management of ovarian cysts dr matt hewitt. benign e.g functional cysts, serous cystademonas,...
TRANSCRIPT
Management of ovarian cysts
Dr Matt Hewitt
Benign• e.g functional cysts, serous cystademonas, dermoid (teratoma)
Non ovarian
Malignant• Epithelial tumours 90% - e.g serous cystadenoacrcinomas• Sex cord tumours• Germ cell tumours• Metastatic
• e.g Hydrosalpinx, tubovarian abcess
Ovarian cysts
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
0
20
40
60
80
100
1 2 3 4
Stage at diagnosis and 5 year survival
Uterus
Cervix
Ovary
FIGO Staging
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
ImagingUltrasound
– 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
Disease
• serious• high prevalence of preclinical stage• natural history understood• lead time bias, length bias
Diagnostic test• sensitive and specific• simple and cheap• safe and acceptable• reliable
Diagnosis & Treatment• facilities are adequate• effective, acceptable, safe treatment available
WHO Principles of Screening
Premenopausal Asymptomatic
Post Menopausal Asymptomatic
Thank you