Ovarian cysts, a nightmare for women, are the most common gynecological problems after myomas. Although the detection of a cyst immediately requires surgery, only some of the ovarian cysts require surgery. In this section, ovarian cysts, which are especially common, will be explained. We can simply divide ovarian cysts into physiological (those that do not require surgery) and pathological cysts (those that require surgery).
Physiological Cysts An egg develops in one of the ovaries at the beginning of each menstrual period. (follicle). This is actually a small cyst. It has a wall and a clear liquid inside. It looks like a balloon filled with water. With ovulation, blood fills into this egg cyst and it is called ovulation cyst (Corpus Luteum). If pregnancy occurs, this ovulation cyst produces the hormone progesterone, which protects the pregnancy. If pregnancy has not occurred, this cyst disappears with menstrual bleeding.
Such cysts that do not disappear with menstruation and are the size of an egg to the size of an orange are called egg cysts or physiological cysts. It can generally shrink and disappear on its own. If it does not disappear, it can be eliminated to a large extent with medication. However, in cases where the cyst bursts and bleeding into the abdomen or the cyst twists around its stem, requiring urgency, surgery may be considered. Sometimes ovulation cyst (corpus luteum) causes bleeding after ovulation and may require surgery due to a condition we call cyst bleeding.
Cysts Requiring Operation
These cysts are described above. Unlike cysts, they do not respond to drug treatment and must be removed by surgery when detected. The most common ones are simple cysts, chocolate cysts(endometriosis cysts), dermoid cysts, fibromas and cysts suspected of cancer.
Simple Cysts:
They are generally egg cysts. . It can be thought of as a balloon filled with clear water. It does not respond to drug treatment and its dimensions are over 5 cm. The reason for the operation is that it can damage the ovary by putting pressure on it, the possibility of it bursting, and the possibility of twisting around the stem.
Chocolate Cysts (Endometriosis Cysts)
The inside is filled with a thick liquid that resembles melted chocolate. Also often in the abdomen It is accompanied by adhesions. Endometriosis foci are also found in the abdomen. Although it is possible to treat these cysts with special medications when they are small in size, the definitive treatment method is surgery. In addition, adhesions in the abdomen and endometriosis foci need to be treated.
Dermoid Cysts
They arise from some residues in the ovaries while in the womb. Generally, formations such as dark oily fluid, hair and sometimes teeth are visible inside the cyst. When detected, they definitely require surgery because they are confused with ovarian cancer. In the operation of this type of congenitally occurring cysts, pathological examination should be performed simultaneously and the treatment plan should be made accordingly.
Fibromas
They are solid and hard masses like billiard balls, similar to myomas in the uterus. It requires surgery due to its similarity with cancer in ultrasonography and operation
Cysts Suspicious of Cancer:
Due to ultrasonography findings, these cysts, which have more hard parts than liquid parts, require surgery because the probability of malignant disease is high. In fact, during the operation, the pathologist evaluates the removed part and if it is benign, the operation is completed routinely. If the character is bad, cancer surgery is performed.
What are the Symptoms of Cysts?
– Abdominal and groin pain: It occurs in different severities. In cases of very severe and unbearable pain, cyst bursting or twisting around its stem (torsion) is suspected.
– Low back pain
– Abdominal swelling
– Palpable mass
Diagnostic Methods
Ultrasonography
In this method, which has a very important place in gynecological masses, information can be obtained about the size and character of the cyst. This method, which is performed vaginally in women who are not virgins, gives very detailed information. It also helps distinguish malignant masses. Ultrasonographic findings indicate that the mass is large, has solid parts other than fluid, has fluid in the abdomen, and has irregular walls. These are findings in favor of a malignant mass. Additionally, with Doppler, the blood flow character in the vessels feeding the mass gives information about the cyst. If the ovarian cyst is likely to be malignant, pre-operative MRI Diagnostic methods such as rong> and tomography can also be used to show involvement of lymph nodes and other adjacent organs.
Hormonal Tests
Ca 12?5, Ca 15?3, B-hCG, CEA. These known tests play an important role in distinguishing between benign and malignant cysts. Especially in malignant cysts, Ca 12-5 can be more than 3 times higher than normal. However, Ca 12-5 may also increase in cases such as chocolate cyst, endometriosis, and lining of the abdominal lining infections. B-hcg and CEA can especially help in the distinction of dermoid cysts or teratomas, which are congenital cysts.
Doppler Ultrasonography
It is a diagnostic method that helps in the diagnosis of malignant cysts with the vascularization of cysts and some measurements in these vessels. Especially in benign cysts and masses, vascularity is less and intravascular resistance is high. However, malignant cysts and masses have abundant vascularity and low flow resistance. Doppler ultrasonography can also be performed abdominally or vaginally. Additionally, the distribution of vascularity can be examined with a 3D view.
Treatment Methods
Medication
The most commonly used drugs in benign ovarian cysts are birth control pills. It may be sufficient for treatment in 90% of simple ovulation cysts. Meanwhile, the size is monitored by ultrasonography performed after each menstrual period. Surgery may be considered for cysts that do not respond to medication. Although drugs collected under the name of GnRH analogues can be used to shrink chocolate cysts before the operation or to prevent their recurrence after the operation, surgery is preferred.
Surgical treatment
It can be performed by normal surgery or laparoscopic methods. The type of operation is decided as a result of examinations. Age, fertility, and the size and character of the cyst play a role here. Laparoscopy is especially avoided in cysts with suspected cancer. Because in malignant cysts, the main purpose is to remove the cyst without bursting it.
In cysts with suspicion of cancer, the pathologist is also present during the operation and helps guide the operation by making the initial evaluation of the removed piece. If the cyst is malignant or there is such a suspicion, the uterus, both ovaries, appendix and internal organs called omentum are removed when necessary, with the approval of the family. It also nourishes these organs The ovarian lymph nodes are also removed. The types of surgery performed during the operation may include removing the ovarian cyst, removing the ovary where the cyst is located, or removing the entire uterus and ovaries. In women who want a baby, if the conditions are suitable, efforts are made to preserve the ovary by removing only the cyst. However, if the cyst has completely destroyed the ovary by pressure, the entire ovary is removed. The uterus and ovaries can be removed in older women, in menopausal women, in women with suspicion of cancer and in women who have completed their fertility.
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