Materiały źródłowe

• #1 Patient education: Ovarian cysts (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ovarian-cysts-beyond-the-basics/print

  Ovarian cysts are fluid-filled sacs that develop in or around the ovary. They are common and can happen at any age. Some people with ovarian cysts have pain or pelvic pressure, while others have no symptoms. […] This topic discusses the various causes of ovarian cysts, how ovarian cysts are diagnosed, and what follow-up testing and/or treatment might be recommended. […] Sometimes, an ovarian cyst is found or suspected during a pelvic examination. However, an imaging test is necessary to confirm the diagnosis. Blood tests may also be done depending on the situation. […] The imaging test most commonly used is a pelvic or „transvaginal” ultrasound. This involves inserting a probe into the vagina to create pictures of your ovary and the surrounding area. This provides information about the cyst’s size, location, and other important characteristics.

• #1 Ovarian Cysts: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/9133-ovarian-cysts

  An ovarian cyst is a fluid-filled sac that forms inside or on an ovary. […] You likely won’t know you have one unless your healthcare provider finds one during a pelvic exam or pelvic ultrasound. […] Scheduling regular pelvic exams and speaking with your provider about any symptoms you may be experiencing can help troubleshoot any problems with an ovarian cyst. […] Your healthcare provider will first rule out pregnancy as the cause of your symptoms by giving you a pregnancy test. Then, they may use the following tests to diagnose an ovarian cyst: A pelvic exam. Your provider will feel inside your pelvis for any lumps or changes. Ultrasound. This imaging procedure uses sound waves to create images of your pelvic organs. It can detect cysts on your ovaries, including their locations and whether they’re primarily fluid or solid. Laparoscopy. This is a procedure performed in an operating room. Your provider inserts a camera through an incision (cut) in your abdomen and can view your reproductive organs and pelvic cavity. If your provider diagnoses a cyst at this time, they can remove it.

• #1 Ovarian Cysts

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/ovarian-cysts/

  The diagnosis of an ovarian cyst is most often made based on imaging rather than by physical examination, laboratory testing, or diagnostic procedures. […] Ultrasonography is considered the gold standard for the assessment of ovarian cysts. Transvaginal sonography is preferred, as the probe proximity to the ovary can result in superior images. If transvaginal sonography is not available or not tolerated by the patient, transabdominal sonography through a full bladder or transperineal sonography in virginal or atrophic women can still provide helpful, albeit limited, information. In some cases, ultrasound can specifically diagnose the type of ovarian cyst, especially if certain characteristic findings are present. […] Identifying certain cyst characteristics is especially important in differentiating benign from malignant processes. The ten „Simple Rules” are five ultrasound features indicative of benign cysts (B-features) and five ultrasound features indicative of a malignant cysts (M-features) based on the presence of tumor morphology, degree of vascularity, and ascites.

• #1 Ovarian cysts – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/diagnosis-treatment/drc-20353411

  A cyst on your ovary can be found during a pelvic exam or on an imaging test, such as a pelvic ultrasound. Depending on the size of the cyst and whether it’s filled with fluid or solid, your health care provider likely will recommend tests to determine its type and whether you need treatment. […] Possible tests include: […] Pelvic ultrasound. A wandlike device (transducer) sends and receives high-frequency sound waves to create an image of your uterus and ovaries on a video screen (ultrasound). The image is used to confirm that you have a cyst, see its location, and determine whether it’s solid or filled with fluid. […] Sometimes, less common types of cysts develop that a health care provider finds during a pelvic exam. Solid ovarian cysts that develop after menopause might be cancerous (malignant). That’s why it’s important to have regular pelvic exams.

• #1 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. It is the imaging of choice when attempting to differentiate between benign or malignant mass. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation. […] Surgical indications include suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, and suspected malignancy. […] Patients at high risk for ovarian malignancy should have their case reviewed with a gynecologic oncologist for further assessment and determination of optimal surgical management. Specific guidelines can help gynecologists differentiate when to refer patients with an adnexal mass.

