Ovarian Cyst Removal - Symptoms, Diagnosis, Surgery

An ovarian cyst is a fluid-filled sac in or on a woman’s ovary. The ovaries are part of the female reproductive system. They produce a woman’s eggs and her female hormones.

Ovarian cysts are very common. They often occur when a woman ovulates. This is when the ovary releases an egg each month. These are called functional cysts. Most are noncancerous. Many times, these cysts go away on their own without treatment.

Symptoms

Often, functional cysts do not cause any symptoms. You may have one and not know it. Other times they can cause symptoms. These include:

• Sharp or dull pain in the lower abdomen, usually on one side.


• Bloating.


• Menstrual irregularities.


• Nausea and vomiting.


• Feeling full after eating a small amount.


• Constipation.


• If you are menopausal and are not having periods, functional cysts shouldn’t form. But it is possible for other types of ovarian cysts to form. Call your doctor if you experience any of the symptoms of an ovarian cyst.

Diagnosis

A cyst on your ovary can be found during a pelvic exam. Depending on its size and whether it's fluid filled, solid or mixed, your doctor likely will recommend tests to determine its type and whether you need treatment. Possible tests include:

• Pregnancy test. A positive test might suggest that you have a corpus luteum cyst.


• Pelvic ultrasound. A wandlike device (transducer) sends and receives high-frequency sound waves (ultrasound) to create an image of your uterus and ovaries on a video screen. Your doctor analyzes the image to confirm the presence of a cyst, help identify its location and determine whether it's solid, filled with fluid or mixed.


• Laparoscopy. Using a laparoscope — a slim, lighted instrument inserted into your abdomen through a small incision — your doctor can see your ovaries and remove the ovarian cyst. This is a surgical procedure that requires anesthesia.


• CA 125 blood test. Blood levels of a protein called cancer antigen 125 (CA 125) often are elevated in women with ovarian cancer. If your cyst is partially solid and you're at high risk of ovarian cancer, your doctor might order this test.

Elevated CA 125 levels can also occur in noncancerous conditions, such as endometriosis, uterine fibroids and pelvic inflammatory disease.

Treatment

Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor might suggest:

Watchful waiting. In many cases you can wait and be re-examined to see if the cyst goes away within a few months. This is typically an option — regardless of your age — if you have no symptoms and an ultrasound shows you have a simple, small, fluid-filled cyst.

Your doctor will likely recommend that you get follow-up pelvic ultrasounds at intervals to see if your cyst changes in size.

Medication. Your doctor might recommend hormonal contraceptives, such as birth control pills, to keep ovarian cysts from recurring. However, birth control pills won't shrink an existing cyst.
Surgery. Your doctor might suggest removing a cyst that is large, doesn't look like a functional cyst, is growing, continues through two or three menstrual cycles, or causes pain.

Some cysts can be removed without removing the ovary(ovarian cystectomy). In some cases, your doctor might suggest removing the affected ovary and leaving the other intact (oophorectomy).

If a cystic mass is cancerous, your doctor will likely refer you to a gynecologic cancer specialist. You might need to have your uterus, ovaries and fallopian tubes removed (total hysterectomy) and possibly chemotherapy or radiation. Your doctor is also likely to recommend surgery when an ovarian cyst develops after menopause.

 

What to Expect

Prior to Procedure
Your doctor may do the following:

• Physical exam


• Review of medications


• Blood tests


• Urine test


• CT scan —a type of x-ray that uses a computer to make pictures of organs


• Ultrasound —a test that uses sound waves to examine the abdomen
  Talk to your doctor about what action should be taken if cancer is found during surgery. One option is to remove the ovary.

Leading up to the surgery:

• Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.


• Arrange for a ride to and from the hospital. Also, arrange for someone to help you at home.


• Do not eat or drink for at least 8 hours before the surgery.

Anesthesia
General anesthesia will be used. It will block pain and keep you asleep through the surgery. It will be given through an IV in your hand or arm.

There are 2 main ways surgery can be done on an ovarian cyst:

Laparoscopy. This type of surgery is done with a lighted instrument called a laparoscope that’s like a slender telescope. This is put into your abdomen through a small incision (cut) just above or just below your navel (belly button). With the laparoscope, your doctor can see your organs. Often the cyst can be removed through small incisions at the pubic hair line. If the cyst is small (about the size of a plum or smaller) and if it looks benign on the sonogram, your doctor may decide to do a laparoscopy.

Laparotomy. If the cyst looks too big to remove with a laparoscope or if it looks suspicious in any way, your doctor will probably do a laparotomy. This surgery uses a bigger cut to remove the cyst. The cyst is then tested for cancer. If it is cancerous, you may need to have the ovary and other tissues removed. This could include the fallopian tubes, the other ovary, or the uterus. It’s very important that you talk to your doctor about all of this before the surgery.

Your doctor will talk to you about the risks of each kind of surgery. He or she will tell you how long you are likely to be in the hospital and how long it will be before you can go back to your normal activities.

Immediately After Procedure

After the procedure, you will be given IV fluids and medications while recovering.

How Long Will It Take?
1-2 hours

Will It Hurt?
There will be pain after the surgery. You will be given pain medication.

Average Hospital Stay
You may stay overnight, or you may be able to leave the hospital the same day as your surgery.

Post-procedure Care
During your stay, the hospital staff will take steps to reduce your chance of infection such as:

• Washing their hands.


• Wearing gloves or masks.


• Keeping your incisions covered.

There are also steps you can take to reduce your chances of infection such as:

• Washing your hands often and reminding visitors and healthcare providers to do the same.


• Reminding your healthcare providers to wear gloves or masks.


• Not allowing others to touch your incisions.


• Recovery may take 1-2 weeks.