An ovarian cyst or adnexal mass may present with pelvic pain or as an incidental finding on routine ultrasound. Occasional they will present with sudden acute, severe pain which maybe the result of a twisting of the ovary (called torsion) or a rupture of the cyst with the fluid spilling into the peritoneum causing significant pain. In this situation, surgery may be required but in most cases there is time to do a proper evaluation of the cause.

Any suspected mass should be evaluated with a complete physical examination, pelvic ultrasound and a pregnancy test in reproductive aged women. The first step is to make sure there isn’t an ectopic pregnancy. Typically the ultrasound can provide characterization of the cyst, which will help in determining the next management step. The management is also dependent on the age of the woman since post-menopausal women have a higher risk of ovarian cancer. A single thin walled cyst with smooth borders is most likely benign and the two-thirds tend to resolve even in post-menopausal women if their size is less than 10 cm.

Cysts that are described as complex with solid components are more concerning. The presence of other factors can also help the radiologist determine the chance of cancer. A CA-125 is useful in determing the likelihood of an epithelial ovarian malignancy. If elevated it has a 98% positive predict value in postmenopausal women compared to 49% in premenopausal women. It is not considered useful as a screening test since it is elevated only 50% of the time Stage 1 ovarian epithelial cancers. In addition benign conditions such as endometriosis and leiomyoma (fibroids) can also have an elevated CA 125 level. Other tumor markers can be used if a germ cell tumor is suspected.

If the tests suggest that the adnexal cyst is benign, then observation is indicated. Serially ultrasounds can be done every 6-12 weeks to confirm resolution or stability of the cyst. If it isn’t growing and there aren’t any undesirable symptoms then continued observation is acceptable. Surgery of course would be indicated if the pain is unmanageable or observation is not possible.

The incidental finding of an ovarian cyst is a common occurrence. There isn’t any reason to panic. The vast majority will resolve spontaneously. You should consider surgery if you are having undesirable pain, if the mass is growing or if there is a suspected neoplasm. The majority of growths are not cancerous.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!