Abdominal pain, anomalies in the menstrual cycle, bleeding: the cause could be the ovarian cysts. An ovarian cyst is a fluid-filled or semi-solid sac that forms on an ovary. There are many types of cysts, almost always benign and rarely malignant.
In most cases, these are functional (i.e. non-pathological) cysts due to the failure of a follicle to rupture: if ovulation does not occur and the follicle does not break, it can turn into a cyst, called precisely follicular cyst.
Follicular cysts are very common. They are generally asymptomatic and reabsorb on their own within 60 days. However, if they are not reabsorbed, they can grow a lot (10 cm or more), causing problems with the ovary. Due to their weight, the ovary can twist on itself, choking and eventually becoming necrotized; or, as happens more often, the ovary is no longer able to function, the cycles become anovulatory and the irregular or absent menstruation. In addition to menstrual irregularities, there are also constant pelvic pains.
Multiple follicular cysts can develop due to excess gonadotropins in women I take drugs to induce ovulation (clomiphene, gonadotropins etc.). Another reason can be polycystic or multifollicular ovary.
The lutein cysts or hematomas of the corpus luteum they develop when, after ovulation, fluid mixed with blood accumulates in the corpus luteum. These cysts also typically resorb on their own, but if they rupture (hemorrhagic corpus luteum) they can cause bleeding accompanied by severe pelvic pain similar to that of acute appendicitis, which requires a immediate surgery.
Endometriosis can give rise to particular cysts, called cystic endometriomas or chocolate cysts because they are full of blood and therefore dark in color. They are typically small (1.5-2cm) but can grow very large or rupture causing severe infections in the abdomen. Just to avoid breaking them they go removed as soon as possible. Like endometriosis, these cysts are often asymptomatic; sometimes they cause pain during menstruation.
The dermoid cysts they are the most frequent type of benign ovarian tumor (in fact they are also called benign cystic teratomas; they rarely become malignant, about 2% of cases. They are made up of embryonic cells that have remained inactive and then begin to proliferate again and contain various types of tissue (fat, hair, teeth, etc.). these cysts must be removed as soon as possible.
The presence of cysts is detected with ultrasound, with which it is also possible to evaluate whether it is liquid or solid. If the cyst does not resorb on its own, if it recurs or in any case if there is a doubt about its nature, other tests may be required, for example a laparoscopy.
Ultrasound uses ultrasound to obtain images of the different organs of the body. It is an excellent way to evaluate the ovaries. There are two basic types of ultrasound: the transabdominal and transvaginal. When you perform the abdominal one you must have a very full bladder so as to allow the probe (resting on the abdomen) to better look at the ovaries. If you perform the tranvaginal ultrasound, a long, narrow probe (wrapped in a protective glove) is placed gently into the vagina. No type of ultrasound is dangerous or painful.
The doctor might ask for the dosage of CA 125. It is a blood test that is usually performed in women with ovarian cancer to assess how the patient is responding to treatment. Often this test is required of many women with an ovarian cyst to see if the cyst is cancerous. The normal level of CA125 is less than 35. However, this value can also be high in women who are in conditions of absolute benignity (endometriosis, fibroids, etc.): this is particularly true in women who are still in reproductive age. Other tests (the so-called markers) may be required to investigate the nature of an ovarian cyst: CEA, CA199, LDH, alphafetoprotein, HCG.
Especially in young women and adolescents, functional cysts reabsorb on their own within a few months. The doctor will monitor the situation with regular ultrasound scans. If things do not improve, the birth control pill to rest the ovaries. The pill is able to prevent the formation of new cysts and can contribute to the resorption of existing cysts.
If the cysts do not resorb and increase in size, surgery is required.
For remove cysts are sometimes usedaspiration: a needle is inserted into the cyst and the contents are aspirated. This procedure can only be used for small (less than 5 cm) liquid cysts. In other cases the cyst goes removed with surgery, almost always laparoscopically; Street laparotomy it is used only for very large or definitely malignant cysts. In all cases the contents of the cyst are subjected to a histological examination to verify that the cyst is benign.
Laparotomy requires a much larger abdomen cut (sometimes from the pubis to the breastbone). The cyst is examined while you are under anesthesia to assess whether or not it is malignant.
This examination (called extemporaneous examination) is quite precise but it is not definitive: sometimes it happens, in fact, that the cyst can be slightly (borderline) or strongly malignant only at the final histological examination whose response is generally ready after a few weeks from ‘intervention. If the cyst is malignant, it is necessary to perform a staging surgery (an operation that is performed immediately if the extemporaneous examination already indicates the malignancy or after a few weeks if the bad nature of the cyst is the result of the definitive histological examination). The operation, in principle, consists in the removal of the ovaries, of the uterus with the surrounding ligaments and in the removal of the fat that surrounds the vessels of the pelvis and abdomen (lymphadenectomy), of the omentum and of the appendix for the purpose to understand if the tumor is limited to the ovary or if it is also branched elsewhere: this is to establish the possible need for additional radio and / or chemotherapy.
If you have not yet had children and you do not want to permanently preclude this possibility, in the event that the tumor, evaluated at the extemporaneous examination, is limited to the ovary, but keeping in mind the possibility of a greater risk of recurrence and the need for assiduous follow-up after surgery, that this reduced radicality involves, you can ask your gynecologist in writing that the intervention is limited to the removal of the affected ovary, omentectomy and abdominal pelvic lymphadenectomy unilateral.
It is very important to clarify well with the gynecologist what therapeutic strategy he suggests for your case; in particular, ask him about the advantages, disadvantages, risks, early and late complications of the various types of surgery (laparoscopic and / or laparotomy), the presumed duration of the surgery and hospital stay, any pre-post-surgery care.
If you are in menopause and you are not menstruating (or if you have them due to hormone replacement therapy) your cyst is unlikely to be functional. The doctor, therefore, will ask you to also perform an ultrasound, in order to better evaluate the characteristics of the cyst itself. The further to be done depends on your age, the appearance of the cyst, the presence or absence of disorders related to it: pain and abdominal swelling, constipation, feeling very full after eating even just a little.
To date there is no safe method for the early diagnosis of ovarian tumors and that many times ovarian lesions, even important ones, can escape even a careful gynecological examination: state of tension, full intestine, obesity, so many scholars recommend to perform once a year together with the visit also a transvaginal ultrasound to better monitor the state of the ovaries and the inner part of the uterus.