Ovarian cysts may be physiological, benign or malignant tumours. Ovarian pathology may give rise to symptoms: when ovarian enlargement causes pressure on the bladder or rectum or abdominal distension if the ovary/cyst torts, bleeds or ruptures should hormonal production be affected.
Physiological Cysts (Distension Cysts)
Follicular cysts: Due to enlargement of follicles which fail to rupture. They may be associated with anovulatory cycles, fertility drugs and PCOs. Usually symptomless and resolve spontaneously. Corpus luteum cysts: can cause Amenorrhoea followed by heavy vaginal bleeding. Spontaneous resolution is the norm, but intra-abdominal bleeding may cause significant pain.
Endometriomas: Result from invagination of endometrial deposits on the surface of the ovary. Polycystic ovaries: enlarged, with numerous small sub capsular follicular cysts.
Ovarian Tumours – Benign and Malignant
Benign Tumours of the ovary are common. Ovarian cancer has an incidence of 14 per 100 000 women. The incidence of ovarian cancer increases with age, with the peak incidence in the sixties.
Ovarian cancer is often either symptomless or associated with non-specific symptoms such as dyspepsia. A malignant tumour should be suspected in older women, especially if it is fixed. Bilateral, rapid-growing or associated with ascites. A solid, or a mixed cystic and solid appearance on ultrasound scanning is also suggestive. In advanced disease there may be venous obstruction of the legs, pain and palpable supraclavicular lymphadenopathy.