• #1 Investigation and management of an ovarian mass

  https://www.racgp.org.au/afp/2015/january-february/investigation-and-management-of-an-ovarian-mass

  Although ultrasonography is the best mode of imaging we have for assessment of ovarian pathology, its sensitivity and specificity for the diagnosis of ovarian cancer is only 8691% and 6881% respectively. […] The International Ovarian Tumor Analysis (IOTA) Group has developed a list of characteristics for benign and malignant masses. […] Any patient with an M-rule should be referred to a gynaecologist. […] The presence of ascites has a positive predictive value of 95% for ovarian cancer. […] Serum Ca125 is a glycoprotein antigen and is the most widely used tumour marker in the assessment of ovarian masses. […] In premenopausal women, Ca125 should be measured only if the ultrasound appearance of a mass raises suspicion of malignancy. […] It is unreliable in differentiating malignant from benign, as Ca125 35 U/ml has a sensitivity and specificity for ovarian cancer of 80% (potentially as low as 5060%).

• #1 The Radiology Assistant : Roadmap to evaluate ovarian cysts

  https://radiologyassistant.nl/abdomen/unsorted/roadmap-to-evaluate-ovarian-cysts

  Step 3 To aid in selecting the proper work-up, the final step is to determine whether a patient falls into a low-risk category (i.e. premenopausal women without additional risk factors) or a high-risk category (i.e. post-menopausal or premenopausal with additional risk factors). […] Based on these steps we can determine further management: ignore, follow-up with US, further evaluation with MRI or excision. […] Role of Ultrasound For characterization of ovarian masses, ultrasound is often the first-line method of choice, especially for distinguishing cystic from complex cystic-solid and solid lesions. […] Role of MRI For complex lesions, primary evaluation with ultrasound is often followed by further evaluation with MRI. Even with MRI it is often not possible to make an accurate diagnosis of neoplastic subtype. By using MRI as an adjunct to sonography a delay in the treatment of potentially malignant ovarian lesions is prevented. This is not only beneficial to the small number of women who do have ovarian cancer, but also a proven cost-effective approach to the management of sonographically indeterminate adnexal lesions.

• #1 Why Do I Need an MRI for Ovarian Cyst Diagnosis? Your | Scan.com UK

  https://uk.scan.com/health-hub/why-do-i-need-an-mri-for-ovarian-cyst-diagnosis-your-complete-guide

  An MRI ovarian cyst scan can distinguish between a non-cancerous (benign) and cancerous (malignant) ovarian mass, with an overall accuracy of 88% to 93% for the diagnosis of malignancy. […] MRI’s advanced technology and range of techniques make it excellent for visualising the size and shape of a mass, but also its tissue characterisation. This means MRI can identify various tissue types inside an ovarian cyst, including fluid, fat, blood, mucus, or solid materials, to determine whether a lump is a cyst or a tumour. […] With the comprehensive information obtained through MRI imaging of an ovarian mass, it becomes possible to determine whether an ovarian cyst is benign or malignant.

• #1 Ovarian Cysts Workup: Approach Considerations, Procedures, Laboratory Tests

  https://emedicine.medscape.com/article/255865-workup

  Moreover, CA125 should not be drawn in pregnant patients with ovarian cysts or in the acute setting with ovarian cyst accidents, as this marker is raised in peritonitis, hemorrhage, cyst rupture, and infection, as well as in menstruation, fibroids, and endometriosis. […] This is the primary imaging tool for a patient considered to have an ovarian cyst. Findings can help to define a cysts morphologic characteristics. If the ultrasonographic features are not typical of an ovarian cyst, follow-up ultrasonography can be performed to exclude ovarian neoplasm. […] CT scanning is more sensitive but less specific than ultrasonography in detecting ovarian cysts. The addition of CT scanning to the workup of ovarian cysts offers very little additional information and usually does not alter treatment plans. […] MRI, in conjunction with ultrasonography, may provide marginal improvements in specificity, but in most cases, the additional cost in not justified.

• #1 Ovarian Cysts Workup: Approach Considerations, Procedures, Laboratory Tests

  https://emedicine.medscape.com/article/255865-workup

  The definitive diagnosis of all ovarian cysts is made based on histologic analysis. Each cyst type has characteristic findings. […] No laboratory tests are diagnostic for ovarian cysts. However, the following laboratory tests can aid in the differential diagnosis and in the diagnosis of cyst-related complications: Urinary pregnancy test – Should always be performed in all women of childbearing age with abdominal pain or similar complaints. […] Keep in mind the possibility of cancer when managing an ovarian cyst. Cancer antigen 125 (CA125) is a protein expressed on the cell membrane of normal ovarian tissue and ovarian carcinomas. A serum level of less than 35U/mL is considered normal, although in some laboratories, the upper limit of normal may be lower than this. […] While CA125 values are elevated in 85% of patients with epithelial ovarian carcinomas overall, the value is elevated in only 50% of patients with stage I cancers confined to the ovary.

