Simple vs. Complex Ovarian Cysts: The Link to Ovarian Cancer

Women’s Health

Differentiating simple from complex ovarian cysts is key for gynecologists, as is ascertaining the cancer risk they pose. Learn how to identify these masses.

Jessica Cerretani May 1, 2019

Women’s Health

• Gynecology
• Ovarian Cancer
• Benefits & Applications
• Diagnostics
• 3D Ultrasound
• Cancer
• 2D Ultrasound
• Best Practices
• Pelvic Pain
• Ultrasound

A practitioner’s first concern upon spotting an ovarian mass on a patient image is often to determine what kind of mass it is and the possible impact on a patient’s health. Your patient’s first concern, however, is often knowing whether or not that mass means cancer.

Understanding complex ovarian cysts and being able to differentiate them from simple ovarian cysts is paramount for physicians and gynecologists. Being able to explain the risk for ovarian cancer in a straightforward and reassuring way for your concerned patients is equally crucial.

With the help of a growing number of imaging and modeling tools, healthcare professionals are now better equipped than ever to treat ovarian cysts and masses and determine the probability that they will lead to cancer.

Simple vs. Complex Ovarian Cysts

Ovarian cysts are sacs that develop in or on the ovary. There are two main types of cysts: simple ovarian cysts and complex ovarian cysts. Simple ovarian cysts are fluid-filled sacs, and they are fairly common in both premenopausal and postmenopausal women. These sacs don’t typically lead to cancer or an increased risk of it, and many simple ovarian cysts will disappear on their own without treatment. In fact, one recent study estimated that fewer than one out of 1,000 women with only a simple ovarian cyst would develop ovarian cancer.

Simple ovarian cyst

Ovarian cystadenoma

Unlike simple cysts, complex ovarian cysts are solid or irregular masses. Types of complex masses include endometriomas, dermoids and cystadenomas. Although there is a complex ovarian cyst cancer risk, these masses won’t necessarily lead to cancer either. The U.S. Department of Health and Human Services estimates that 5 to 10 percent of women have surgery to remove an ovarian cyst, but only 13 to 21 percent of those are cancerous. Gynecologists can use ultrasound technology to distinguish between these different types of ovarian masses.

Rules for Identifying Ovarian Masses

Transvaginal ultrasound, especially 3D ultrasound, can help physicians differentiate between benign simple cysts and potentially cancerous complex ovarian masses. For example, cysts that contain papillary structures, solid areas and increased vascularity are more likely to be malignant. Still, it can be difficult for clinicians to differentiate between some complex and simple ovarian masses.

The International Ovarian Tumor Analysis (IOTA) model attempts to clarify these differences by providing practitioners with specific guidelines. The IOTA group’s “Simple Rules” are a preoperative classification system for ovarian tumors that outlines five common characteristics of benign tumors and five common characteristics of malignant tumors. Certain ultrasound machines such as the GE Voluson™ series have these IOTA protocols available onboard, making ovarian mass evaluation even easier for clinicians.

A growing body of research suggests that the use of these rules also has the potential to improve care for women with ovarian masses. For example, one meta-analysis of previously published studies found that the IOTA rules could be applied in up to 89 percent of tumors, which could be transformative for the accuracy of ovarian cancer diagnosis. Additionally, one case-control prospective study of 50 patients concluded that the sensitivity for malignancy detection in cases where the IOTA guidelines were applicable was more than 91 percent, with a specificity of more than 84 percent and an accuracy of more than 86 percent.

Using the IOTA ultrasound guidelines may help gynecologists make critical calls in differentiating between the types of ovarian cysts. Reassure your patients that finding an ovarian cyst does not have to be a cause of stress and that diagnosis and treatment can be simpler and more routine than they think.

IOTA terms

IOTA Simple Rules protocol Voluson E10 system

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Ovarian Cyst: Symptoms, Causes, & Treatment

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Types of Ovarian Cysts

• Ovarian Cyst Types & Symptoms
• Ovarian Cyst Removal

Ovarian cysts are sacs or pockets of fluid that form on the ovaries. There are two types of cysts: simple and complex.

Simple Cysts

These are fluid-filled cysts that have no solid features. They are often either a functional cyst or a noncancerous tumor.  It’s rare for a simple cyst to be associated with cancer. Functional cysts frequently form in reproductive-aged women as part of regular ovulation (releasing an egg from an ovary during the menstrual cycle), but they usually go away on their own.

The most common types are:

• Corpus luteum cysts — These cysts occur after your ovary’s follicle (sac) releases an egg and the sac fills with fluid. When the follicle bleeds, it’s called a hemorrhagic (bleeding) ovarian cyst.
• Follicular cyst — These types of cysts appear when the sac doesn’t release an egg. However, the sac will keep expanding.

Other simple cysts may be caused by benign tumors that will persist but may not need to be removed if they are not growing or causing symptoms.

