Ovarian Cysts During Pregnancy

Ovarian Cyst during Pregnancy What are ovarian cysts? Ovarian cysts are fluid-filled, sac-like structures within an ovary. The term cyst refers to a fluid-filled structure. Therefore, all ovarian cysts contain at least some fluid. What causes ovarian cysts? Ovarian cysts form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve on their own over the course of days to months. Cysts can contain blood (hemorrhagic or endometrioid cysts) from injury or leakage of tiny blood vessels into the egg sac. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are called dermoid cysts. What symptoms are caused by ovarian cysts? Most cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. The pain can be caused from rupture of the cyst, rapid growth and stretching, bleeding into the cyst, or twisting of the cyst around its blood supply. How are ovarian cysts diagnosed? Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting ovarian cysts. Ultrasound is an imaging method that uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and causes no harm. Cysts can also be detected with other imaging methods, such as CAT scan or MRI scan (magnetic resonance imaging). How can the physician decide if an ovarian cyst is dangerous? If a woman is in her 40's, or younger, and has regular menstrual periods, most ovarian masses are â€Å"functioning ovarian cysts,† which are not really abnormal. They are related to the process of ovulation that happens with the menstrual cycle. They usually disappear on their own during a future menstrual cycle. Therefore, especially in women in their 20's and 30's, these cysts are watched for a few menstrual cycles to verify that they disappear. Because oral contraceptives work in part by preventing ovulation, physicians will not really expect women who are taking oral contraceptives to have common â€Å"functioning ovarian cysts. † Thus, women who develop ovarian cysts while taking oral contraceptives may be advised against simple observation; rather, they may receive closer monitoring with pelvic ultrasound or, less commonly, surgical exploration of the ovary. Other factors are helpful in evaluating ovarian cysts (besides the woman's age, or whether she is taking oral contraceptives). A cyst that looks like it's just one simple sac of fluid on the ultrasound is more likely to be benign, than a cyst with solid tissue in it. So the ultrasound appearance also plays a role in determining the level of suspicion regarding a serious ovarian growth. Ovarian cancer is rare in women younger than age 40. After age 40, an ovarian cyst has a higher chance of being cancerous than before age 40, although most ovarian cysts are benign even after age 40. CA-125 blood testing can be used as a marker of ovarian cancer, but it does not always represent cancer when it is abnormal. First, many benign conditions in women of childbearing age can cause the CA-125 level to be elevated, so CA-125 is not a specific test, especially in younger women. Pelvic infections, uterine fibroids, pregnancy, benign (hemorrhagic) ovarian cysts, and liver disease are all conditions that may elevate CA-125 in the absence of ovarian cancer. Second, even if the woman has an ovarian cancer, not all ovarian ca ncers will cause the CA-125 level to be elevated. Furthermore, CA-125 levels can be abnormally high in women with breast, lung, and pancreatic cancer. How are ovarian cysts treated? Most ovarian cysts in women of childbearing age are follicular cysts (functional cysts) that disappear naturally in 1-3 months. Although they can rupture (usually without ill effects), they rarely cause symptoms. They are benign and have no real medical consequence. They may be diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed. A follicular cyst in a woman of childbearing age is usually observed for a few menstrual cycles because the cysts are common, and ovarian cancer is rare in this age group. Sometimes ovarian cysts in menstruating women contain some blood, called hemorrhagic cysts, which frequently resolve quickly. Ultrasound is used to determine the treatment strategy for ovarian cysts because if can help to determine if the cyst is a simple cyst (just fluid with no solid tissue, seen in benign conditions) or compound cyst (with some solid tissue that requires closer monitoring and possibly surgical resection). In summary, the ideal treatment of ovarian cysts depends on the woman's age, the size (and change of size) of the cyst, and the cyst's appearance on ultrasound. Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA-125 to help determine the potential for cancer (keeping in mind the many limitations of CA-125 testing described above). The tumor can be removed either with laparoscopy, or if needed, an open laparotomy (using and incision at the bikini line) if it is causing severe pain, not resolving, or if it is suspicious in any way. Once the cyst is removed, the growth is sent to a pathologist who examines the tissue under a microscope to make the final diagnosis as to the type of cyst present. Ovarian Cysts At A Glance Ovarian cysts are fluid-filled, sac-like structures. Ovarian cysts form for numerous reasons. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. Most cysts are diagnosed by ultrasound. The treatment of ovarian cysts varies from observation and monitoring to surgical procedures. Case Study: Ovarian Cyst during Pregnancy I am 35 and 13 weeks into my second pregnancy. Four weeks ago, I went to the hospital for pain in my lower right quadrant. A sonogram showed a cyst on my right ovary, about 15cm. The doctor has had me in bed since then, and I have had two more sonograms. It hasn't gone down. The doctors seem to think it is fluid-filled and not cancerous. Can cysts really go down on their own? How long should I wait to see if it will go down? Have you heard of any cysts this large during pregnancy, and do they pose a danger to the baby? Cysts (fluid-filled structures) can go down on their own, but it is unlikely a 15cm cyst in pregnancy will do so. Cysts are not that uncommon during pregnancy, affecting about 1 in 1,000 pregnant women. The vast majority of ovarian masses found during pregnancy are benign; the incidence of ovarian cancer is 1 in 25,000 births. Ultrasound can be helpful in determining if a mass is benign or malignant, but it cannot do so with 100 percent certainty. If ultrasound shows that the mass is strictly fluid-filled, without septation or thick walls, it is probably benign. The problem with large, even benign, cysts during pregnancy is that they may rupture or torse (twist on themselves). Either of these events leads to significant pain for mom and the potential for miscarriage or preterm labor and delivery for the baby. Large (more than 6-8cm) cysts are usually removed surgically if they do not decrease in size spontaneously over the course of a few weeks. In pregnancy, the best time to operate is in the second trimester, ideally around 14-16 weeks. Occasionally, a cyst may be dealt with via laparoscopy, but very large cysts often require a large, open incision. A 15 cm cyst is rather big, and the potential for complications like rupture is high. If it has remained for more than two weeks, I suggest you talk to your doctor about your option. Your doctor may have been just watching you for now, until you get out of the first trimester (the first 13 weeks of pregnancy). I have removed several masses this size during pregnancy, and all of my patients went on to deliver normal, healthy babies.