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Ovarian Cyst Treatments

A cyst is a fluid-filled sac. Cysts develop in various places in the body. Depending on the type of cyst, the fluid within the cyst can range from thin and watery to thick and paste-like. Some cysts have a thicker solid outer part with some fluid within.

Cysts on the ovary are very common. The vast majority of ovarian cysts are non-cancerous (benign) but some are cancerous (malignant), or may become cancerous over time. Ovarian cysts can vary in size – from less than the size of a pea to the size of a large melon (occasionally even larger). There are various types, ∂which include the following:

Functional ovarian cysts

These are the most common type. They form in some women of childbearing age (women who still have periods) when there is a functional fault with ovulation. They are very common. There are two types:

  • Follicular cysts. A follicle (see in ‘Ovulation’, above) can sometimes enlarge and fill with fluid. They can occur commonly in women who are receiving infertility treatment.
  • Corpus luteum cysts. These occur when the corpus luteum (see in ‘Ovulation’, above) fills with fluid or blood to form a cyst. A blood-filled cyst is sometimes called a haemorrhagic cyst.

Both of these cysts can grow up to about 6 cm across. They usually do not need treatment, as they normally go away on their own within a few months.

Dermoid cysts (sometimes called benign mature cystic teratomas)

Dermoid cysts tend to occur in younger women. These cysts can grow quite large – up to 15 cm across. These cysts often contain odd contents such as hair, parts of teeth or bone, fatty tissue, etc. This is because these cysts develop from cells which make eggs in the ovary. An egg has the potential to develop into any type of cell. So, these cysts can make different types of tissue. In about 1 in 10 cases a dermoid cyst develops in both ovaries. Dermoid cysts can run in families.

Cystadenomas

These develop from cells, which cover the outer part of the ovary. There are different types. For example, serous cystadenomas fill with a thin fluid and mucinous cystadenomas fill with a thick mucous-type fluid. These types of cysts are often attached to an ovary by a stalk rather than growing within the ovary itself. Some grow very large. They are usually benign but some are cancerous.

Endometriomas

Many women who have endometriosis develop one or more cysts on their ovaries. Endometriosis is a condition where endometrial tissue (the tissue that lines the womb (uterus)) is found outside the uterus. It sometimes forms cysts which fill with blood. The old blood within these cysts looks like chocolate and so these cysts are sometimes called chocolate cysts. They are benign.

Polycystic ovary syndrome (PCOS)

Polycystic means many cysts. If you have PCOS you develop many tiny benign cysts in your ovaries. The cysts develop due to a problem with ovulation, caused by a hormonal imbalance. PCOS is associated with period problems, reduced fertility, hair growth, obesity, and acne.

Others

There are also other rare types of ovarian cysts. There are also various types of benign ovarian tumors, which are solid and not cystic (do not have fluid in the middle).

Symptoms and Problems related to Ovarian Cysts

  • Abdominal bloating or swelling
  • Painful bowel movements
  • Pelvic pain before or during the menstrual cycle
  • Painful intercourse
  • Pain in the lower back or thighs
  • Breast tenderness
  • Nausea and vomiting

What is the treatment for ovarian cysts?

Dr. Ahdoot will advise on the best course of action. This depends on factors such as:

  • Your age.
  • Whether you are past the menopause.
  • The appearance and size of your cyst from the ultrasound scan.
  • Whether you have any symptoms.

Observation

Many small ovarian cysts will resolve and disappear over a few months. You may be advised to have a repeat ultrasound scan after a few months or so. If the cyst goes away then no further action is needed.

Operation Details

Removal of an ovarian cyst may be advised, especially if you have symptoms or if the cyst is large. Sometimes Dr. Ahdoot may want to remove it to determine exactly which type of cyst it is and to make sure there are no cancer cells in it. Most smaller cysts can be removed by ‘keyhole’ (laparoscopic) surgery. Some cysts require a more traditional style of operation.

