ConditionOvarian Cyst & Pelvic Mass
In most cases, ovarian cysts are small, harmless & produce no symptoms. However, immediate attention is needed if they get larger, if they twist (torsion), or if they burst. The surgeons at CIGC have a niche focus in GYN techniques that result in fast recovery with less pain. Their advanced techniques allow women to have minimally invasive cyst removal.
WHAT ARE THE OVARIES?
The ovaries are a pair of small, almond-shaped organs in the female reproductive system. They are present in the female pelvis on the right and left of the uterus. They are responsible for releasing an egg on a monthly basis during a woman’s reproductive years. The egg can be subsequently fertilized by the sperm. One other important function of the ovaries is to produce the female hormones estrogen and progesterone. These hormones are necessary for a woman’s menstrual cycle, pregnancy, if present, body shape, bone health and overall health.
WHAT IS A FUNCTIONAL OVARIAN CYST?
Before the egg is released from the ovary, it forms in a small fluid-filled sac called a follicle. The fluid protects the egg while it develops and is released with the egg during ovulation.
If the follicle does not break open and the fluid is not released, a follicular ovarian cyst may develop. If the follicle reseals after it bursts and the fluid re-accumulates, a corpus luteum cyst will then develop. Bleeding inside the follicle results in a hemorrhagic ovarian cyst. These types of cysts are called functional cysts, as they may develop monthly during the normal function of the ovary. Functional cysts are the most common types of ovarian cysts, and they usually resolve within one to two months.
WHAT IS A BENIGN OVARIAN CYST OR TUMOR?
Ovarian cysts that are not part of a menstrual cycle are known as ovarian tumors. Some tumors can be cystic or filled with fluid, some can be solid, and some can have both cystic and solid components. Ovarian tumors usually do not resolve and require surgical removal.
The following are some of the more common ovarian cysts and tumors.
- Dermoid Tumor – This tumor is also known as a Mature Cystic Teratoma and has both a cystic and solid component. It is filled with tissue from other parts of the body such as hair, teeth and fat. These tumors most commonly occur in teenage girls and young women.
- Mucinous Cystadenoma – This is an ovarian cyst that contains mucous material. It is the most common benign ovarian tumor and can grow very large.
- Serous Cystadenoma – This is an ovarian cyst that contains clear yellow fluid.
- Endometrioma – This is also known as chocolate cyst. It is filled with endometriotic fluid, which has a thick brown consistency.
- Fibroma – This is a solid ovarian tumor resembling a fibroid. It can often be mistaken for a pedunculated fibroid on the ultrasound or MRI.
WHAT IS PCOS?
Polycystic ovarian syndrome is a condition that causes the development of multiple small, benign cysts on the ovaries and is usually present due to hormonal imbalance. Other characteristics of this syndrome are irregular menstrual cycle, and elevated levels of male hormone causing excess facial and body hair.
WHAT IS A PELVIC MASS?
A pelvic mass is a general term for any growth or tumor on the ovary or in the pelvis. A pelvic mass can be cystic (cystadenoma), solid (fibroma), or both (dermoid). A pelvic mass can be benign or malignant.
WHAT ARE COMMON SYMPTOMS THAT YOU MIGHT HAVE WITH AN OVARIAN CYST OR PELVIC MASS?
In most cases, ovarian cysts are small, harmless and produce no symptoms. In other cases, cysts may cause problems if they get larger, if they twist (ovarian torsion), or if they burst and cause internal bleeding. Immediate attention and treatment is then needed. If you have an ovarian cyst, you might experience any of the following symptoms:
- Menstrual irregularities or abnormal bleeding
- Dull ache in your lower back or thighs
- Pelvic pain shortly before or after the beginning of your menstrual cycle
- Pelvic pain with intercourse (dyspareunia)
- Fullness or heaviness in your abdomen
- Nausea, vomiting or bloating
- Pressure on your bowel or pain during bowel movements
- Difficulty emptying your bladder completely
It is always important to remember that some ovarian cysts may be cancerous. Although very rare in younger women during their reproductive years, the risk of ovarian cancer increases with age.
HOW DO WE DIAGNOSE OVARIAN CYSTS?
- Ultrasound: Examining an ovarian cyst via ultrasound will help determine proper diagnosis and management. Essentially, aspects examined include the shape (regular or irregular), the size, and the composition of the cyst. It is important to know whether a cyst is fluid-filled, solid or mixed. Fluid-filled cysts (commonly called simple cysts on an ultrasound) are not likely to be cancerous and most often require observation and close follow-up unless they are too large or causing disturbing symptoms. Those cysts that are solid or mixed (fluid-filled and solid) may require further evaluation to determine if cancer is present and most often require surgical treatment. These cysts are commonly called complex cysts on the ultrasound.
