Removal of ovarian cysts
Definition
An ovarian cyst is a sac filled with fluid, or more rarely solid matter, inside or outside of an ovary.
Ovarian cysts are sacs filled with liquid or solid matter that form inside or outside of the ovaries.
In most cases, the cysts are small and harmless, while in other cases they can be large and painful or, even worse, a sign of a malignant ovarian tumor.
To establish the exact nature of an ovarian cyst, and to establish whether it is a benign or malignant tumor, a thorough gynecological examination and the performance of a transabdominal or transvaginal ultrasound are necessary.
Less serious ovarian cysts do not require treatment, as they heal spontaneously within weeks/months. Severe ovarian cysts, on the other hand, must be surgically removed to avoid unpleasant consequences.
Causes
Ovarian cysts are mostly physiological and depend on the menstrual cycle. In a minority of cases, they are rather the effect of a tumoral process or other morbid conditions. In light of this, ovarian cysts are divided into two categories:
Functional Cysts. They are the most common version of ovarian cysts. They are due to a physiological process, so they are considered completely harmless.
Pathological cysts (or non-functional). This category includes cysts that arise due to a tumor, benign or malignant, and those that form during certain pathologies, such as endometriosis or polycystic ovary syndrome.
Functional cysts
There are 3 types of functional ovarian cysts:
The follicular cysts. The egg forms inside a protective structure called a follicle. As soon as the ovum is mature, therefore ready for possible fertilization, a hormonal signal is triggered which causes the follicle to rupture and the ovum itself to exit towards the fallopian tubes and the uterus. In some circumstances, this mechanism does not work perfectly and the egg remains confined inside the follicle, which fills with fluid and forms a follicular cyst. Follicular cysts are by far the most common ovarian cysts and almost never cause problems. Their resolution, which requires no treatment, usually occurs within a few weeks (two or three menstrual cycles).
Luteal Cysts (or Luteal Cysts). After the egg has been expelled, the follicle is called the corpus luteum. Sometimes the opening the egg came out of can close up, trapping fluids of all kinds and blood inside. On these occasions, a luteal cyst forms. Luteal cysts, compared to follicular cysts, are less frequent but more dangerous: they can indeed rupture suddenly and give rise to painful internal bleeding. Their spontaneous resolution usually takes a few months.
Luteal cysts are especially common during pregnancy.
Thecal Cysts. Thecal cysts form from the thecal cells that make up the follicle under the influence of chorionic gonadotropin, a hormone produced during pregnancy. They are less common than follicular and luteal cysts.
Pathological cysts
The main pathological (or non-functional) cysts are:
Dermoid cysts. Dermoid cysts develop from the cells that produce the oocyte during embryonic life. For this reason, within them it is possible to trace portions of human tissue resembling hair, bone, fat, teeth or blood. Dermoid cysts can take on significant dimensions and even reach 15 centimeters in diameter; when the dermoid cyst is very large and causes alteration of the normal anatomy of the ovaries and uterus, surgery may be required to remove it. Dermoid cysts are benign tumors that very rarely become malignant.These are the most common non-functioning cysts in women under 40.
Cystadenoma. They are benign tumors that grow on the outer surface of the ovaries and may contain (as cysts) water or mucus. If they contain water, they are called serous cystadenomas, while if they contain mucus, they are called mucinous cystadenomas.Serous cystadenomas generally do not reach large dimensions and do not cause particular disorders; mucinous cystadenomas, on the other hand, can grow considerably and even reach 30 centimeters in diameter.A large mucinous cystadenoma may grow on the adjacent bowel or bladder, causing bouts of indigestion or frequent urination; it can also rupture or block the blood supply to the ovaries.The transformation of a benign cystadenoma into a malignant tumor is a very rare event.These are the most common non-functioning cysts in women over 40.
Cysts due to endometriosis (or endometriomas). Endometriosis is a disease characterized by the presence of endometrial tissue outside of its natural location, which is the uterus. In some women, however, it can also be characterized by the appearance of blood-filled ovarian cysts.
