Management of ovarian cysts Dr Matt Hewitt. Benign e.g functional cysts, serous cystademonas,...

Management of ovarian cysts

Dr Matt Hewitt

Benign• e.g functional cysts, serous cystademonas, dermoid (teratoma)

Non ovarian

Malignant• Epithelial tumours 90% - e.g serous cystadenoacrcinomas• Sex cord tumours• Germ cell tumours• Metastatic

• e.g Hydrosalpinx, tubovarian abcess

Ovarian cysts

Ovarian cancer

• Lifetime risk 1 in 70• 90% are epithelial tumours• 75% present at late stage III/IV• 5 – 10 % Hereditary predisposition BRCA I and

II HNPCC

0

20

40

60

80

100

1 2 3 4

Stage at diagnosis and 5 year survival

Uterus

Cervix

Ovary

FIGO Staging

Pre menopausal ovarian cysts• 10% of women will undergo ovarian

surgery at some point• Symptomatic cysts 1 to 3 1000 population• Simple cysts < 5cm usually resolve, do not

require follow up • PCO on scan do not require follow up scan

Post menopausal cysts• Increasing detection of ovarian cysts

• 21% have abnormal ovarian pathology

• Simple Cysts <5cm – low risk of malignancy

Clinical examination

• If its palpable it needs surgery

• Ascites

• Tenderness

• Fixed

• Differentiating between uterus and ovarian mass

ImagingUltrasound

– good assessment of the ovary and presence of ascites

MRI

– good but expensive assessment of ovary

– Rarely gives additional information on nature of cyst

– Is good in

CT scan

– not good at evaluating cyst

- good in presence of ascites

Ultrasound• Trans abdominal and transvaginal (TVS)• Size• Simple – unilocular, no blood flow• Complex – Multilocular, solid elements, irregular,

papillary projections, blood low• Ascites

Tumour markers

• Ca 125– not sensitive and not specific– Should not be used in assessment of abdominal

pain

• hCG, α-FP, LDH– Should not routinely be used– Secondary care assessment germ cell tumours

Surgical management • Laparoscopy – up to 12cm• Laparotomy• Cystectomy – if confident not malignant• Unilateral oophorectomy• Bilateral oophorectomy

Disease

• serious• high prevalence of preclinical stage• natural history understood• lead time bias, length bias

Diagnostic test• sensitive and specific• simple and cheap• safe and acceptable• reliable

Diagnosis & Treatment• facilities are adequate• effective, acceptable, safe treatment available

WHO Principles of Screening

Premenopausal Asymptomatic

Post Menopausal Asymptomatic

Thank you