In this episode of PodMD, experienced Gynaecologist, Obstetrician and Laparoscopic Surgeon Dr Ruth-Ann Sterling will be discussing the topic of ovarian cysts, including what ovarian cysts are, the risks of having ovarian cysts, the treatment options available, likelihood of recurrence, when to refer and more.
- Transcript
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*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMD studio Dr Ruth-Ann Sterling
Dr Ruth-Ann Sterling is an experienced Gynaecologist, Obstetrician and Laparoscopic Surgeon providing care in Liverpool, Norwest and surrounding areas. Ruth-Ann is a Fellow of the Royal Australian College of Obstetrics & Gynaecologists and has been caring for women in Southwest Sydney for over five years.
Ruth-Ann completed her medical degree at the University of Sydney and completed her training in major teaching hospitals in Newcastle, Sydney and London. Ruth-Ann is published in various women’s health areas and actively participates in teaching medical students and registrars. She is also the RANZCOG training ITP coordinator at Liverpool Hospital.
Today, we’ll be discussing the topic of ovarian cysts.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.Ruth-Ann, thanks for talking with us on PodMD today.
Ruth-Ann: Thank you for having me.
Question 1
The topic of today’s discussion is ovarian cysts. Ruth-Ann, Can you describe for our listeners what ovarian cysts are?Ruth-Ann: So ovarian cysts are essentially fluid fuel sacs in the ovaries. They can be benign or borderline or malignant. The majority are benign and often will resolve on their own, but occasionally you’ll have those that are persistent and still benign. And then of course malignant.
Question 2
How would a patient with ovarian cysts typically present?Ruth-Ann: So many ovarian cysts actually present as incidental findings during investigations for other presentations. However, some will present with pelvic pain, bloating, discomfort, pressure, urinary frequency and some will also have symptoms of other conditions, such as endometriosis, such as menorrhagia, dysmenorrhea, or dyspareunia.
Question 3
What are the risks of the condition?Ruth-Ann Sterling: So there are certain conditions that puts a woman at risk of having ovarian cysts, such as PCOS, ovulation stimulating drugs such as clomiphene or letrozole, pregnancy or fertility treatment, endometriosis, PID, or previous ovarian cysts, and complications that can arise from having ovarian cysts include rupture or torsion, and of course, if there’s suspicious features to the cyst. You know, then there may be borderline or malignant causes that need to be excluded. Also, in some cases, such as endometriosis, subfertility may be a complicating issue.
Question 4
What are the treatment options?Ruth-Ann: So our treatment options really start with conservative management. So many times a simple benign functional or very insist will resolve on its own. So I will often rescan a lady in approximately 3 months to see if the cyst is still present. It can also help to determine or differentiate between simple things like a haemorrhagic system and endometrioma as those cysts can have similar features.
Of course, if the cyst is still present and the woman remains asymptomatic, there is no issues with conservatively managing this woman with repeated ultrasounds in 6 to 12 months. For older women tumour markers you know are usually performed to ensure that there’s no malignancy, the other management option is surgical removal and this is mainly for cysts that are suspicious in nature or a patient is quite symptomatic, and the cyst is quite large. Also, if they’re abnormal tumour markers and there is even a suspicion of malignancy then yes, I would recommend for the cyst to be removed.
Question 5
Have there been any developments in treatment in the last years or are there any in trials or development now?Ruth-Ann: So I think the main things that have come about in, in you know recent years that most ovarian system managed, if they’re being managed surgically or managed laparoscopically and patient goes home on the same day and with minimally invasive surgery that has really transformed the way how we have managed ovarian cysts. The other thing that has really come about is that there are a few classification systems for ovarian cysts. One example is the international variant tumour analysis, classification, or IOTA. And this is really used to differentiate between benign and malignant cysts , and what I find most often is that I may see an ultrasound scan and it has a complex cyst, but they haven’t fully described why the cyst is truly complex.
So often I will have to resend the patient to a more expert scanning facility, who will then use the IOTA criteria to determine whether not the cyst has benign or suspicious features. And then it informs my management from that point on. And so I guess, you know, one recommendation is that if a GPC’s report with a complex cyst that it may be warranted to be rescanned in a more specialised ultrasound facility, where that cyst can be reassessed, and those features described properly.
Question 6
Are there any warning signs a GP or their patient can look out for?Ruth-Ann: I guess most of the time the patient will usually present with pain or bloating and they’ve already kind of you know noted that and presented for that reason. But the things that you know should set off alarm bells is clearly unexplained weight loss. If they’ve had enlargement of their abdomen for unexplained reasons, I mean, unfortunately we do see patients who come in has had, you know, their stomach has been enlarging for the last six months and they haven’t presented, and they’ve come in with advanced staged ovarian cancer. And you ask them, why didn’t they present? And they just. It happened so slowly that they didn’t kind of realise. So these are kinds of the things that you know should send off warning signs for a possible pathology and possible malignant pathology.
Question 7
What is the likelihood of recurrence of the condition?Ruth-Ann: Ovarian cysts are very common. If you’ve had a previous ovarian cyst, you will probably have another, but also it depends on the cause of the cyst, so you know, for example, in endometriosis, if you’ve had an endometrioma and yes, it has been removed, there is a good chance that you may have another endometrioma at some other point. Unfortunately, it’s not something that we can prevent.
Question 8
When should a GP refer?Ruth-Ann: So I think a GP should refer if they’re concerned at all, if the cyst is simple, small, persistent, the patient is asymptomatic, they can probably be watched. But if the patient would like further reassurance, I’m more than happy to see them. In terms of being watched I would say what that means is rescanning in 6 to 12 months, especially if this is quite small. For large or symptomatic cysts, then definitely refer on to us. If there’s any suspicion of malignancy or indeterminate or borderline features, definitely refer to us.
Concluding Question
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on ovarian cysts?Ruth-Ann: I guess the key messages are: ovarian cysts are quite common. Most are benign and will resolve on their own, and so the initial management could be rescanning in three months time. If it’s a simple cyst or a haemorrhagic cyst and then refer on as needed.
Thanks for your time and the insights you’ve provided.
Ruth-Ann: Thank you