Complex Ovarian Cysts­

A complex or non-functional cyst is one that isn’t associated with ovulation. These are solid or partially solid and can grow to cause discomfort or pain. Most ovarian cysts are noncancerous, but a small percentage of complex cysts are cancerous. The cancer risk is somewhat higher for post-menopausal women.

Why Choose University of Utah Health?

U of U Health offers the most effective treatment options for ovarian cysts, such as the latest minimally invasive techniques. Our multidisciplinary women’s health specialists will work with you to provide individualized treatment for your ovarian cysts while keeping your reproductive goals in mind.

Ovarian Cyst Symptoms

Sharp or dull pain is typically the only symptom of an ovarian cyst. The pain may be located in your pelvis or either side of your abdomen. Ovarian cysts may also cause bloating or a feeling of abdominal or pelvic fullness as the cyst pushes against other areas within your pelvis.

When to See a Doctor for Ovarian Pain

Since most ovarian cysts don’t show symptoms, it can be difficult to know when to seek help. You should see your doctor right away if you experience any of the following signs:

• sudden or severe ovary pain,
• fever,
• nausea or vomiting, and
• dizziness or fainting.

Diagnosing Ovarian Cysts

Your doctor will often discover an ovarian cyst during your annual pap smear. However, if you make an appointment for pelvic pain, your doctor will perform an internal and external pelvic exam to feel for cysts. If they suspect you have a cyst, they will order an ultrasound to confirm their diagnosis.

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What Is the Treatment for an Ovarian Cyst?

Our experts will work with you to determine the best course of treatment. Most of the time, your doctor will perform an ultrasound every three to six months to keep an eye on your cysts. This will help them determine if and when they require removal.  

If your ovarian cyst needs to be surgically removed, we will perform one of the following procedures:

• laparoscopic surgery (using a small tool with a camera attached) or
• open surgery (cutting into the abdomen). 

Your surgical options will depend on the number and size of your cysts. Our highly trained gynecologic surgeons are usually able to keep your ovary intact if the cyst is not too large. We will discuss each treatment option with you.

Draining Ovarian Cysts

We do not drain ovarian cysts because:

• they typically return fast using this method.
• this method won’t allow us to get enough tissue to test for cancer.

What Can Happen If a Cyst Is Left Untreated?

Most cysts will go away on their own. However, if an untreated cyst twists or ruptures, you could risk losing your ovary or bleeding excessively. These complications can affect your fertility and, in rare cases, lead to death. If you experience ovarian cyst symptoms, it’s important to discuss them with your doctor immediately.

What to Expect After an Ovarian Cyst Ruptures

It’s common for a simple, fluid-filled cyst to rupture or burst due to its increasing size. However, a rupture usually doesn’t need to be treated because your body reabsorbs the fluid.

Other Ovarian Cyst Complications

• Ovarian torsion—Torsion occurs when the cyst has twisted. The twisting causes severe pain and could cut off blood circulation to your ovary. Ovarian torsion is an emergency that requires surgery within hours to save the ovary.
• Malignancy—An ovarian cyst malignancy, or cancer, is rare, especially among premenopausal women. However, your doctor will want to rule out cancer if you have a complex ovarian cyst or are considered high-risk.

You should see a doctor as soon as possible if you experience:

• severe pain,
• heavy uterine bleeding,
• dizziness,
• nausea, or
• fever.

Make An Appointment With Our Gynecologists

If you have symptoms of ovarian cysts or are considering treatment for known cysts, call 801-213-2995 for an appointment with one of our gynecologists. No referral is necessary to see one of our specialists for ovarian cyst treatment and management.

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Serous ovarian cyst – causes, symptoms, diagnosis, treatment and prevention

• What is a serous cyst
• Symptoms
• Diagnostics
• Treatment
• Doctors
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What is a serous cyst

A serous cyst is the most common among benign ovarian tumors (occurs in about 70% of cases). It is a capsule (pouch) filled with a straw-colored watery liquid (serosa). Unlike retention cysts, in a serous cyst, the capsule shell is denser and almost completely inelastic. Due to the dense tissue of the capsule, such formations are often called epithelial tumors. This type of cyst is rare but leads to ovarian cancer.

Symptoms

There are no specific symptoms of a serous cyst. It is usually detected by chance, as a result of a routine examination by a gynecologist. If a woman does not have the habit of regularly visiting a doctor, a serous cyst can be “missed”. In this case, when it reaches a large size, the cyst begins to compress neighboring organs and disrupt their functions.

Among the most common manifestations of a serous ovarian cyst:

• dull pain in the abdomen and groin,
• changes in the nature of menstruation (copious or scanty),
• constipation and urinary problems,
• Abdominal asymmetry with large cyst,
• weakness,
• temperature increase.

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Ovarian cyst: surgery or conservative treatment?

Diagnostics

The most important thing in the diagnosis of serous cystadenoma is to find out its nature: is it a benign tumor or has it already degenerated into oncology. To do this, along with an ultrasound of the ovaries, it is necessary to conduct a laboratory test – take a blood test for the CA125 protein. Normally, its level should not exceed 35 U / ml.