Cysts due to polycystic ovary syndrome. Polycystic ovary syndrome (or ovarian polycystosis) is a morbid condition characterized by enlarged ovaries covered with numerous small cysts. Determining its onset is usually an imbalance in the production of ovarian (i.e., produced by the ovaries) and pituitary (i.e., produced by the pituitary gland) hormones.
Symptoms and Complications
In most cases, ovarian cysts cause no discomfort; however, when it happens that:
They reach large sizes.
They break, release their content.
Blocking the blood supply to the ovaries (a condition known as ovarian torsion or torsion of the ovary).you may experience the following signs and symptoms:
Pelvic pain. It may be dull, if the ovarian cyst is large but still intact, or sharp and sudden, if the ovarian cyst has ruptured. Sometimes the painful sensation is also felt in the back and thighs.
Pelvic pain during sex.
Difficulty completely emptying the bowel.
Need to urinate often. This is due to the fact that the ovarian cyst constantly presses on the bladder.
Variations in the normal menstrual cycle.
Sensation of heaviness and swelling in the abdomen.
Recurring indigestion and feeling full even after light meals.
Dizziness, vomiting and feeling of emptiness in the head.
Feeling of persistent fatigue.
Treatment
Asymptomatic and harmless ovarian cysts do not require treatment, as they resolve spontaneously within weeks or months.Symptomatic cysts, on the other hand, require much more attention, constant monitoring and, if large or malignant, surgical treatment.The parameters that the doctor takes into consideration, to establish the most appropriate treatment, are three in number:
The size of the cyst
The severity of current symptoms
The age of the patient, because according to various studies, malignant ovarian cysts are more common in women who have passed menopause.If the cyst is benign and the patient is still of childbearing age, the operation will only affect the cyst (ovarian cystectomy); if, on the contrary, the cyst is very large or even malignant or if the patient is no longer fertile (therefore she has passed the menopause), then the operation will concern the entire diseased ovary (oophorectomy).Two surgical techniques are available to the operating physician:
Laparoscopy. Reserved for patients with large but not excessive benign cysts , laparoscopy is a minimally invasive surgical procedure, ideal for ovarian cystectomy operations.
Laparotomy. Indicated for patients with very large and/or malignant (or presumed) cysts, it is a very invasive surgical procedure, since the surgeon, to completely remove the cyst, must make a major incision on the stomach.
Generally, the removal involves the entire ovary, although in the case of benign tumors, it is possible to limit the removal of the cyst alone.After the operation is completed, the incision is closed with stitches.The diseased ovary (if removed due to suspected malignancy) is given to a pathologist for laboratory analysis. The latter (if they confirm the presence of a malignant tumour) make it possible to establish the degree of malignancy of the tumor and the chemotherapy to be adopted.
Prognosis
For most women with ovarian cysts, the prognosis is good, since the appearance of a cyst is almost always without unpleasant consequences.
However, if the cyst required surgery, things are decidedly different: first, one must consider the reason that led to the operation and, second, the type of intervention adopted; indeed, while it is true that ovarian cystectomy and unilateral oophorectomy do not affect the fertility of a woman potentially still able to procreate, the same is not true for bilateral oophorectomy and hysterectomy. .
Prevention
Preventing the appearance of ovarian cysts is impossible.
However, by undergoing regular ultrasounds of the pelvic region and regular gynecological check-ups, it is possible to diagnose many anomalies at an early stage that can develop in the female genital tract (therefore not only in correspondence with the ovaries , but also to damage the uterus, fallopian tubes and vagina).
Furthermore, it is a good idea to pay attention to any strangeness in the menstrual cycle (irregularity, intense pain, excessive bleeding, etc.) which tends to repeat itself for at least two or three consecutive cycles: it may indeed be a sign due to the presence of an ovarian cyst.