eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Ovarian Cysts: Treatment & Medication

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

Treatment

Medical Care

  • Many patients with simple ovarian cysts based on ultrasonography findings do not require treatment.
  • In a postmenopausal patient, a persistent simple cyst smaller than 5 cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonography examinations. Some evidence suggests that cysts up to 10 cm can be safely followed in this way.
  • Premenopausal women with asymptomatic simple cysts smaller than 8 cm on sonograms in whom the CA125 value is within the reference range may be monitored with a repeat ultrasonographic examination in 8-12 weeks. Hormone therapy is not helpful for suppressing ovarian stimulation by gonadotropins.

Surgical Care

  • Persistent simple ovarian cysts larger than 5-10 cm and complex ovarian cysts should be removed surgically.
  • Reserve a laparoscopic approach for patients who have undergone a thorough workup and are thought to not have malignant disease. Such patients include those considered to have a dermoid or endometrioma, those with functional or simple cysts that are causing symptoms and have not resolved with conservative management, and those presenting with acute symptoms. In all cases, one should be able to remove the cyst intact.
  • A laparotomy should be performed on patients thought to have a significant risk for malignant disease and on patients with benign-appearing cysts that cannot be removed intact laparoscopically.
  • Whether performing a laparoscopy or laparotomy, the goals are as follows:
    • To confirm the diagnosis of an ovarian cyst
    • To assess whether the cyst appears to be malignant
    • To obtain fluid from peritoneal washings for cytologic assessment
    • To remove the entire cyst intact for pathologic analysis, including frozen section, which may mean removing the entire ovary
    • To assess the other ovary and other abdominal organs
  • Excision of the cyst alone, with conservation of the ovary, may be performed in patients who desire retention of their ovaries for future fertility or other reasons. Included are endometrioma, dermoid, and functional cysts.
  • If the ovarian cyst is benign, removal of the opposite ovary should be considered in postmenopausal women, in perimenopausal women, and in premenopausal women older than 35 years who have completed their family and are considered at increased risk for subsequent development of ovarian carcinoma. These issues should be discussed with the patient preoperatively.
  • A gynecologic cancer specialist should be available to help with any patient who undergoes surgery for a potentially malignant ovarian cyst. This allows the appropriate surgery to be performed on patients found to have cancer. Whenever possible, the patient should have consulted with the specialist prior to the surgery to allow all issues to be addressed.

Consultations

  • Infertility and reproductive endocrinologist for endometrioma and polycystic ovary syndrome
  • Gynecologic oncologist for any complex ovarian cyst or adnexal mass, especially if the serum CA125 level is elevated above 35 U/mL and for a patient with a strong family history of ovarian carcinoma

Diet

Normal healthy diet

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.