• #1

  https://www.nhs.uk/conditions/ovarian-cyst/

  If a GP thinks you may have an ovarian cyst, you’ll probably be referred for an ultrasound scan, carried out by using a probe placed inside your vagina. […] If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks, or a GP may refer you to a doctor who specialises in female reproductive health (gynaecologist). […] If there’s any concern that your cyst could be cancerous, the doctor will also arrange blood tests to look for high levels of chemicals that can indicate ovarian cancer. […] But having high levels of these chemicals does not necessarily mean you have cancer, as high levels can also be caused by non-cancerous conditions, such as: endometriosis, a pelvic infection, fibroids, your period.

• #1 Ovarian Cysts: Symptoms, Types & Treatment in Akron, Ohio

  https://www.summahealth.org/medicalservices/womens/gynecological-services/ovarian-cysts

  Ovarian Cyst Diagnosis Your doctor or physician may conduct any or all of the following tests to determine if the cyst is cancerous and to assist in developing a treatment plan: […] Ultrasound. Sound waves are used to create an image of the ovaries, which can help your physician determine the size and location of the cyst or tumor, and if it is fluid-filled, solid or mixed. […] Other imaging tests. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are highly detailed imaging scans your doctor can use to find any ovarian tumors and determine whether they’ve spread as well as how far they may have spread. […] Hormone levels. Your doctor may take a blood test to check the levels of several hormones, such as luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol and testosterone.

• #1 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  When an ovarian mass is suspected, the provider should first determine whether the patient is pre or postmenopausal. […] A complete blood count should focus on the hematocrit and hemoglobin levels to evaluate for anemia caused by acute bleeding. […] Cancer antigen 125 (CA125) is a protein present on the cell membrane of healthy ovarian tissues and ovarian carcinomas. […] Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation.

• #1 Ovarian Cysts – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/ovarian-cysts-diagnosis-treatment/

  Symptomatic, non-ruptured, cysts should be observed for persistence of symptoms as cysts often resolve on their own with expectant management. […] Indications for surgical intervention include: hemodynamic instability, increasing hemoperitoneum or declining hemoglobin, symptoms that persist >48 hours or diagnostic uncertainty, including risk suspicion of ovarian torsion.

• #1 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  As a result of ovulation, a fluid-filled sac known as an ovarian cyst can form on one or both ovaries. […] Various subcategories have characterized more than thirty types of ovarian masses, and management is determined by the characteristics of the lesion, the age of the patient, and the risk factors for malignancy. […] In women of reproductive age, most ovarian cysts are functional and benign and do not require surgical intervention. However, ovarian cysts can lead to complications such as pelvic pain, cyst rupture, blood loss, and ovarian torsion that require prompt management. […] The etiology of ovarian cysts or adnexal masses ranges from physiologically normal (follicular or luteal cysts) to ovarian malignancy. […] Although most ovarian cysts are benign, age is the most important independent risk factor, and post-menopausal women with any type of cyst should have proper follow-up and treatment due to a higher risk for malignancy.

• #1 Ovarian cysts – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405

  Ovarian cysts are common. Most of the time, you have little or no discomfort, and the cysts are harmless. Most cysts go away without treatment within a few months. […] To protect your health, get regular pelvic exams and know the symptoms that can signal what might be a serious problem. […] Get immediate medical help if you have: Sudden, severe abdominal or pelvic pain. […] There are other types of cysts that are not related to menstrual cycles: […] Functional cysts are usually harmless. They rarely cause pain and often disappear on their own within 2 to 3 menstrual cycles. […] They don’t happen often, but complications can occur with ovarian cysts. These include: Ovarian torsion. […] There’s no way to prevent most ovarian cysts. But, regular pelvic exams help ensure that changes in your ovaries are diagnosed as early as possible.

• #1 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. […] Referral to a gynecologic oncologist is recommended for the following patients: Postmenopausal patient with elevated CA125, imaging findings consistent with malignancy, ascites, a nodular or fixed mass, or evidence of metastases. […] The prognosis for benign cysts is excellent. […] Most malignant ovarian tumors are epithelial ovarian cystadenocarcinomas. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven.

