Every woman after puberty gets them.
Every gynecologist feels them. Thankfully, most of them don't really
matter at all. They are ovarian cysts and while they often strike fear
into a woman's mind, it is up to us physicians to tell them when to mind
at all.
It's important to understand
the most common type of ovarian cyst--the follicle. An ovarian follicle
is that little cavity that grows an egg set for release at mid-cycle, or ovulation.
The ovarian follicle is both a result of and an integral part of the menstrual cycle. It contains a little puddle
of fluid that functions in the development of the egg. The release
of the egg, called ovulation, is a midpoint in the cycle. If ovulation
fails to occur, the rest of the cycle is often suspended or irregular.
The follicle is therefore a product of function, a word which will figure
importantly below.
When a follicle gets to
be bigger than about two centimeters or so, semantics dictate that it be
referred to as a cyst. That's the difference--semantics.
Of course, a cyst can be thought of as an exaggerated follicle, but it is
still a matter of normal functioning. Therefore, we speak of theses
cysts as "Functional Cysts," and nothing need
be done other than wait it out. If a woman has pain from it, or if she
doesn't want to wait it out because she's not seeking pregnancy, it can be
melted away usually with the temporary use of birth control pills.
After all, how do birth
control pills work? By suppressing ovulation and therefore the cysts
that may develop from it.
Waiting, admittedly, can
be a bit nerve-wracking, because a period is usually delayed in all of the
"functional" confusion. Still, regardless of management, the condition
is usually harmless and doesn't require surgery, unless the cyst becomes really
huge, bleeds, or twists on itself ("torsion") causing tissue damage.
And then there are the rest
of the ovarian cysts.
Pre-cancerous cysts don't
go away with birth control pills, so a failure here may indicate that there's
something more dangerous than a functional cyst. This is when gynecologists
start discussing laparoscopy to either make a diagnosis or to shell it out,
saving the ovary it's in if possible. A test called "CA-125" is a blood test that could raise the index
of suspicion if abnormal. And ultrasound is helpful to indicate whether
the cyst is a simple sack (encouraging) or complex (worrisome).
Family history also plays
a part in how aggressive a doctor may be. If a patient's mother or sister
had cancer of the ovary, we worry over any cyst, resolved to prove it functional
or not. A family history is when things start to get a little creepy,
because one out of seventy women will get ovarian cancer; but if a mother
had it, a daughter's chances are anywhere between one in twelve to one in
twenty. If two close members of her family have it, the chances can
get as ridiculously high as one in two! No wonder we worry.
New laparoscope techniques
make surgical cyst management easier on the patient, and good diagnostics
can ensure we don't get carried away with mere functional cysts, which are
the vast majority of them. But a suspicion of malignancy or even pre-malignancy
is never taken lightly and poses one of the most important exclusions of
every routine GYN exam.
This is the beginning of
a series on the ovary and things that can go on within it. In the next links
I will go into more detail, a series called, “The Good,
the
Bad, and the Ugly.”
© 2000 Gerard M. DiLeo,M.D., F.A.C.O.G.
