Ovarian Cysts: Types, Symptoms, Causes and Diagnosis

Ovarian cysts are one of the most common disease during woman's reproductive life. The ovarian cysts themselves are not painful; however, an accident with cysts such as hemorrhage, rupture or torsion can cause pelvic pain. Ovarian cysts develop as a normal part of a healthy menstrual cycle; mature ovaries often have cysts. An ovarian cyst is a sac filled with liquid or semi-liquid material that occurs in an ovary. Although the discovery of an ovarian cyst causes significant anxiety in women because of the fear of malignancy, the vast majority of these lesions are benign

Most patients with ovarian cysts are asymptomatic and cysts are discovered randomly during ultrasound or routine pelvic examination. However, some cysts can be associated with a variety of symptoms, sometimes serious. Many patients with simple ovarian cysts detected by ultrasound do not need treatment

Definition of Ovarian Cyst 

Ovarian cysts are fluid-filled sacs that form on or on the surface of the ovaries, which are the female reproductive organs present in the lower abdomen. Ovarian cysts appear and disappear regularly as part of the normal menstrual cycle. However, cysts can become a medical problem if they remain in the ovaries, swell and cause pain or other symptoms. They can occur during the fertile years or after menopause. Most ovarian cysts are benign (non-cancerous) and go away on their own without treatment. Rarely, a cyst can be malignant (cancer)

Types of ovarian cysts

Types of cysts include the following:

Functional cyst: a functional cyst corresponds to the formation of a non-neoplastic pathological structure that contains a cavity full of liquid. Cystic lesions correspond to solitary cysts of follicular origin (they appear during regular activity of the ovaries). They are the result of the expansion of the original cavity of the preovulatory follicles (follicular cysts) or of the corpus luteum (cyst of the corpus luteum). Their incidence is unknown, but in many cases they are considered common, often subclinical and spontaneously regressive. They are more common in non-pregnant women of reproductive age, particularly in the periods of menarche and menopause. They are generally benign (non-cancerous)

Follicular Cysts

Follicular cysts: In a normal menstrual cycle, the egg grows inside a small sac called a follicle. When the egg matures, the follicle opens to release the egg. Follicular cysts are formed when the follicle does not open to release the egg. This causes the follicle to continue growing in a cyst. These cysts often have no symptoms and disappear within one to three months

Cyst of The Corpus luteum

Cyst of the corpus luteum: Once the follicle opens and releases the egg, the empty follicle sac contracts into a cell mass called corpus luteum. The corpus luteum produces hormones to prepare the next egg for the next menstrual cycle. The cysts of the corpus luteum are formed if the sac does not shrink. Instead, the sack is closed again after the egg has been released. Then the fluid collects inside. Most cysts of the corpus luteum disappear after a few weeks, but can grow to almost four inches wide. They can also bleed or twist the ovary and cause pain

Other types of ovarian cysts include:

Teratoma: also called dermoid cysts or germ cell cysts, they are much less common but more reliable because they can grow quite large. The key characteristic of a dermoid cyst is that it consists mainly of epithelial tissue, although it can also contain fatty tissue and fragments of hair. Dermoid cysts are congenital (present from birth). Doctors don't know how they occur, although they believe they come from cells that escape migration when all three layers of the early EMBRIA (mesoderm, ectoderm and endoderm) develop

Cystadenoma: these cysts are located on the outer surface of the ovary and can grow very large. Ovarian cystoadenomas are common benign epithelial neoplasms that have an excellent prognosis. The two most common types of cystoadenomas are: 

• Ovarin serous cystoadenomas
• Ovarian mucinous cystoadenomas

Endometrioma: this cyst is formed due to endometriosis

Most ovarian cysts disappear without treatment or intervention. The gynecologist may recommend the surgical removal of a large, persistent or symptomatic ovarian cyst (causing discomfort, irregular menstrual periods or bleeding) or when the cyst has suspicious characteristics that cause the gynecologist to rule out ovarian cancer. Although ovarian cysts are not cancerous and rarely become cancerous, they can coexist with cancerous tumors

