The ovaries are two small organs located on either side of the uterus in a woman’s body. They make hormones, including estrogen, which trigger menstruation. Every month, the ovaries release a tiny egg. The egg makes its way down the fallopian tube to potentially be fertilized. This cycle of egg release is called ovulation.
What causes ovarian cysts?
Cysts are fluid-filled sacs that can form in the ovaries. They are very common. They are particularly common during the childbearing years.
There are several different types of ovarian cysts. The most common is a functional cyst. It forms during ovulation. That formation happens when either the egg is not released or the sac -- follicle -- in which the egg forms does not dissolve after the egg is released.
Other types of cysts include:
- Polycystic ovaries. In polycystic ovary syndrome (PCOS), the follicles in which the eggs normally mature fail to open and cysts form.
- Endometriosis . In women with endometriosis, tissue from the lining of the uterus grows in other areas of the body. This includes the ovaries. It can be very painful and can affect fertility.
- Cystadenomas. These cysts form out of cells on the surface of the ovary. They are often fluid-filled.
- Dermoid cysts. This type of cyst contains tissue similar to that in other parts of the body. That includes skin, hair, and teeth.
What causes ovarian tumors?
Tumors can form in the ovaries, just as they form in other parts of the body. If tumors are non-cancerous, they are said to be benign. If they are cancerous, they are called malignant. The three types of ovarian tumors are:
- Epithelial cell tumors start from the cells on the surface of the ovaries. These are the most common type of ovarian tumors.
- Germ cell tumors start in the cells that produce the eggs. They can either be benign or cancerous. Most are benign.
- Stromal tumors originate in the cells that produce female hormones.
Doctors aren’t sure what causes ovarian cancer. They have identified, though, several risk factors, including:
- Age -- specifically women who have gone through menopause
- Not having children or not breastfeeding (however, using birth control pills seems to lower the risk)
- Taking fertility drugs (such as Clomid)
- Hormone replacement therapy
- Family or personal history of ovarian, breast, or colorectal cancer (having the BRCA gene can increase the risk)
What are the symptoms of ovarian cysts and tumors?
Often, ovarian cysts don't cause any symptoms. You may not realize you have one until you visit your health care provider for a routine pelvic exam. Ovarian cysts can, however, cause problems if they twist, bleed, or rupture.
If you have any of the symptoms below, it's important to have them checked out. That's because they can also be symptoms of ovarian tumors. Ovarian cancer often spreads before it is detected.
Symptoms of ovarian cysts and tumors include:
How do doctors diagnose ovarian cysts and tumors?
The obstetrician/gynecologist or your regular doctor may feel a lump while doing a routine pelvic exam. Most ovarian growths are benign. But a small number can be cancerous. That’s why it’s important to have any growths checked. Postmenopausal women in particular should get examined. That's because they face a higher risk of ovarian cancer.
Tests that look for ovarian cysts or tumors include:
- Ultrasound. This test uses sound waves to create an image of the ovaries. The image helps the doctor determine the size and location of the cyst or tumor.
- Other imaging tests. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are highly detailed imaging scans. The doctor can use them to find ovarian tumors and see whether and how far they have spread.
- Hormone levels. The doctor may take a blood test to check levels of several hormones. These may include luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, and testosterone.
- Laparoscopy. This is a surgical procedure used to treat ovarian cysts. It uses a thin, light-tipped device inserted into your abdomen. During this surgery, the surgeon can find cysts or tumors and may remove a small piece of tissue (biopsy) to test for cancer.
- CA-125. If the doctor thinks the growth may be cancerous, he might take a blood test to look for a protein called CA-125. Levels of this protein tend to be higher in some -- but not all -- women with ovarian cancer. This test is mainly used in women over age 35, who are at slightly higher risk for ovarian cancer.
If the diagnosis is ovarian cancer, the doctor will use the diagnostic test results to determine whether the cancer has spread outside of the ovaries. If it has, the doctor will also use the results to determine how far it has spread. This diagnostic procedure is called staging. This helps the doctor plan your treatment.
How are ovarian cysts and tumors treated?
Most ovarian cysts will go away on their own. If you don't have any bothersome symptoms, especially if you haven’t yet gone through menopause, your doctor may advocate ''watchful waiting.'' The doctor won’t treat you. But the doctor will check you every one to three months to see if there has been any change in the cyst.
Surgery is an option if the cyst doesn’t go away, grows, or causes you pain. There are two types of surgery:
- Laparoscopy uses a very small incision and a tiny, lighted telescope-like instrument. The instrument is inserted into the abdomen to remove the cyst. This technique works for smaller cysts.
- Laparotomy involves a bigger incision in the stomach. Doctors prefer this technique for larger cysts and ovarian tumors. If the growth is cancerous, the surgeon will remove as much of the tumor as possible. This is called debulking. Depending on how far the cancer has spread, the surgeon may also remove the ovaries, uterus, fallopian tubes, omentum -- fatty tissue covering the intestines -- and nearby lymph nodes.
Other treatments for cancerous ovarian tumors include:
- Chemotherapy -- drugs given through a vein (IV), by mouth, or directly into the abdomen to kill cancer cells. Because they kill normal cells as well as cancerous ones, chemotherapy medications can have side effects, including nausea and vomiting, hair loss, kidney damage, and increased risk of infection. These side effects should go away after the treatment is done.
- Radiation -- high-energy X-rays that kill or shrink cancer cells. Radiation is either delivered from outside the body, or placed inside the body near the site of the tumor. This treatment also can cause side effects, including red skin, nausea, diarrhea, and fatigue. Radiation is not often used for ovarian cancer.
Surgery, chemotherapy, and radiation may be given individually or together. It is possible for cancerous ovarian tumors to return. If that happens, you will need to have more surgery, sometimes combined with chemotherapy or radiation.