• #1 Investigation and management of an ovarian mass

  https://www.racgp.org.au/afp/2015/january-february/investigation-and-management-of-an-ovarian-mass

  In postmenopausal women, Ca125 should be measured routinely. […] This result should then be used in conjunction with ultrasound findings and menopause status in RMI. […] The risk of malignancy index (RMI) is the most widely used risk assessment for ovarian malignancy. […] An RMI 200 has a sensitivity of 87% and specificity of 97% for ovarian cancer and therefore requires urgent assessment by a gynaecological oncologist. […] If malignancy is suspected, an oophorectomy is recommended rather than a cystectomy. […] Ovarian torsion is primarily a clinical diagnosis, but ultrasonography may be useful. […] Suspected ovarian torsion requires urgent gynaecological review. […] There is no routine screening for ovarian cancer for the general population.

• #1 Patient education: Ovarian cysts (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ovarian-cysts-beyond-the-basics/print

  If imaging tests find that you have an ovarian cyst, your health care provider might order blood tests to help determine the nature of the cyst. […] Depending upon your age, symptoms, test results, and family history, your health care provider may recommend either watchful waiting or surgery. […] If a cyst is large, causing pain, or appears suspicious for cancer, treatment usually involves surgery to remove the cyst or the entire ovary. […] If surgery is needed to remove an ovarian cyst, the procedure is usually done in a hospital or surgical center. Whether the surgery involves removing only the cyst or the entire ovary depends upon your age and what is found during the procedure. […] After an ovarian cyst resolves, you will not need further imaging tests if you do not have symptoms.

• #1 Evaluation of Ovarian Cysts | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/od1.html

  What is the appropriate follow-up for a patient with an ovarian cyst identified on ultrasonography? […] Initial evaluation of an ovarian cyst is largely determined by its characteristics on ultrasonography, in addition to the presence of symptoms, laboratory evaluation, and patient history. Women with an ovarian cyst, but with no symptoms, family or personal history of cancer (e.g., ovarian, breast, colorectal), physical or laboratory evidence suggestive of infection, pregnancy, or systemic illness, are considered at low risk of ovarian cancer and may be followed with serial ultrasonography. […] A cyst identified on transvaginal ultrasonography is usually benign if it is thin-walled, unilocular, smooth-bordered, and less than 10 cm in diameter. […] A complex cyst without benign features should be aggressively evaluated for ovarian cancer.

• #1

  https://www.nhs.uk/conditions/ovarian-cyst/treatment/

  In most cases, ovarian cysts disappear in a few months without the need for treatment. […] Whether treatment is needed will depend on: its size and appearance, whether you have any symptoms, whether you’ve had the menopause if you are postmenopausal there is a slightly higher risk of ovarian cancer. […] In most cases, a policy of „watchful waiting” is recommended. […] If you have been through the menopause you may be advised to have ultrasound scans and blood tests every 4 months for a year, as you will have a slightly higher risk of ovarian cancer. […] Surgery may be recommended if the cyst is still there. […] Large or persistent ovarian cysts, or cysts that are causing symptoms, usually need to be surgically removed. […] Surgery is also normally recommended if there are concerns that the cyst could be cancerous or could become cancerous.

• #1 Evaluation of Ovarian Cysts | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/od1.html

  Cysts that are characterized as complex adnexal masses or as persistent, thin-walled cysts should be evaluated for possible ovarian cancer. […] Testing for cancer antigen (CA) 125 may be useful in women with these cysts, particularly in postmenopausal women. […] The risk of ovarian cancer algorithm analyzes changes in CA 125 levels to provide greater sensitivity and specificity than a single value alone. […] However, only 50 percent of stage I epithelial cancers secrete CA 125 at the time of diagnosis. […] When combined with CA 125 measurement, biomarker HE4 increases the sensitivity by 22 percent and specificity by 90 percent. […] A risk of malignancy index has been created using menopausal status, ultrasound results, and CA 125 level in a single scale. […] The index has a sensitivity of 85 percent and specificity of 97 percent in determining the difference between benign and malignant pelvic masses.

