To monitor the cyst or surgery?

September 16, 2015


So, let’s get the most important issue is to observe or to operate on an ovarian cyst.

Naturally, all that is written in this article, refers not only to the complicated ovarian cyst. After all if you developed a serious complication, without urgent hospitalization is not necessary. Although I am sure that you have it is not complicated cyst, otherwise it is unlikely you would be wasting your time reading these lines.

As you know, observation to be only functional ovarian cyst (follicular cyst of a yellow body). All other cysts must be removed.

At first glance, everything is very simple. But the complexity of the situation is that from the first glance to distinguish functional cyst can be very difficult.

The fact that on ultrasound they may be similar as two drops of water. So, the cyst of a yellow body often looks the same as endometrioid or dermoid cyst. A follicular cyst can be confused with parasailing or serous cystadenomas.

But there is one feature functional cysts which helps all to understand. they change Over time. Literally within 1-3 months the cyst may disappear entirely, decrease, or change their internal contents.

This is why short observation will help us understand whether your cyst is functional in nature and will disappear after a while or need an operation.

And here I want to draw your attention to the most important – active surveillance should not exceed a few months! Monitoring the cyst over a year, in the hope that it will still dissolve completely unnecessarily!

Functional cyst quickly changing. Quickly when they arise, they can quickly disappear without a trace, or at least reduced in size. They can change their structure (typical of a cyst of a yellow body).

In order to commit these changes enough to do an ultrasound after the next menstrual period and then another in a month. If there are improvements, the size of the cyst decreased significantly, then you may look a little longer.

If for several months, no changes occur, then further follow-up is absolutely useless.

During the observation of the cyst ultrasound must be done not less than 1 time in 3 months. The total observation time should not exceed 1 year!

What mistakes are made most often.

1 error — urgent operation.

Some doctors found by ultrasound ovarian cyst, confident in his innocence, immediately send the patient for surgery. This usually happens with endometrioid or dermoid cyst. And already before the surgery, we find only a cyst of a yellow body. And sometimes do nothing, because during the preparation for the surgery, she disappeared without a trace. As I said, the first time even the most experienced professionals are not always able to distinguish one type of cyst from the other.

Even doctors are often afraid of the size of cysts more than 5 cm But, as they say, size doesn’t always crucial.

In my practice I have met functional cysts up to 10 cm in diameter. I must admit, some of them still had to do the surgery. The reasons were different – frequent pain, suspect torsion of the cyst, etc.

Those same patients who did not have to do surgery within a few months everything went absolutely unnoticed. And this despite the fact that these girls were sent to me for surgery!

While not completely excluded the functional nature of the cyst, in the absence of serious complications and complaints, rush to surgery is not necessary!

For a true ovarian cyst period of several months of no role play. But it gives you a chance to avoid surgery.

But this approach is not acceptable, when by all indications we exclude functional cyst. In this case, of course, is not worth waiting, and as soon as possible need carry out the operation.

2 error — failure to observe the recommendations.

The success of expectant management is mandatory in compliance with all recommendations. These recommendations generally are private in nature and depend on the size and structure of the cyst, your age and lifestyle.

Functional cysts have a thin capsule, so it is quite easy, it may produce a gap. Almost all patients to madness fear of rupture or torsion of the cyst. After all, this is an emergency. That’s why some prefer to do elective surgery to avoid emergency surgery.

But in fact, it’s not all bad. Very much depends on the size of the cyst. At small sizes (up to 5 cm), burst cyst usually causes very little pain in the abdomen. And that’s all! Some don’t even notice that moment in the rush of modern life.

Of Course, large cysts may cause more serious symptoms and even require emergency surgical intervention.

It is Therefore very important to avoid excessive exercise, sudden movements, fitness activities and dance. Very careful to have intercourse (or suspend it until the next menstrual period and ultrasound). With significant amounts of the cyst is better to postpone flights and long trips.

These simple recommendations will help you without incident to wait for the next ultrasound and to determine further recommendations.

3 error – long observation of the cyst.

As I mentioned above, the observation of the cyst should not exceed one year.

But sometimes, during the ultrasound, the doctors say things like “you have a small cyst on the ovary. It is functional. Itself pass away.”

It calms you (after all, “the cyst itself will be”) and you continue to enjoy life, oblivious to the fact that the ovary is something there. Following ultrasound examination (ultrasound), usually held a few years later. And there are already an impressive tumor.

This is a very common situation. Almost all of my patients with large cysts all started out that way. In hindsight, they regretted that the time has not controlled the state of their ovaries.

Another common reason for long-term observation is the small size of the cyst (3 cm). Unfortunately, till now in world practice there is no common view on this issue. Some experts believe that such small cyst don’t need to operate, others that any entity will be removed.

As always, the right supporters of both points of view. And in each situation the question of surgical treatment of small cysts should be treated individually. A lot depends on your age, comorbidities, medical history, fertility, complaints, etc.

So in this situation I won’t be able to give you a decisive answer. Each case is dealing individually with individual recommendations and action plan.

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