An ovarian cyst is a sac filled with liquid or semi-liquid material found in an ovary. Some, such as those arising from the follicles, occur during ovulation and are benign. Other types of ovarian cysts include endometriomas (uterine lining tissue in the ovaries), cystadenomas (ovary surface), and dermoid cysts (contain skin, hair, and teeth). These cysts are generally benign.
However, neoplastic cysts can be either malignant or benign. They are caused by an overgrowth of cells within the ovary. Malignant neoplasms may arise from all ovarian cell types and tissues. By far, the most frequent are those arising from the surface epithelium (cells covering the ovary), and most of these are partially cystic lesions. The benign counterparts of these cancers are called “serous and mucinous cystadenomas.” Other malignant ovarian tumors may contain cystic areas, and these include granulosa cell tumors from sex cord stromal cells and germ cell tumors from primordial germ cells.
Ovarian tumors, on the other hand, are solid masses of abnormal tissue found in the ovary. They can be benign or malignant. The most common type of ovarian tumor is an epithelial cell tumor, which starts from surface cells on the ovaries. Germ cell tumors start in the preliminary egg cells, and most are benign. Stromal tumors originate in the cells that produce female hormones.
When ovarian growths and cysts are benign, a surgeon can insert a laparoscope (a slender viewing instrument) through a small incision to inspect the cyst. If the growths or cysts are benign, removal is optional. However, if the tumor or cyst may be malignant, a large open abdominal incision (laparotomy) is usually used to remove the tumor or large cyst. For smaller, benign cysts, laparoscopic surgery can be used to remove the cyst, where smaller abdominal incisions are used. In all cases of cyst and tumor removal, general anesthesia is used.
Who is a candidate?
Candidates who have ovarian cysts or tumors that are malignant are candidates for removal. Additionally, those who have cysts that are larger than 2.5 inches in diameter, solid, or causing pain are candidates for ovarian cyst/tumor removal.
Who is not a candidate?
Patients who have benign cysts that do not require cyst or tumor removal are not candidates.
Any nonprescription drugs such as aspirin and other pain relievers should be discontinued 7 days before the procedure to reduce the risk of bleeding. Your doctor will likely have you stop eating and drinking the night before surgery (8 hours before). Refrain from shaving the pubic or vaginal area, as this can increase the risk of infection.
Patients should expect to take pain relievers after the surgery. Most women who have ovarian cyst removal return home after an overnight hospital stay or even leave the day of the procedure. Full recovery should take 1-2 weeks if performed laparoscopically, or longer (up to 6 weeks) if performed through an open abdominal incision. Incisions should be kept clean.
If a laparoscopic procedure is done, the cervix may be stretched. Patients should not use tampons or put anything into the vagina, including douching or engaging in sexual intercourse. A follow-up with your physician should help you assess when it is okay to return to work and resume sexual activity. For open abdominal incisions, there may be fewer restrictions, but always consult with your physician first.
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. A proper assessment of every patient, along with complete lab work, will help to prevent postoperative complications. A postoperative course of antibiotics can reduce the risk of infection. After healing, scars are handled with special treatments to minimize their appearance.
Risks specific to ovarian cyst or tumor removal include scar tissue forming on the ovaries and bowel or bladder damage. Ovarian cysts may recur and pain may persist for some time.
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