In addition, it is not uncommon for women with a serous cyst to undergo a CT scan, as it will help to see the lymph nodes that increase in size in ovarian cancer.

However, until now, the only reliable way to distinguish ovarian cancer from a serous ovarian cyst is a histological examination of the cyst after it has been removed.

Treatment

Usually, doctors prescribe complex therapy for serous ovarian cysts. Treatment with medications alone (hormonal contraceptives, gestagens, vitamins) may be ineffective, especially if the cystadenoma has reached a large size. Then surgery is required.

The operation is usually performed using a laparoscopic technique, it is anemic and in most cases well tolerated by patients. The serous cyst is removed completely, usually together with the ovary, and given for histological examination to select further therapy. In this case, the doctor usually saves the second ovary, which is very important for young women who have not yet given birth. In women who have entered the menopausal age, surgeons usually remove both ovaries. This is associated with a high risk of malignancy of the ovary.

After the operation, it is necessary to be observed by a gynecologist and follow his recommendations regarding postoperative conservative treatment of a serous ovarian cyst.

Dear women, remember: often your health is in your own hands! Do not neglect regular consultations and examinations with a gynecologist. Listen to yourself, if you have any doubts, contact us. Specialists of the International Medical Center ON CLINIC will always provide prompt and qualified assistance!

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how it manifests itself and whether it needs to be treated

Follicular ovarian cyst is a benign formation of the ovary of functional origin. Occurs against the background of ovulation disorders during the menstrual cycle. Often a follicular cyst is an “accidental finding” on ultrasound, completely unexpected for a woman. Tatyana Vladimirovna Galushkina, an obstetrician-gynecologist at the HappyDerm Medical Center, will tell about the features of education and the tactics of its treatment.

What is a follicular cyst

This is a bubble ~ 30-50 mm in size with thin walls Occurs at the site of a non-bursting follicle: the egg dies, and the follicle degenerates into a cyst. It is important to understand that education has nothing to do with the malignant process, but it is necessary to monitor it in dynamics. In the vast majority of cases, the formation is detected during a routine gynecological examination or during an ultrasound scan of the pelvic organs.

Many women are asymptomatic. If the follicular cyst has grown to a size of 50 mm or more, symptoms may occur.

• Delayed menses. If after 1. 5-2 months the next menstruation does not occur, the pregnancy test is negative, the probability of developing this pathology is high.
• Cycle violation. This includes the abundant nature of the discharge, prolonged menstruation. Intermenstrual spotting is also possible.
• Pain in the lower abdomen. Aching pains are localized in the lower abdomen or in the projection of the ovary. It is also characterized by discomfort and distension in the lower abdomen. Why does a follicular cyst hurt? This is due to the growth of the bladder and compression of the nerves, impaired blood supply to the tissues.

Only one of the described manifestations can be observed, sometimes the symptoms accompany each other.

Diagnosis

A gynecologist can suspect a follicular cyst during a bimanual vaginal examination. A change in size, compaction of the right or left ovary may indicate a pathology. Additional examinations are prescribed to verify the diagnosis. The follicular ovarian cyst in premenopause requires special attention – it is important to exclude the malignant nature of the formation. If the function of the ovaries has died away, cysts of this type can no longer develop, and the formation is often an epithelial tumor.

• Ultrasound. This is the main method for diagnosing a follicular cyst. During the examination, the localization and size of the neoplasm are established, the characteristics of the blood flow are evaluated.
• Laparoscopic examination. It is performed on an emergency basis with a suspected rupture of the cyst or torsion of its legs.
• CT or MRI. An in-depth examination, which is prescribed for the differential diagnosis of a follicular cyst from other diseases.
• Blood test. In some cases, tests are prescribed to determine the level of sex hormones and tumor markers-antigens.

The follicular ovarian cyst on ultrasound has the appearance of a single-chamber rounded formation with thin walls and a smooth, smooth inner surface. The content is homogeneous, liquid.

Treatment of ovarian follicular cyst

If the bladder is small and asymptomatic, treatment of the follicular cyst is not required. Observation by a gynecologist with ultrasound control is prescribed. Often this formation disappears on its own after 2-3 cycles.

Most other cases require conservative treatment. If the cyst does not decrease or its size continues to increase, oral contraceptives, vitamins and anti-inflammatory drugs are prescribed.

If the diameter of the follicular cyst is 80 mm or more, exfoliation of the bladder with suturing of the wall is indicated, and in complicated cases, resection of the ovary may be required. Operations in most cases are performed laparoscopically, without a cavity incision. When the pedicle of the ovarian cyst is twisted, its walls are ruptured, an emergency surgical intervention is performed. Violation of blood circulation in the ovary is an indication for removal of the organ.

According to medical statistics, the follicular cyst of the right ovary is diagnosed more often. This is due to the peculiarities of the blood supply to the left appendage: the follicles there mature less frequently than in the right ovary, and therefore cysts rarely form.