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Diseases & Surgery - Ovarian Cysts

What are Ovarian Cysts?
Ovarian cysts are fluid filled tumours that arises from one or both ovaries.

4 Main Types

1. Functional Cyst
    - Abnormal egg production
    - Hormonal imbalance
    - Fertility drug treatment

Disappear after 1-2 months. Mostly do not require surgery
Normal "cystic structure" - follicle, corpus luteum

2. Endometriotic Cyst
    - Menstrual lining and menstrual blood embedded in the ovary and enlarges in
      size
    - "Chocolate cysts"
    - Associated with infertility
    - Lower abdominal pain or painful menses

3. Benign Ovarian Cysts (non-cancerous)
    Various types e.g.
    - Serous cystadenoma (30% cancer risk)
    - Mucinous cystadenoma (5-10% cancer risk)
    - Dermoid cyst - oil, hair, cartilage, teeth

4. Ovarian Cancer
    - Less than 5% of all ovarian cysts
    - Solid or semi-solid tumours
    - Poor outcome

What are the symptoms of Ovarian Cysts?

• No symptom especially small cyst - detected on routine checkup

• Swelling of the abdomen

• Lower abdominal pain or discomfort

• Severe pain when cysts ruptures or twisted

• Pressure on bladder - urinary symptoms

• Pressure on rectum - urge to open bowel or constipation

Do I need an operation?

This will depend on:
• Severity of complaints
• Size of cysts
• Complexity of cysts on ultrasound study
• Suspicion of cancer

Right ovarian endometriotic cyst

"Chocolate" contents of endometriotic cyst

Operation

1.	Ovarian Cystectomy Removal of cyst and conserving the ovary for hormonal function especially for young women
2.	Oophorectomy Removal of whole ovary - if most or all of the cyst has occupied the whole ovary
3.	Total Hysterectomy & Bilateral Oophorectomy Removal of both ovaries and the uterus

How?

• Laparotomy - open method

• Laparoscopy or "key-hole" surgery

• Minimally Invasive Surgery (MIS)

Advantages of Laparoscopy (MIS)

1. Small scars - less painful and cosmetically better

2. Day surgery or shorter hospitalization

3. Able to eat and resume normal activities earlier

4. Able to return to work earlier