1. Management of ovarian cysts
Dr Matt Hewitt

2. Ovarian cysts Benign Malignant Non ovarian
e.g functional cysts, serous cystademonas, dermoid (teratoma)
Malignant
Epithelial tumours 90% - e.g serous cystadenoacrcinomas
Sex cord tumours
Germ cell tumours
Metastatic
Non ovarian
e.g Hydrosalpinx, tubovarian abcess

3. Ovarian cancer Lifetime risk 1 in 70 90% are epithelial tumours
75% present at late stage III/IV
5 – 10 % Hereditary predisposition BRCA I and II HNPCC

4. Stage at diagnosis and 5 year survival FIGO Staging Uterus Cervix
Ovary
FIGO Staging

5. Pre menopausal ovarian cysts
10% of women will undergo ovarian surgery at some point
Symptomatic cysts 1 to population
Simple cysts < 5cm usually resolve, do not require follow up
PCO on scan do not require follow up scan

6. Post menopausal cysts Increasing detection of ovarian cysts
21% have abnormal ovarian pathology
Simple Cysts <5cm – low risk of malignancy

7. Clinical examination If its palpable it needs surgery Ascites
Tenderness
Fixed
Differentiating between uterus and ovarian mass

8. Imaging
Ultrasound
good assessment of the ovary and presence of ascites
MRI
good but expensive assessment of ovary
Rarely gives additional information on nature of cyst
Is good in
CT scan
– not good at evaluating cyst
- good in presence of ascites

9. Ultrasound Trans abdominal and transvaginal (TVS) Size
Simple – unilocular, no blood flow
Complex – Multilocular, solid elements, irregular, papillary projections, blood low
Ascites

10. Tumour markers Ca 125 not sensitive and not specific
Should not be used in assessment of abdominal pain
hCG, α-FP, LDH
Should not routinely be used
Secondary care assessment germ cell tumours

11. Surgical management Laparoscopy – up to 12cm Laparotomy
Cystectomy – if confident not malignant
Unilateral oophorectomy
Bilateral oophorectomy

12. WHO Principles of Screening
Diagnostic test
sensitive and specific
simple and cheap
safe and acceptable
reliable
Disease
serious
high prevalence of preclinical stage
natural history understood
lead time bias, length bias
Diagnosis & Treatment
facilities are adequate
effective, acceptable, safe treatment available

13. Premenopausal Asymptomatic
Ovarian cyst
Simple
<5cm
No FU
5-7cm
Rescan 3/12
>7cm
Refer
Complex
<3cm
3-5cm
Re scan
3/12
>5cm
Premenopausal Asymptomatic

14. Post Menopausal Asymptomatic
Ovarian cyst
Simple
<3cm
Re scan 3/12
>5cm
Refer
Complex
Re scan
3/12
>3cm
With ascites
Urgent Referal
Post Menopausal Asymptomatic

15. Thank you