• #1 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Ovarian cysts are fluid-filled structures that may be simple or complex. They are common findings usually discovered incidentally on physical examination or imaging. Ovarian cysts can cause complications, including rupture, hemorrhage, and torsion, which are considered gynecological emergencies. Therefore, it is essential to promptly diagnose and treat them to avoid high morbidity and mortality. […] This article reviews the evaluation, treatment, and complications of ovarian cysts and highlights the role of the interprofessional team in evaluating and treating patients with this condition. […] When an ovarian mass is suspected, the provider should first determine whether the patient is pre or postmenopausal. If the former is true, the first step is to perform a serum beta hCG or urine pregnancy test. Once pregnancy is ruled out, imaging should be done for further evaluation. […] Cancer antigen 125 (CA125) is a protein present on the cell membrane of healthy ovarian tissues and ovarian carcinomas. A blood level of less than 35U/ml is taken as normal. CA125 values are raised in 85% of patients with epithelial ovarian cancer, while it is raised in 50% of patients with stage I cancer confined to the ovary. The finding of an elevated CA 125 level is most useful when combined with an ultrasound while evaluating a postmenopausal woman with an ovarian cyst.

• #1 Diagnosis and management of ovarian cyst accidents – PubMed

  https://pubmed.ncbi.nlm.nih.gov/19299205/

  Ovarian cyst accidents include cyst rupture, haemorrhage and torsion. […] Suspected adnexal torsion should always be managed with early laparoscopy and de-torsion of the twisted tube or ovary. […] Ovarian cyst rupture and haemorrhage usually occur in association with physiological (functional) cysts and are generally self-limiting. […] Laparoscopy may be necessary in cases where the diagnosis is in doubt or for haemodynamic compromise. […] Ultrasound is the first-line investigation and is diagnostic in the case of haemorrhage. […] Typical ultrasound findings have been described for ovarian torsion, including an enlarged oedematous ovary with peripheral displacement of follicles. […] Recurrent cyst rupture or haemorrhage should be prevented by suppression of ovulation, usually with the combined oral contraceptive. […] Fixation of the ovary by a variety of techniques should be considered to prevent recurrent torsion.

• #1 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. […] The definitive diagnosis of all ovarian cysts is made based on histologic analysis. Each cyst type has characteristic findings. […] Laboratory tests, although not diagnostic for ovarian cysts, may aid in the differential diagnosis of cysts and in the diagnosis of cyst-related complications. […] Per ACOG and other guidelines, transvaginal ultrasound is the preferred imaging modality for assessment of a suspected pelvic mass. […] Many patients with simple ovarian cysts found through ultrasonographic examination do not require treatment. […] In a postmenopausal patient, a persistent simple cyst smaller than 10 cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonographic examinations.

• #1 Guidance for the Diagnosis and Management of Ovarian Cysts – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/guidance-for-the-diagnosis-and-management-of-ovarian-cysts/3/

  Ovarian cysts 3 cm in diameter are considered normal and typically resolve without complication.34 However, if an ovarian cysts ruptures or bleeds, hemodynamic stability monitoring and ultrasound should be conducted. […] Significant bleeding on ultrasound or unstable patients should be admitted to an inpatient service for close monitoring, volume replacement, and, if warranted, referral for surgery.35 […] For patients at low risk for cancer whose ovarian cysts appear benign, a follow-up ultrasound 3- to 6-months after the initial ultrasound is recommended (Table 3).4,40 In women whose cyst contains malignant features, a repeat ultrasound is recommended 6 weeks after the initial ultrasound.20 Surgery may be necessary to accurately evaluate the tissue morphology if the cyst cannot be differentiated as benign or malignant, or in the case of malignant-appearing cysts.41,42

• #1 Guidance for the Diagnosis and Management of Ovarian Cysts – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/guidance-for-the-diagnosis-and-management-of-ovarian-cysts/3/

  In all postmenopausal women, biomarkers CA 125 and HE4 should be assessed during the initial ultrasound.31 […] Cysts found to be growing, symptomatic, or malignant require surgical consultation. Surgery is recommended in this population when the cyst appears malignant, preferably after the first trimester. […] In patients of adolescent age or younger, ultrasounds should be performed monthly until the cyst has resolved.43 […] Malignant-appearing cysts may be further evaluated with magnetic resonance imaging. If surgery is warranted in a pregnant patient, the recommendation is to wait until after the first trimester and perform the surgery laparoscopically rather than open surgery whenever feasible.44 […] In a study of 15,735 postmenopausal women, serial transvaginal ultrasounds were used to assess the presence of simple cysts and the development of subsequent ovarian cancer.

