Ovarian Cysts and Screening for Ovarian Cancer

Ovarian cysts are a swelling within the ovary which is mainly filled with fluid. During reproductive years, each month a fluid-filled sac called follicle develops in the ovaries, reaches approximately two centimetres in size and then releases an egg in the middle of the cycle. Sometimes, the follicle does not release the egg and grows larger and causes discomfort and pain. These are known as ‘functional cysts’, which are the most common cysts found in the ovaries. The ovaries may contain other benign ovarian cysts, which can occur both before and after menopause. Large benign cysts, which are causing symptoms, may need to be surgically removed. Many small benign cysts; however, are detected incidentally on scans performed to investigate various gynaecological and non-gynaecological problems. In such cases the presence of the cyst sometimes causes concern if there is uncertainty about their nature. Cancerous cysts are rare, but they can cause serious health problems and they should be treated as soon as the diagnosis is established with certainty.

Different types of ovarian cysts and their treatment

There are three types of ovarian cysts: benign, borderline and cancerous. Accuracy in diagnosis should result in better management of women affected by ovarian lesions. Benign cysts, which cause no symptoms, may not require any treatment and would benefit from monitoring by ultrasound, whilst those causing pain or pressure on other organs could be removed using key-hole surgery. Women with borderline cysts could have fertility-preserving surgery, whilst those with cancerous cysts often require major open surgery.

The ability of ultrasound examination to differentiate between various types of ovarian cysts is largely dependent on the skill and experience of the examiner as well as the quality of the ultrasound equipment. Our centre has state of the art ultrasound machines, and our consultants have been in the forefront of developments in ultrasound diagnosis of ovarian pathology for many years.  They are all able to differentiate between benign, borderline and cancerous ovarian cysts in most cases by performing a systematic and detailed analysis of the cyst appearance.  The diagnosis is often made in a one-stop visit that does not rely on a blood test to measure tumour markers like CA125. This results in a more efficient approach to managing these cysts and reduction in the overall cost.

Screening for ovarian cancer

We also provide scans to women who wish to have regular check-ups to exclude ovarian cancer. This is particularly important for women with a personal or family history of ovarian or breast cancer who may be at increased risk of developing new or recurrent ovarian cancer.  One of the problems with the ovarian cancer screening is that many benign abnormalities which are of no threat to women’s health could be identified on ultrasound. In less experienced hands such abnormalities could cause concern and lead to unnecessary interventions. The high diagnostic accuracy of ultrasound scanning in our centre reduces the risk of false alarms and plays a pivotal role in reassuring the majority of these women there is nothing to worry about. On the other hand, women who are found to have cancerous cysts could be offered a prompt and effective care.