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: Feb 2, 2010

Treatment

Medical Care

  • Many patients with simple ovarian cysts based on ultrasonographic 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.21,22 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, including the use of the oral contraceptive pill, is not helpful in causing resolution.23

Surgical Care

  • Persistent simple ovarian cysts larger than 5-10 cm, especially if symptomatic, and complex ovarian cysts should be considered for surgical removal.
  • The surgical approaches include an open incisional technique (laparotomy) and a minimally invasive technique (laparoscopy) with very small incisions. Whichever route is used, the goals remain the same and include the following: 
    • 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 (This may mean removing the entire ovary.)
    • To assess the opposite ovary and other abdominal organs
    • To perform additional surgery as indicated
  • The use of laparoscopic techniques is becoming widespread and the indications are extending. Laparoscopy is preferred to laparotomy when indicated because it has less adverse effects for the patient and leads to faster recovery.24 However, it is essential that the disease outcome for the patient is not inferior to that achieved with laparotomy.25
  • Some patients, including those with chronic lung disease who are unable to tolerate a high intra-abdominal pressure or a steep head-down position, are unsuitable for laparoscopy. Others are unsuitable because of previous surgeries causing severe adhesions. For many situations the most important factor is the skill and experience of the surgeon.
  • With benign cysts there is no absolute contraindication to the use of laparoscopy. Such patients include those considered to have a dermoid cyst 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. Although the aim should be to remove all cysts intact26,27 , if this is not possible the cyst and/or affected ovary may be placed in a protective bag that allows the cyst to be ruptured and drained without contamination prior to removal.
  • Malignant ovarian cysts associated with widespread disease are usually managed by laparotomy.
  • Some controversy surrounds the surgical approach for very large benign-appearing ovarian cysts. The traditional approach for both was a long, midline incision. Some now promote the laparoscopic drainage of the former allowing the ovary to be removed through a small incision.28 The down side to this is the potential for the cyst to spill cancer cells into the abdominal cavity. Laparoscopy is now used to remove small to medium-sized cancerous ovarian cysts (up to about 12 cm) and to stage ovarian cancer.
  • Excision of a benign 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, perimenopausal, and premenopausal women older than 35 years who have completed their family and are considered at increased genetic risk for subsequent development of ovarian carcinoma. These indications are all relative and the issues should be discussed with the patient prior to any surgery.
  • 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. 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.

  2. 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].

  3. McDonald JM, Modesitt SC. The incidental postmenopausal adnexal mass. Clin Obstet Gynecol. Sep 2006;49(3):506-16. [Medline].

  4. American Cancer Society. Cancer Facts and Figures 2009. Estimated New Cancer Cases and Deaths by Sex, US, 2009. American Cancer Society. Available at http://www.cancer.org/docroot/stt/stt_0.asp?from=fast. Accessed December 24, 2009.

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

  6. 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.

  7. 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.

  8. Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. Oct 2009;23(5):711-24. [Medline].

  9. 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].

  10. Petricoin EF, Ardekani AM, Hitt BA, Levine PJ, Fusaro VA, Steinberg SM, et al. Use of proteomic patterns in serum to identify ovarian cancer. Lancet. Feb 16 2002;359(9306):572-7. [Medline].

  11. Visintin I, Feng Z, Longton G, Ward DC, Alvero AB, Lai Y. Diagnostic markers for early detection of ovarian cancer. Clin Cancer Res. Feb 15 2008;14(4):1065-72. [Medline].

  12. McIntosh M, Anderson G, Drescher C, Hanash S, Urban N, Brown P. Ovarian cancer early detection claims are biased. Clin Cancer Res. Nov 15 2008;14(22):7574; author reply 7577-9. [Medline].

  13. Greene MH, Feng Z, Gail MH. The importance of test positive predictive value in ovarian cancer screening. Clin Cancer Res. Nov 15 2008;14(22):7574; author reply 7577-9. [Medline].

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

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

  16. 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].

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

  18. 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].

  19. 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].

  20. 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].

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

  22. Bailey CL, Ueland FR, Land GL, DePriest PD, Gallion HH, Kryscio RJ, et al. The malignant potential of small cystic ovarian tumors in women over 50 years of age. Gynecol Oncol. Apr 1998;69(1):3-7. [Medline].

  23. [Best Evidence] Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev. Apr 15 2009;CD006134. [Medline].

  24. Medeiros LR, Rosa DD, Bozzetti MC, Fachel JM, Furness S, Garry R, et al. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. Apr 15 2009;CD004751. [Medline].

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

  26. Vergote I, De Brabanter J, Fyles A, Bertelsen K, Einhorn N, Sevelda P. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet. Jan 20 2001;357(9251):176-82. [Medline].

  27. Bakkum-Gamez JN, Richardson DL, Seamon LG, Aletti GD, Powless CA, Keeney GL, et al. Influence of intraoperative capsule rupture on outcomes in stage I epithelial ovarian cancer. Obstet Gynecol. Jan 2009;113(1):11-7. [Medline].

  28. Eltabbakh GH, Charboneau AM, Eltabbakh NG. Laparoscopic surgery for large benign ovarian cysts. Gynecol Oncol. Jan 2008;108(1):72-6. [Medline].

  29. 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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

ovarian cyst, ovarian cyst treatment, ovarian cyst causes, ovarian cyst symptoms, benign ovarian cyst, dermoid tumor, graafian follicles, functional cysts, theca-lutein cysts, hyperreactio luteinalis, ovarian hyperstimulation syndrome, serous cystadenoma, mucinous cystadenoma, granulosa cell tumor, sex cord stromal tumor, germ cell tumor, primordial cell tumor, teratoma, endometrioma, pseudomyxoma peritonei, ovarian tumors

gestational trophoblastic neoplasia, hydatidiform mole, choriocarcinoma, polycystic ovary syndrome, polycystic ovarian syndrome, PCOS, epithelial ovarian cystadenocarcinomas

[ 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.