Management of ovarian cysts Dr Matt Hewitt

Ovarian cysts Benign Malignant Non ovarian e.g functional cysts, serous cystademonas, dermoid (teratoma) Malignant Epithelial tumours 90% - e.g serous cystadenoacrcinomas Sex cord tumours Germ cell tumours Metastatic Non ovarian e.g Hydrosalpinx, tubovarian abcess

Ovarian cancer Lifetime risk 1 in 70 90% are epithelial tumours 75% present at late stage III/IV 5 – 10 % Hereditary predisposition BRCA I and II HNPCC

Stage at diagnosis and 5 year survival FIGO Staging Uterus Cervix Ovary FIGO Staging

Pre menopausal ovarian cysts 10% of women will undergo ovarian surgery at some point Symptomatic cysts 1 to 3 1000 population Simple cysts < 5cm usually resolve, do not require follow up PCO on scan do not require follow up scan

Post menopausal cysts Increasing detection of ovarian cysts 21% have abnormal ovarian pathology Simple Cysts <5cm – low risk of malignancy

Clinical examination If its palpable it needs surgery Ascites Tenderness Fixed Differentiating between uterus and ovarian mass

Imaging Ultrasound good assessment of the ovary and presence of ascites MRI good but expensive assessment of ovary Rarely gives additional information on nature of cyst Is good in CT scan – not good at evaluating cyst - good in presence of ascites

Ultrasound Trans abdominal and transvaginal (TVS) Size Simple – unilocular, no blood flow Complex – Multilocular, solid elements, irregular, papillary projections, blood low Ascites

Tumour markers Ca 125 not sensitive and not specific Should not be used in assessment of abdominal pain hCG, α-FP, LDH Should not routinely be used Secondary care assessment germ cell tumours

Surgical management Laparoscopy – up to 12cm Laparotomy Cystectomy – if confident not malignant Unilateral oophorectomy Bilateral oophorectomy

WHO Principles of Screening Diagnostic test sensitive and specific simple and cheap safe and acceptable reliable Disease serious high prevalence of preclinical stage natural history understood lead time bias, length bias Diagnosis & Treatment facilities are adequate effective, acceptable, safe treatment available

Premenopausal Asymptomatic Ovarian cyst Simple <5cm No FU 5-7cm Rescan 3/12 >7cm Refer Complex <3cm 3-5cm Re scan 3/12 >5cm Premenopausal Asymptomatic

Post Menopausal Asymptomatic Ovarian cyst Simple <3cm Re scan 3/12 >5cm Refer Complex Re scan 3/12 >3cm With ascites Urgent Referal Post Menopausal Asymptomatic

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