Ovarian cysts are most often fluid-filled growths of the ovaries. They can be functional (not cancerous), neoplastic (benign or cancerous), or endometriotic (also called endometriomas, and very rarely cancerous). Occasionally infection of the ovaries or tubes can resemble an abnormal cystic structure (abscess).

Before initiating treatment, a physician should take into consideration the size and appearance of cysts on an ultrasound exam, the patient’s age, presence or absence of symptoms, and any risk factors. If a cyst is discovered in a woman of reproductive age, it is most commonly the functional type; endometriotic cysts are the second most common type. Neoplastic cysts are the least common type in this age group. The chance of cysts being malignant (cancer) is 13-15% (compared to 45-50% in postmenopausal women).

Drs. Nezhat are among the most experienced surgeons in the world in laparoscopic management of different ovarian cysts. The Nezhats reported laparoscopic removal of a dermoid cyst for the first time in Obstetrics and Gynecology Journal in 1992. They reported on 10 years of experience in removing dermoid cysts in 2002, and have also reported on laparoscopic management of endometriomas and other cysts.

Functional cysts

• Most common type in women of reproductive age
• Three types: follicular, corpus luteum, and theca luteal cysts
• Caused by and causing hormonal imbalance
• Usually regress spontaneously
• Rarely bigger than 10 cm
• May break and cause pain or intra-abdominal bleeding, necessitating surgery (cystectomy)

Endometriotic ovarian cysts (endometriomas)

• Present in 60% of women with endometriosis
• Only 1% of women with endometriosis has the disease present only in the ovaries
• Can cause infertility and severe pain
• Best treatment recommended for improved fertility, relief of pain, and to minimize recurrences is a cystectomy (excision the cyst). This surgery is performed in our center using minimally invasive (laparoscopic) surgery .

Neoplastic cysts (benign or malignant)

• In women of reproductive age, over 85% of these cysts are not malignant
• This percentage goes down to 51% if found in women beyond menopause, as well as in girls before they reach puberty (before they get their period)
• Most common benign ovarian neoplasm (tumor) is the mature cystic teratoma (dermoid cyst)

Important notes:

• Ovaries containing large cysts may undergo torsion (twisting around their base), which results in arrest of blood flow to the ovary and severe pain. Torsion requires emergency surgery.
• Cysts that remain unchanged or grow over a period of observation most often need surgical removal. Sizes of cysts range from a few mm to over 30 cm (1 foot). In general, most cysts over 8cm, regardless of appearance, have to be removed.

Please email us at DrNezhat@gmail.com for your questions about Gynecologic Oncology.