
  • Malignant change: The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven. Malignant change can occur in a small percentage of dermoid cysts and endometriomas.

Prognosis

  • The prognosis for benign cysts is excellent. All such cysts may occur in residual ovarian tissue or in the contralateral ovary.
  • Mortality associated with malignant ovarian carcinoma is related to the stage at the time of diagnosis, and patients with this carcinoma tend to present late in the course of the disease. The 5-year survival rate overall is 41.6%, varying between 86.9% for FIGO stage Ia and 11.1% for stage IV.
  • Granulosa cell tumors are associated with an 82% survival rate, whereas squamous cell carcinomas arising in a dermoid cyst are associated with a very poor outcome.
  • Most germ cell tumors are diagnosed at an early stage and are associated with an excellent outcome. Advanced-stage dysgerminoma are associated with a better outcome compared to nondysgerminomatous germ cell tumors.
  • A distinct group of less aggressive tumors of low malignant potential runs a more benign course but still is associated with definite mortality. The overall survival rate is 86.2% at 5 years.

Patient Education

For excellent patient education resources, visit eMedicine’s Women's Health Center and Cancer and Tumors Center. Also, see eMedicine’s patient education articles Ovarian Cysts, Female Sexual Problems, and Ovarian Cancer.

Miscellaneous

Medicolegal Pitfalls

  • Any pelvic mass should be assumed to be a cancer until proven otherwise, particularly in a patient with a prior history of breast cancer or a family history of breast/ovarian cancer.
  • An ultrasonographic examination of the pelvis should always be obtained if a patient is thought to have a pelvic mass on clinical examination.
  • If a patient has large fibroids, missing concomitant ovarian pathology, both clinically and on ultrasonographic examination, is possible.
  • Always be vigilant about patients with an increased risk of ovarian cancer, and arrange appropriate counseling.

Special Concerns

  • Ovarian cysts in pregnancy
    • Because of the routine use of ultrasonography, ovarian cysts are commonly diagnosed in pregnancy. Cysts should be evaluated in pregnant patients the same way as in nonpregnant patients, with ultrasonographic examinations and CA125 testing. MRI is preferable to CT scanning, but both modalities should be avoided in the first trimester.
    • In addition to the normal complications of cysts, they may cause obstructed labor in pregnancy.
    • Benign simple cysts can be monitored, and most resolve spontaneously.
    • Persistent cysts larger than 5-10 cm or those that are symptomatic or have features suggestive of malignancy may be removed surgically, preferably in the second trimester.
  • Ovarian cysts occurring in children
    • In a child found to have a symptomatic abdominopelvic mass, the ovary is the most common site of origin.
    • Although such masses are infrequent occurrences, the percentage due to malignant tumors is thought to be higher than for older age groups. The most common are germ cell tumors, followed by epithelial and granulosa cell tumors. Such tumors may be partially cystic.
 


More on Ovarian Cysts

Overview: Ovarian Cysts
Differential Diagnoses & Workup: Ovarian Cysts
Treatment & Medication: Ovarian Cysts
Follow-up: Ovarian Cysts
Multimedia: Ovarian Cysts
References
[ CLOSE WINDOW ]

References

  1. Chan L, Lin WM, Uerpairojkit B, Hartman D, Reece EA, Helm W. Evaluation of adnexal masses using three-dimensional ultrasonographic technology: preliminary report. J Ultrasound Med. May 1997;16(5):349-54. [Medline].

  2. Kupesic S, Plavsic BM. Early ovarian cancer: 3-D power Doppler. Abdom Imaging. Sep-Oct 2006;31(5):613-9. [Medline].

  3. Caruso PA, Marsh MR, Minkowitz S, Karten G. An intense clinicopathologic study of 305 teratomas of the ovary. Cancer. Feb 1971;27(2):343-8. [Medline].

  4. Clement PB. Anatomy and histology of the ovary. In: Kurman RJ, ed. Blaustein's Pathology of the Female Genital Tract. 4th ed. New York, NY: Springer-Verlag; 1989:438-70.

  5. Dewhurst J, Pryce-Davis J, Helm W. Diagnosis and management of granulosa/theca cell tumours in childhood. Paediatric and Adoloscent Gynaecology. 1985;3(2):131-56.

  6. Evans AT 3rd, Gaffey TA, Malkasian GD Jr, Annegers JF. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. Obstet Gynecol. Feb 1980;55(2):231-8. [Medline].

  7. Farah L, Azziz R. Polycystic Ovary Syndrome. The Female Patient. 1999;24:79-86.

  8. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. Jan-Feb 2000;50(1):7-33. [Medline].

  9. Higgins RV, Matkins JF, Marroum MC. Comparison of fine-needle aspiration cytologic findings of ovarian cysts with ovarian histologic findings. Am J Obstet Gynecol. Mar 1999;180(3 Pt 1):550-3. [Medline].