In addition, ovarian cancer tumors commonly have cystic features. It is often possible to remove the cyst without damaging the ovary. When the cyst is large or questionable, the surgeon may need to remove the entire ovary as known as oophorectomy. In the case that the remaining ovary is healthy and functional, removing a single ovary does not affect the menstrual cycle or fertility

Symptoms of the ovarian cyst

Some cysts can be asymptomatic (without symptoms), while others can cause swelling, pain, acute pain and bleeding. Cyst pain can last from a few minutes to a few days. Other symptoms of cysts include late or missed periods, a feeling of pressure or weight in the lower abdomen and constipation and problems with urination due to the internal pressure of the cysts. Broken cysts can cause intense pain and produce symptoms similar to appendicitis, infection or ectopic pregnancy. while malignant ovarian cysts often do not cause symptoms until they reach an advanced stage. See a doctor immediately for the following symptoms:

• Sudden sharp pain in the lower abdomen
• Persistent pain on the right side of the abdomen accompanied by illness, fever or vomiting
• Abdominal pain with vaginal discharge, fever or swelling
• Intermittent bursts of pain in the lower abdomen during sex, bowel movements or exercise

Causes of ovarian cysts

• Hormonal problems: Functional cysts usually disappear on their own without treatment. They can be caused by hormonal problems or medications used to help you ovulate

• Endometriosis: Endometriosis occurs when the lining of the uterus (uterus) grows outside the uterus. Women with endometriosis can progress a type of ovarian cyst named an endometrioma. The tissue of endometriosis can join the ovary and form growth. These cysts can be painful during sex and during menstruation

• The pregnancy: An ovarian cyst usually develops in early pregnancy to help support pregnancy until the placenta is formed. Sometimes the cyst remains in the ovary until late in pregnancy and may need to be removed

• Severe pelvic infections: Infections can spread to the ovaries and fallopian tubes and cause cyst formation

Diagnosis of ovarian cysts

A large ovarian cyst should be palpable abdominally from the pelvis. The smaller cysts will be palpable in the bimanual examination due to the presence of fullness in any of the attachments. Positive test results will be easily lost if the patient is overweight or if you experience discomfort during the test. Pelvic ultrasound will detect the pathology in most cases. Both the transabdominal and transvaginal approaches should be used whenever possible. 

A transvaginal approach has been shown to improve sensitivity compared to a transabdominal approach for smaller cysts, while transabdominal scanning will detect very large cysts, which might otherwise be missing. Magnetic resonance imaging (MRI) of the pelvis and abdominal computed tomography (CT scan) can be used in case of concern about the neoplasm or the site of origin of the disease

Diagnostic laparoscopy may be useful for further evaluation of a suspicious cyst on some occasions and laparoscopy for pelvic pain or infertility may result in the finding of a previously unsuspected ovarian cyst

Physical examination

• Include pelvic exam
• Exclude pregnancy, sexually transmitted diseases (STDs)

Lab test

• Human chorionic gonadotropin (hCG), complete blood count (CBC), STD test
• Pregnancy test: A positive test may suggest having a corpus luteum cyst

• Blood test with CA 125: the blood levels of a protein called cancer antigen 125 (CA 125) are often high in women with ovarian cancer. If the cyst is partially solid and you are at high risk for ovarian cancer, your doctor may order this test. High levels of CA 125 can also occur in noncancerous conditions, such as endometriosis, uterine fibroids and pelvic inflammatory diseases

Imaging 

• Ultrasound: the presence of calcification suggests a teratoma
• CT scan: can clarify images / useful for distinguishing gastrointestinal complaints (eg appendicitis) from the ovaries
• Magnetic Resonance Imaging: can outline complicated uterine anomalies