OVARIAN CYST

Ovarian disorders

Ovarian cyst – ovarium cysta

Of the internal female genital organs, the ovaries (in Latin: ovarium) is a pair of abdominal organs located between the pelvic wall and the womb. In the period of sexual fullness it is an almond-shaped organ measuring about 1.5x3x4 centimetres with double function:

1. It is the most important location of female hormone production. Several hormones are produced here. Among them, estrogens have the most important role in the development of female sexual features, and maintaining female sexuality and biological balance. After childhood, the increase of estrogen levels will induce sexual development, especially the development of the breasts. In addition, it will produce progesterone in the second half of the menstrual cycle, whose adequate level is essential for healthy conception and implantation of the fertilized egg cell.
2. Another important function is the follicular maturation in the ovaries in the age of sexual fullness, in case of a regular cycle every 28 days. This is where the Latin name of the ovary comes from: ovum = egg, egg cell. The ovulation around day 14 of the menstrual cycle creates the most important condition for the fertilization.

The term cyst comes from the Greek kystis = vesicle, and it means a mostly fluid-filled lesion covered by a membrane or thicker wall. It is a relatively frequent lesion of the ovaries. Ovarian cyst is a summarized term, it may involve a variety of forms.

It can have thin or thick wall, one or more compartments. The contents of the lumen may also be various.

There are several possible explanations for the development of the cyst, however, its exact cause is not known. Ovulation is often missed in the process of follicular maturation, and the fluid (serum) inside it will increase further, this is how most functional cyst develop. Cysts filled with fluid similar to menstruation blood may also develop in association with endometriosis. In the matrix of the ovary, a so-called dermoid cyst may develop from previously in the fetal period encapsulated abnormal cell remnants, which may contain variable tissue components (hair, tooth, etc.). Their removal requires surgery. Fortunately, most of the ovarian cysts are benign in the youth and child-bearing age. The risk of malignancy is significantly larger after menopause.

Constitutional factors as well as higher hormone levels stimulating the ovaries may play a role in the development of benign cysts.

In addition to abnormal estrogen/progesterone rate, hereditary factors predisposing for disease, and risk factors emerging from false and unhealthy lifestyle (smoking, alcohol, stress, chemicals, etc.) may also stand in the background of malignant processes.

Smaller ovarian cysts are mostly symptom-free, do not cause any complaints, and are detected only at gynecological screening or sonography performed for any other reason. Gynecological songography is performed transvaginally at most places. Non-gynecological sonography (mainly requested by internists or surgeons, and GPs) is performed transabdominally. During this, small cysts measuring 2-3 cm are often seen in the ovaries. These are mostly irrelevant, and do not require any therapy based on gynecological examination.

Larger cysts may lead to distension, compression of surrounding organs resulting in pain. Lower abdominal pain may increase upon movement, it may also occur during sexual intercourse. Bleeding disorders caused by hormonal contents of the cyst may also occur. The degree of pain is not necessarily proportional to the size of the cyst. Sometimes cysts grow, hemorrhage develops in them, or the cyst may twist. The latter may also lead to very intense, stab-like pain. Sometimes these cysts rupture, their contain enters the abdominal cavity. This may lead temporarily to mild lower abdominal cramps and pain, however, the fluid does not cause any complications in most of the cases, it will be absorbed from the abdominal cavity.

In case of malignancy, a large amount of effusion may collect in the abdominal cavity bulging the abdominal wall, this is called ascites in medical language.

Based on age and complaints of the patient, information gained by manual and sonographic examination, the benign or malignant nature of the cyst can be considered. Certain laboratory results from blood test, so-called tumour markers may help in that. Benign or malignant nature, as well as the exact type of the disease can only be determined finally by assessment of tissue or cell sample taken from the lesion. Simple benign cysts usually disappear spontaneously after one or two menstrual cycles. Generally, no intervention is required. In the background of various benign cysts, hormone system disturbance, and estrogen/progesterone imbalance, is often detected.

If the cyst is seen for months, its diameter exceeds 5 cm, it contains tissue components, or sonography gives abnormal result indicating malignancy, the usual protocol means surgical removal.
In some cases, cysts can be punctured through the vagina and their contents aspirated under short venous anesthesia. Cytological evaluation may determine the benign or malignant nature of the cyst, which may help to choose further treatment.

Current surgery for benign cysts means laparoscopy. During operation we will attempt to isolate the cyst from the matrix of the ovary in a way that the least possible functioning, healthy ovarian tissue gets removed. If this is not possible from surgical technical point of view, unfortunately, the whole ovary must be removed.

Regarding the variability of cysts, their doubtful origin and behaviour, regular follow-up is inevitable in case of verified ovarian cysts.

It is known that contraceptive pills may decrease the prevalence of certain benign and malignant cyst types. However, it has to be noted that by taking contraceptive pills, hormonal changes inducing cysts will not be restored; this will be only a suppression of symptoms! Therefore, lesions in other parts of the body cannot be influenced by contraceptive pills, and eventual diseases cannot be prevented (e.g. breast cysts, breast tumours, fibroids, etc.)!

Cysts and malignant ovarian lesions often show familiar accumulation, regular targeted gynecological screening is therefore extremely important in members of affected families.

IN EVERY CASE COMPLETE HORMONAL EVALUATION IS REQUIRED AND CAUSES OF THE DISORDER SHOULD BE TREATED!

Prior to applied therapy, determination of progesterone/estrogen rate and, depending on the result, further gynecological and endocrinological hormone evaluation is elemental. The time point of hormone evaluation depends on the cycle of the given person, and it will never be determined based on the reference range seen on the laboratory report, whether a hormone normal or abnormal is, we always have to look at their proportion and the influence upon each other.