- MRI: Usually reserved for solid tumors.
- Blood tests: Pregnancy test, hormone levels and CA-125 may be necessary, depending on the characteristic of the cyst on the ultrasound.
WHAT DOES MY CA-125 RESULT MEAN?
CA-125 is a blood test that can be performed to rule out ovarian cancer. However, the results are often high in premenopausal women, because many other benign conditions can lead to an elevated CA-125 level. Endometriosis, fibroids, noncancerous ovarian cysts, infection, liver disease, and many other conditions can falsely elevate the value and give patients an unnecessary scare. The test is somewhat more effective in postmenopausal patients.
In some cases, observation may be all that is necessary, especially for small, functional cysts causing no symptoms. For women who require removal of ovarian cysts or removal of the ovaries, including women seeking prophylactic oophorectomy to reduce future cancer risk, Advanced Laparoscopic Surgery offers fast solutions and nearly painless recovery.
SURGICAL TREATMENT OPTIONS
Laparoscopy is very effective for cysts or masses involving the ovaries or fallopian tubes. Benign (non-cancerous) cysts of the ovary can usually be removed, while preserving the ovary. Extremely large masses or endometriomas may require removal of the entire ovary and fallopian tube. Patients seeking cancer prevention due to increased genetic risk factors will also require complete removal of the ovaries and fallopian tubes.
A decision to remove an ovary is based on the patient’s age, the likelihood of cancer, and the safety of the procedure. Every effort is made to preserve ovaries for patients who desire fertility. However, patients with suspected cancers, with family or personal history of breast or ovarian cancer, or with prior histories of ovarian pain or scarring may need complete removal of the ovary at the time of surgery.
The size and type of cyst present determine if the ovary will need to be removed. A woman’s ovaries are only removed after a full discussion of this possibility before surgery, or if there is no way to remove a mass without significant blood loss or compromising safety during the procedure.
HOW ARE OVARIAN CYSTS OR PELVIC MASSES REMOVED?
Pelvic mass surgery can be performed laparoscopically, no matter the size. This includes ovarian cystectomy (ovarian cyst removal), or oophorectomy (removal of the entire ovary and cyst). During an oopherectomy, the fallopian tube is usually also removed during the procedure since it is adherent to the ovary and may cause further complications if left in place.
OVARIAN CYST SURGERY
Typically, one or two tiny (1/4 inch) incisions and one slightly larger (3/4 inch) incision are necessary for a cystectomy or oophorectomy. The smaller incisions are located at the belly button and on the far right and left side in the bikini line. The larger incision is located just above the pubic bone. The two procedures do not differ surgically in terms of surgical time, incisions, recovery, or any other measure. The only difference is whether ovarian tissue is left in place.
Cysts are surgically removed from the ovary using a unique type of surgical equipment: the Harmonic Scalpel. This device uses sound waves to cut tissue and seal vessels at the same time. There is a risk that an ovarian cyst may rupture when performing cystectomy. In benign, or non-malignant cases, this is of no concern. Cysts or ovarian masses that are suspected of being cancerous may require complete removal of the ovary to avoid rupture. While not of immediate danger, if cancerous masses rupture, patients will require chemotherapy due to the spill of cancerous cells in the pelvis.
In order to remove the cyst or ovary from the body safely, a special bag is used to encapsulate the ovary. This allows for easy removal and prevents fluid from the mass from spilling into the pelvic cavity. Any masses suspected for malignancy are sent for frozen section analysis. In frozen section, the mass is sent to the pathologist while the patient is still asleep on the operating room table. The pathologist carefully reviews the sections of the mass to rule out cancer.
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC TREATMENT?
Since the vast majority of ovarian cysts and masses in premenopausal patients are benign, laparoscopy is a great option for many patients. Minimally invasive procedures allow patients to avoid large open incisions for the removal of their cysts, thereby decreasing hospital stays, recovery times, and pain. Postmenopausal patients with masses are also usually benign, with cancer rates ranging from five to 20 percent of all masses, depending on the study cited. Laparoscopy is of significant benefit for these patients as well, since it will prevent an open surgery, and recovery from open surgery can be increasingly difficult for older women.
Women who have laparoscopic cystectomy or oopherectomy are almost always discharged from the hospital the same day, with excellent pain control and rapid recovery. Most patients are back to work within seven days.
WHAT IF MY OVARIAN MASS IS CANCEROUS?
