How can the physician decide if an ovarian cyst is dangerous?

 

  Ovarian cysts are closed, sac-like structures within the ovary that are filled with a liquid or semisolid substance. Ovarian cysts form for numerous reasons. Pain in the abdomen or pelvis is the most common symptom of an ovarian cyst, but most are asymptomatic.  Most cysts are diagnosed by ultrasound or physical exam. The treatment of an ovarian cyst depends upon its likely diagnosis and varies from observation and monitoring to surgical treatment.



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 "functional ovarian cysts," which are not really abnormal. Examples include follicular cysts and corpus luteum cysts. These 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 by preventing ovulation, physicians will not generally expect women who are taking oral contraceptives to have common "functioning ovarian cysts." These women do not have functional ovarian cysts. They may receive further evaluation with pelvic ultrasound or possibly surgical intervention. Functional ovarian cysts do not occur in women after they have reached menopause. Small cystic arrested follicles may persist in the ovary after menopause.

Other factors are helpful in evaluating ovarian cysts (besides the woman's age, or whether she is taking oral contraceptives). A cyst that contains a simple sac of fluid on ultrasound is more likely to be a benign neoplasm than a cyst with solid tissue in it. So the ultrasound appearance also plays a role in determining the level of suspicion regarding an ovarian tumor.

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, even when it is abnormal, and it may be normal in the presence of malignancy. CA-125 is a protein that is elevated in the bloodstream of approximately 80% of women with advanced ovarian cancer.

    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, endometriosis, and liver disease are some of the conditions that may elevate blood CA-125 levels in the absence of ovarian cancer.
    Second, even if the woman has an ovarian cancer, not all ovarian cancers 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.