Does a cyst mean I’m at risk for ovarian cancer?
‘Today’ contributor Dr. Judith Reichman sheds some light on ovarian cysts and offers advice on how they should be treated
By Dr. Judith Reichman
“Today” show contributor
Q: I’m 35, and I recently saw my doctor because of increased cramping. After examining me, she did an ultrasound and found I have an ovarian cyst. Does this mean I’m at risk for ovarian cancer? Do I need immediate surgery?
A: Probably not, and probably not.
Studies have shown that cysts found prior to menopause are benign more than 90 percent of the time. Eight percent of women without any symptoms whatsoever, if given a pelvic exam or ultrasound, have been found to have cysts larger than 2.5 centimeters (or, a little over an inch) in diameter.
Most cysts in women of reproductive age are functional, meaning they appear as a function of ovulation. Remember that during this process, the follicle enlarges, produces fluid that surrounds the egg, then breaks open and releases the egg. A cyst can occur if there is too much fluid initially, or if, after the egg is released, there is bleeding into the remains of the follicle (a hemorrhagic cyst). The latter is more likely to cause cramping.
There are several things your doctor can do to reassure you. First, if on clinical exam the cyst is compressible and can be moved around, it is likely to be benign. An ultrasound should also be done to ascertain whether the fluid in the cyst is clear or has an echo pattern that is consistent with new or old blood or solid elements within the cyst wall.
If the fluid is clear, the cyst is less than six centimeters in diameter, and you are not in a lot of pain, the best thing to do is simply wait and follow with a repeat ultrasound after six to 10 weeks. (Studies have shown that 90 percent of all cysts dissolve after five weeks.)
However, if the cyst shows solid elements that are deemed suspicious, your doctor may add a blood test to measure a substance in the blood called CA-125. The problem is that there are many non-cancerous diseases that can increase the level of CA-125, such as uterine fibroids, endometriosis, benign cysts and the menstrual cycle itself — so overall, it’s a very poor marker for women under 35.
A CT scan or MRI might also help determine whether the cyst looks suspicious and/or contains elements (such as teeth) found in a dermoid cyst that develops from germ cells. (This is a very interesting sort of growth: it’s as if the germ cell that creates the egg is trying to create a pregnancy without the benefit of sperm and fertilization.)
Dr. Reichman’s Bottom Line: If the cyst doesn’t go away, if you are in severe pain, or if your doctor’s suspicion is very high, a minor surgery called a laparoscopy should be performed. But in general, the chance of cancer in pre-menopausal women is low and not every cyst should create a panic. After all, ovaries make cysts for their ovulatory livelihood.
Dr. Judith Reichman, the “Today” show’s medical contributor on women’s health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, “Slow Your Clock Down: The Complete Guide to a Healthy, Younger You,” which is now available in paperback. It is published by William Morrow, a division of HarperCollins.