An ovarian cyst is a collection of fluid inside an ovary. They are very common and do not usually cause any symptoms. It may be filled with clear fluid mostly or blood or even pus sometimes. An ovarian cyst is a collection of fluid inside an ovary. Most ovarian cysts occur as a normal part of the process of ovulation called functional cysts. These cysts usually go away within a few months without any treatment.

An ovarian cyst can be more concerning in a female who isn't ovulating. Some tests are needed if the cyst is large or if it does disappear in a few months. Even though most of these cysts are benign, a small number of them could be cancer.

Symptoms of Ovarian Cyst

An ovarian cyst is more likely to cause pain

• Becomes large
• Bleeds
• Breaks open
• During sexual intercourse
• Twisted or torsion of ovarian cyst

Symptoms of ovarian cysts can also include:

• Bloating or swelling in the abdomen
• Pain during bowel movements
• Pain in the pelvis may be related to menstrual period
• Pelvic pain -- constant, dull aching
• Sudden and severe pelvic pain, often with nausea and vomiting, with torsion or twisting of the ovarian cyst

Diagnosis of Ovarian Cyst

• Routine pelvic examination
• Vaginal ultrasound (TVS)
• Laparoscopy
• Blood tests -CA 125

CA-125 Blood Test

CA-125 has found application as a tumor marker or biomarker that may be elevated in the blood of some patients with specific types of cancers, or other benign conditions. CA125 is the most frequently used biomarker for ovarian cancer detection.

Symptoms that could be caused by ovarian cancer should be offered a CA-125 blood test, to help diagnose the disease at an earlier stage, when treatment is more likely to be successful. Women with higher levels of the marker in their blood would then be offered an ultrasound scan to determine whether they need further tests.

Around 90% of women with advanced ovarian cancer have elevated levels of CA-125 in their blood serum, making CA-125 a useful tool for detecting ovarian cancer after the onset of symptoms. Monitoring CA125 blood serum levels is also useful for determining how ovarian cancer is responding to treatment and for predicting a patient’s prognosis after treatment.

CA-125 may also be elevated in a number of relatively benign conditions, such as

• Endometriosis
• Several diseases of the ovary
• Menstruation and pregnancy
• Any inflammatory condition in the abdominal area, both cancerous and benign
• Cirrhosis
• Diabetes mellitus

Treatment

• Combined oral contraceptive pills
• Surgery - If your cyst is large or causing symptoms
• No treatment at all for small size cysts and those are not symptomatic

There are many factors while deciding surgery or no surgery and alos open or by laparoscopy. Some of them are

• Size and type of cyst
• Age
• Symptoms
• Desire to have children

Ovarian Cyst in Pregnancy

It occurs in 1 in 100 to 1 in 10,000 pregnancies. In the first trimester of pregnancy, ovarian cysts are often functional without complications. After 16 weeks of gestation, frequency of ovarian cyst is reported between 0.5 and 3.0%. Incidence has increased in recent past because of dating ultrasound in the first trimester and also due to an increase in assisted reproductive technologies.

Frequency of ovarian cancer is reported between 1 out of 15,000 and 1 out of 32,000 pregnancies. A surgical intervention is necessary if suspect signs are observed at ultrasonographic examination.

Almost all unilocular cyst with a diameter < 5 cm and persistent in second and third trimester are not associated with complications and are regressive during pregnancy; in this cases, abstention seems warranted. Conclusions are similar for dermoid cysts with diameter < 6 cm and without malignant criteria but there are a few studies on theses topics.

Complications of Ovarian Cyst in pregnancy

Torsion,

Rupture,

Infection,

Malignancy,

Impaction of cyst in the pelvis causing retention of urine,

Obstructed labor and malpresentations of the fetus.

Treatment of Ovarian Cyst in Pregnancy

Evacuation by puncture is not well evaluated and is not recommended during pregnancy. If an intervention is decided, laparoscopy is warranted until 16-17 weeks. Cesarean section is warranted only if a cyst in the pelvis obstruct labour. During caesarean section, removal of a cyst should be performed. If the surgery is needed for ovarian cyst in pregnancy it is ideal to perform a laparoscopic ovarian cystectomy.

Laparoscopy is safe and effective treatment in gravid patients with symptomatic ovarian cystic masses. Observation is acceptable for all other cystic lesions provided ultrasound is not concerning for malignancy and tumor markers are normal. Initial observation is warranted for most cystic lesions <6 cm in size.

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