The type of operation depends on factors such as the type of cyst, your age, and whether cancer is suspected or ruled out. In some cases, just the cyst is removed and the ovary tissue preserved. In some cases, the ovary is also removed, and sometimes other nearby structures such as the womb (uterus) and the other ovary. Dr. Ahdoot will advise on the options for your individual situation.

  • Pap Smear Abnormalities

Women are encouraged to start getting yearly Pap smears at the age of 21 or within 3 years of becoming sexually active. Pap smears are not diagnostic tests, but they are screening tools used to find any abnormal cells or dysplasia in the cervix.

When women are faithful in having regular Pap smears, they increase their chances for early detection and treatment of any potential problems.

What Does An Abnormal Pap Smear Mean?

Being alarmed or worried is a completely normal reaction when told your Pap smear is abnormal. An abnormal Pap smear may indicate that you have an infection or abnormal cells called dysplasia.  It’s important to remember that abnormal Pap smear results do not mean you have cancer.

These results just show that further testing should be done to verify whether or not there is a problem.

What Could Cause An Abnormal Pap Smear Result?

An abnormal Pap smear may indicate any of the following:

  • An infection or an inflammation
  • Herpes
  • Trichomoniasis
  • Recent sexual activity
  • HPV (Human Papilloma Virus) This is also called genital warts (up to 60% of women may carry this virus on their cervix, genital area, or skin and are completely unaware of it).
  • Dysplasia (abnormal cells that can be pre-cancerous)

What Is The Treatment For An Abnormal Pap Smear?

A positive result indicates the presence of abnormal cells, also called an abnormal Pap. Remember that this is a test, not a diagnosis. A positive result does not prove that you have cancer or even dysplasia (a pre-cancerous condition).

However, it usually means you should have further evaluation, such as another Pap smear, a colposcopy (using a microscope to look into the cervix) or a biopsy (removing a small amount of tissue from the cervix). Your doctor will discuss the results with you.

One in ten Pap smears indicate some abnormality, though most are not serious. Further testing will be required to determine if you have infection, inflammation, a yeast infection, trichomoniasis, herpes or the Human Papilloma Virus (HPV).

HPV is the main risk factor for cervical cancer, but most women who receive treatment for abnormal cells caused by HPV, do not develop cervical cancer.

In 2003, the FDA approved a screening test that can be done in conjunction with a Pap smear to determine if you have the HPV virus. The HPV DNA test can detect high risk types of HPV before any abnormal cells can be detected on the cervix. This screening is recommended for women over the age of 30, who are at an increased risk of an HPV infection turning into pre-cancerous cells.

Some Pap smears indicate an unsatisfactory sample because of recent sexual activity or use of vaginal creams and douches. Regardless of the reason, an abnormal Pap will require another Pap smear in a few months.

If the abnormal cells are persisting, you may need further treatment, which may include the following:

  • A colposcopy is an examination in which a speculum is inserted into the vagina, and the cervix is painted with a vinegar solution which makes any abnormal areas stand out. When an abnormal area is located, a sample (biopsy) of the area may be taken for accurate diagnosis by a pathologist.
  • Cryosurgery, or a freezing of the abnormal cells, is usually performed next. Cone biopsy is a procedure in which a triangle of cervical tissue is removed including the abnormal cells; this is either performed in a doctor’s office or as an outpatient procedure. Bleeding and watery discharge are common after this treatment.
  • The LEEP procedure is similar to a cone biopsy, but a loop-shaped instrument is used to remove the abnormal area.  Bleeding and discharge may also occur.

What Check-Ups Are Necessary After Treatment?

Check-ups following treatment are necessary to make sure all the abnormal cells are gone and the cervix has healed. Early detection is the key to minimize the risk of cancer developing. After treatment, women will be advised by their health care providers as to how often they will need to have routine Pap smears.

What If I Have An Abnormal Pap Smear During Pregnancy?

It is safe to have a Pap smear during pregnancy. If your Pap smear results are abnormal, a colposcopy could be performed during your pregnancy. However, further treatment will probably be delayed until after your baby is born.

Frequently, the birth of your baby will wash away any abnormal cervical cells. Having an abnormal Pap smear does not pose a risk to your baby.

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