Ovarian Cysts Follow-up

  • Author: C William Helm, MB, BCh, MA, FRCS(Edin), FRCS; Chief Editor: Michel E Rivlin, MD   more...
 
Updated: Apr 22, 2011
 

Deterrence/Prevention

  • Current use of oral contraceptive pills protects against the development of functional ovarian cysts. Existing functional cysts do not regress more quickly under treatment with combined oral contraceptives compared to expectant management, and should not be used for that purpose.[32]
  • Current and previous use of oral contraceptive pills 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.
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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.
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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.
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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.

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Contributor Information and Disclosures
Author

C William Helm, MB, BCh, MA, FRCS(Edin), FRCS  Professor, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, St Louis University School of Medicine, St. Louis, MO

C William Helm, MB, BCh, MA, FRCS(Edin), FRCS 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 Research Registry of patients treated with hyperthemic intraperitoneal chemotherapy; Sanofi-Aventis, Inc Grant/research funds Support for and investigator initiated research study of HIPEC for consolidation in ovarian cancer; ThermaSolutions, Inc Honoraria Speaking and teaching; UpToDate Royalty Online Text Book Chapters; Genzyme, Inc Honoraria Speaking and teaching

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

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.

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.

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An ovarian cyst that has undergone torsion (twisting of the vascular pedicle). The patient presented with a short history of severe lower abdominal pain. The twisted pedicle can be seen attached to the cyst, which has turned dusky due to ischemia. No viable epithelial lining was available for histologic diagnosis.
Endovaginal sonogram shows a striking echogenic mass lateral to the uterus, with posterior acoustic shadowing giving a "tip-of-the-iceberg" appearance. This is pathognomonic for dermoid cyst. Occasionally, this appearance may be mistaken for gas-filled bowel. Courtesy of Patrick O'Kane, MD.
A dermoid cyst (mature cystic teratoma) after opening the abdomen. Note the yellowish color of the contents seen through the wall.
A dermoid cyst has been opened in the operating room to reveal copious sebaceous fluid. This cyst also contained hair.
A dermoid cyst has been opened and contains teeth.
Theca-lutein cysts replacing an ovary in a patient with a molar pregnancy. Despite their size these cysts are benign and usually resolve after treatment of the underlying disease.
A 24-cm diameter multilocular right ovarian cyst is seen with adjacent Fallopian tube and uterus. The infundibulo-pelvic ligament carrying the ovarian artery and vein has been divided. Histology reported a mucinous cystadenocarcinoma of low malignant potential.
Transabdominal sonogram of a 24-cm diameter multilocular right ovarian cyst with adjacent Fallopian tube and uterus. The infundibulo-pelvic ligament carrying the ovarian artery and vein has been divided. This sonogram demonstrates a large, complex, cystic mass with vascularity within the septations. Red and blue colors show blood flow towards and away from the transducer. The resistive index was low. Histology reported a mucinous cystadenocarcinoma of low malignant potential. Courtesy Patrick O'Kane, MD.
The cyst in Images 7-8 has been removed and cut open. It has a smooth surface and a multicystic internal structure.
Cross-section of a clear cell carcinoma of the ovary. Note the cystic spaces intermingled with solid areas.
 
 
 
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