  10. International Federation of Gynecology and Obstetrics. Annual Report on the Results of Treatment in Gynaecological Cancer. J Epidemiol Biostat. 1998;3:1-68.

  11. Jacobs I, Bast RC Jr. The CA 125 tumour-associated antigen: a review of the literature. Hum Reprod. Jan 1989;4(1):1-12. [Medline].

  12. Loyer EM, Whitman GJ, Fenstermacher MJ. Imaging of ovarian carcinoma. Int J Gynecol Cancer. Sep 1999;9(5):351-361. [Medline].

  13. Lu D, Davila RM, Pinto KR, Lu DW. ThinPrep evaluation of fluid samples aspirated from cystic ovarian masses. Diagn Cytopathol. May 2004;30(5):320-4. [Medline].

  14. Maiman M. Laparoscopic removal of the adnexal mass: the case for caution. Clin Obstet Gynecol. Jun 1995;38(2):370-9. [Medline].

  15. Miller BA, Kolonel LN, Bernstein L, et al. Racial/Ethnic Patterns of Cancer in the United States 1988-1992. Bethesda, Md: National Cancer Institute; 1996.

  16. Moran O, Menczer J, Ben-Baruch G, et al. Cytologic examination of ovarian cyst fluid for the distinction between benign and malignant tumors. Obstet Gynecol. Sep 1993;82(3):444-6. [Medline].

  17. Osmers R. Sonographic evaluation of ovarian masses and its therapeutical implications [editorial]. Ultrasound Obstet Gynecol. Oct 1996;8(4):217-22. [Medline].

  18. Peterson WF, Prevost EC, Edmunds FT, et al. Benign cystic teratomas of the ovary; a clinico-statistical study of 1,007 cases with a review of the literature. Am J Obstet Gynecol. Aug 1955;70(2):368-82. [Medline].

  19. Ries LAG, Kosary CL, Hankey BF, et al. Cancer Statistics Review: 1973-1996. Bethesda, Md: National Cancer Institute; 1999.

  20. Roman LD. Small cystic pelvic masses in older women: is surgical removal necessary?. Gynecol Oncol. Apr 1998;69(1):1-2. [Medline].

  21. Schmeler KM, Mayo-Smith WW, Peipert JF, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. May 2005;105(5 Pt 1):1098-103. [Medline].

  22. Schnorr JA Jr, Miller H, Davis JR, et al. Hyperreactio luteinalis associated with pregnancy: a case report and review of the literature. Am J Perinatol. Feb 1996;13(2):95-7. [Medline].

  23. Simpkins F, Zahurak M, Armstrong D, et al. Ovarian malignancy in breast cancer patients with an adnexal mass. Obstet Gynecol. Mar 2005;105(3):507-13. [Medline].

  24. Steinkampf MP, Hammond KR, Blackwell RE. Hormonal treatment of functional ovarian cysts: a randomized, prospective study. Fertil Steril. Nov 1990;54(5):775-7. [Medline].

  25. Sykes PH, Quinn MA, Rome RM. Ovarian tumors of low malignant potential: a retrospective study of 234 patients. Int J Gynecol Cancer. 1997;7:218-26.

  26. Weiss NS, Homonchuk T, Young JL Jr. Incidence of the histologic types of ovarian cancer: the U.S. Third National Cancer Survey, 1969-1971. Gynecol Oncol. Jun 1977;5(2):161-7. [Medline].

  27. Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. Nov 15 1992;136(10):1184-203. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

ovary, benign cyst, graafian follicles, functional cysts, theca-lutein cysts, hyperreactio luteinalis, ovarian hyperstimulation syndrome, serous cystadenoma, mucinous cystadenoma, neoplastic cyst, malignant cyst, granulosa cell tumor, sex cord stromal tumor, germ cell tumor, primordial cell tumor, teratoma, endometrioma, pseudomyxoma peritonei, ovarian tumors, cystadenocarcinoma

gestational trophoblastic neoplasia, hydatidiform mole, choriocarcinoma, polycystic ovary syndrome, polycystic ovarian syndrome, PCOS, ovarian hyperstimulation syndrome, epithelial ovarian cystadenocarcinomas, ovulation induction with gonadotropins, ovulation induction with clomiphene citrate, ovulation induction with letrozole

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

C William Helm, MB, BCh, MA, FRCS(Edin), FRCSE, Associate Professor, Division of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville
C William Helm, MB, BCh, MA, FRCS(Edin), FRCSE is a member of the following medical societies: American College of Obstetricians and Gynecologists, European Society of Gynaecologic Oncology, and International Gynecologic Cancer Society
Disclosure: ThermaSolutions, Inc Grant/research funds Support for the HYPERO database - a collaborative clinical research study analysing outcomes for HIPEC in ovarian cancer; Sanofi-Aventis, Inc Grant/research funds Support for and investigator initiated research study of HIPEC for consolidation in ovarian cancer

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.