Embarrassing Illnesses

Whether your ovarian cyst needs to be treated depends on:

• your age,
• whether you have been through the menopause,
• the appearance and size of the cyst, and
• whether there are symptoms.

Observation

In some cases, observation may be all that is necessary. This is common in pre-menopausal women who have a small (2-5cm) functional cyst.

You will need to have an ultrasound scan after a month or so to check on the cyst. Most disappear after a few weeks without treatment.

Women with ovarian cysts who have gone through the menopause are usually monitored with ultrasound scans and blood tests for the CA125 protein. This varies depending on factors such as the size of the cyst and how it changes over time.

The risk of developing cancer is very low if you have small cysts on one ovary. More than half of such cysts disappear within three months.

Post-menopausal women are advised to have a follow-up ultrasound scan four months after the cysts have gone.

Surgery

If the cyst is large or is causing symptoms, it will probably be removed. Sometimes doctors recommend taking the cyst out even if you do not have symptoms, because it is not always possible to tell what type of cyst it is without looking at it under a microscope. This reduces the risk of the cyst becoming cancerous later on.

There are two types of operation, which are usually done under general anesthetic. Both are described below.

Laparoscopy

Smaller cysts can sometimes be removed using a surgical technique called laparoscopy. This is a type of keyhole surgery in which two small cuts are made in the lower abdomen and gas is blown into the pelvis to lift the wall of the abdomen away from the organs inside.

A laparoscope (a small, tube-shaped microscope with a light on the end) is then passed into the abdomen so the surgeon can see the internal organs. Using tiny surgical tools, the surgeon can remove the cyst through the small skin cuts. Sometimes the surgeon just take a sample of the cyst to see what type it is.

The cuts are then closed using dissolvable stitches. This operation takes about half an hour, depending on the size and type of cyst. Most women are able to go home the same day.

This type of operation is the preferred approach, because it causes less pain, helps to preserve fertility and allows you to return to normal activity sooner.

Laparotomy

If there is a risk that the cyst is cancerous, you may be advised to have a more serious operation called a laparotomy.

For this operation, a larger cut is made across the top of the pubic hairline to give the surgeon better access to the cyst. The whole cyst is taken out and sent to a laboratory to check that it is not cancerous. The skin is closed using stitches. You may have to stay in hospital overnight or for a few days.

Treatment for cancer

If the cyst is found to be cancerous, you may need treatment to remove both of the ovaries, the uterus, a fold of fatty tissue called the omentum and some lymph nodes.

If this is recommended, your doctor will talk to you beforehand about the risks of each kind of surgery, how long you are likely to be in hospital and how long it will be before you can go back to your normal activities.