Transcript Slide 1
Management of ovarian cysts Dr Matt Hewitt Ovarian cysts Benign • 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 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 Stage at diagnosis and 5 year survival 100 80 Uterus 60 Cervix 40 Ovary 20 0 1 2 FIGO Staging 3 4 Pre menopausal ovarian cysts • 10% of women will undergo ovarian surgery at some point • Symptomatic cysts 1 to 3 1000 population • Simple cysts < 5cm usually resolve, do not require follow up • PCO on scan do not require follow up scan Post menopausal cysts • Increasing detection of ovarian cysts • 21% have abnormal ovarian pathology • Simple Cysts <5cm – low risk of malignancy Clinical examination • • • • • If its palpable it needs surgery Ascites Tenderness Fixed Differentiating between uterus and ovarian mass 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 Ultrasound • • • • Trans abdominal and transvaginal (TVS) Size Simple – unilocular, no blood flow Complex – Multilocular, solid elements, irregular, papillary projections, blood low • Ascites 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 Surgical management • • • • • Laparoscopy – up to 12cm Laparotomy Cystectomy – if confident not malignant Unilateral oophorectomy Bilateral oophorectomy 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 Premenopausal Asymptomatic Ovarian cyst Simple Complex <5cm 5-7cm >7cm <3cm No FU Rescan 3/12 Refer No FU 3-5cm Re scan 3/12 >5cm Refer Post Menopausal Asymptomatic Ovarian cyst Simple Complex <3cm >5cm Re scan 3/12 Refer <3cm Re scan 3/12 >3cm With ascites Refer Urgent Referal Thank you