If cancer is identified, a staging operation is performed during the same surgery. Staging means evaluating other areas such as lymph nodes to rule out metastasis, or spread of disease, that may require chemotherapy. Frozen section and staging with identification of cancer is helpful to both the surgeon and the patient. By having the section immediately reviewed and staging in the same surgery, the patient avoids having to undergo a second surgical procedure at a later date. Not only is laparoscopic surgery easier to recover from for all patients, but we find that our oncology patients feel better and stronger if chemotherapy is required, if they are not recovering from extensive open surgery as well. Occasionally, a patient with more extensive malignancy will require open surgery for complete removal of malignant masses, as indicated.
WHAT ARE THE RISKS OF LAPAROSCOPIC SURGERY FOR OVARIAN CYSTS?
Rupture of an ovarian mass is possible with either laparoscopic or open surgical procedures. According to the medical literature, rupture rates are higher in laparoscopy than open procedures. For the reasons stated above, and that rupture poses no risk of harm in benign cases, laparoscopy should always be considered unless an ovarian cancer is confirmed prior to surgery by imaging studies, such as CT scan, or ultrasound with elevated CA-125 (hormone marker for ovarian cancer), and confirmed pelvic exam. In some cases, malignancy can be treated laparoscopically as well, but requires a complete assessment by a gynecologic oncologist.
Please note that ovarian cancer is a very rare disease, with the risk being only one in 70, or 1.4 percent in the general population. In properly selected patients, the treatment of ovarian masses with laparoscopy saves thousands of women every year the difficult recovery and increased complications associated with open surgery.
LAPAROSCOPIC MANAGEMENT OF OVARIAN CYSTS AND MASSES
|Indications||All patients without confirmed evidence of ovarian cancer|
|Discharge Home||Same day|
|Recovery Time||Five to seven days|
|Incision Size||One to two 1/4 inch incisions with one 3/4 inch incision|
|Pain Tolerance||Very good to excellent|
|Procedure Time||Less than one hour, range 15 to 60 minutes|
|CA-125||A hormone marker for ovarian cancer. Can be falsely elevated in premenopausal patients.More accurate in postmenopausal patients|
|Frozen Section||Performed at the time of surgery to rule out cancer for suspicious masses only.If cancer is identified, staging is accomplished at the same surgical procedure, avoiding a second surgery at a later date.|
|Conversion to Open||Rare, usually indicated if ovarian cancer has spread outside of the ovary|
WHY CIGC FOR MY OVARIAN CYST OR PELVIC MASS SURGERY?
Although ovarian cysts are fairly common and some even resolve themselves, some can be cancerous, and some may burst, causing internal bleeding.
Many women respond well to hormonal therapy, however in some cases, you may need emergency surgery. In any situation, it is important to put your health in the hands of a trusted surgeon when seeking ovarian cyst or pelvic mass treatment.
The surgeons at CIGC have a niche focus: techniques for GYN surgery that facilitate optimal care and rapid recovery. Gynecological surgery is the only medicine we practice.
Because we are so focused on GYN surgery, all of our surgeons have undergone extensive training to become board-certified and fellowship-trained in Minimally Invasive Technology or Gynecological Oncology. No one is more qualified than CIGC to treat your ovarian cysts, whether they are cancerous or not.
We use DualPortGYN, a minimally invasive, laparoscopic technique to remove ovarian cysts. Laparoscopy is extremely effective for masses in the ovaries or fallopian tubes, and laparoscopic procedures for ovarian cysts have many benefits. They allow the patients to avoid large, open incisions for removal. Smaller incisions mean minimal scarring and a same-day discharge from the hospital. Most OB/GYNs use open procedures, which can cause a painful recovery. Recovery from large incisions is especially difficult for older women, so laparoscopic procedures are beneficial for everyone.
Why not my OB/GYN?
Many patients have a strong bond with their OB/GYNs. However the main focus of an OB/GYN is obstetrics, with GYN surgery making up a small percentage of their practice. We partner with OB/GYNs to ensure that patients have the best possible care.
It is always better for the patient to have a minimally invasive surgical procedure rather than an invasive open or robotic procedure. At CIGC, our specialists have made a commitment to minimally invasive GYN surgery. We perform a higher volume of cases, see a wider range of case types, and undergo comprehensive training sessions. Surgical expertise is only acquired through performing a high volume of procedures, and since GYN surgery is our main focus, we have developed the advanced skills needed to get patients back to themselves faster, with less pain.
As a patient, it is your decision where to get treated. As experts in the field, we urge you to visit us and find peace of mind in the form of nuanced expertise and years of experience. If you want to know more about the practices and techniques we employ to treat your ovarian cysts or pelvic mass, please give us a call at (888) 787-4379.
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