• #1 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  The sensitivity of pelvic examination is low, further workup in symptomatic women should occur even with negative pelvic examination results. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. […] Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #1 Investigation and management of an ovarian mass

  https://www.racgp.org.au/afp/2015/january-february/investigation-and-management-of-an-ovarian-mass

  Ovarian masses are very common in pre- and postmenopausal women and are typically an incidental finding. […] This article aims to provide a systematic approach to an ovarian mass for general practitioners including investigations, risk of ovarian cancer and referral considerations. […] Investigation for an ovarian mass includes both transvaginal and transabdominal ultrasound. […] The use of the cancer antigen 125 (Ca125) tumour marker can be unreliable in premenopausal women given the low sensitivity for ovarian cancer; however, it is useful in postmenopausal women. […] Ca125 is used in conjunction with ultrasound findings and is used to determine risk of ovarian cancer through the risk of malignancy index (RMI). […] Gynaecological oncology referral is required if RMI is 200. […] The only definitive diagnosis of an ovarian mass is through histology; however, there are typical characteristics of certain structures seen on an ultrasound.

• #2 Patient education: Ovarian cysts (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ovarian-cysts-beyond-the-basics

  Ovarian cysts are fluid-filled sacs that develop in or around the ovary. They are common and can happen at any age. Some people with ovarian cysts have pain or pelvic pressure, while others have no symptoms. […] This topic discusses the various causes of ovarian cysts, how ovarian cysts are diagnosed, and what follow-up testing and/or treatment might be recommended. […] Sometimes, an ovarian cyst is found or suspected during a pelvic examination. However, an imaging test is necessary to confirm the diagnosis. Blood tests may also be done depending on the situation. […] The imaging test most commonly used is a pelvic or „transvaginal” ultrasound. This involves inserting a probe into the vagina to create pictures of your ovary and the surrounding area. This provides information about the cyst’s size, location, and other important characteristics.

• #2 Ovarian Cysts | OB/GYN & Women’s Health Services | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/obgyn-womens-health/conditions-and-treatments/general-gynecology/ovarian-cysts

  The OB/GYN experts at University Hospitals can diagnose and manage ovarian cysts with both surgical and non-surgical treatment options. […] Your healthcare provider may perform the following tests when diagnosing an ovarian cyst: […] Ultrasound uses sound waves to create images of your pelvic organs, enabling your provider to detect and locate ovarian cysts. […] During this minimally invasive procedure a camera attached to a thin instrument (laparoscope) is inserted through a small incision in the abdomen to view the ovaries. If a cyst is found, it can be removed during the same procedure.

• #2 Ovarian Cysts

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/ovarian-cysts/

  The diagnosis of an ovarian cyst is most often made based on imaging rather than by physical examination, laboratory testing, or diagnostic procedures. […] Ultrasonography is considered the gold standard for the assessment of ovarian cysts. Transvaginal sonography is preferred, as the probe proximity to the ovary can result in superior images. If transvaginal sonography is not available or not tolerated by the patient, transabdominal sonography through a full bladder or transperineal sonography in virginal or atrophic women can still provide helpful, albeit limited, information. In some cases, ultrasound can specifically diagnose the type of ovarian cyst, especially if certain characteristic findings are present. […] Identifying certain cyst characteristics is especially important in differentiating benign from malignant processes. The ten „Simple Rules” are five ultrasound features indicative of benign cysts (B-features) and five ultrasound features indicative of a malignant cysts (M-features) based on the presence of tumor morphology, degree of vascularity, and ascites.

• #2 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. It is the imaging of choice when attempting to differentiate between benign or malignant mass. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation. […] Surgical indications include suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, and suspected malignancy. […] Patients at high risk for ovarian malignancy should have their case reviewed with a gynecologic oncologist for further assessment and determination of optimal surgical management. Specific guidelines can help gynecologists differentiate when to refer patients with an adnexal mass.

• #2 Ovarian Cysts

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/ovarian-cysts/

  Magnetic resonance imaging (MRI) is a valuable tool when ultrasound is inconclusive or limited. The advantages of MRI are that it is very accurate and it provides additional information on the composition of soft-tissue tumors. […] It is almost never appropriate to aspirate an ovarian cyst for diagnostic purposes. False negative results are common and leakage of cyst contents into the peritoneal cavity potentially increases the stage of any cancer found, decreasing patient survival.

• #2 Ovarian Cyst | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26445

  When an ovarian mass is suspected, the provider should first determine whether the patient is pre or postmenopausal. […] A complete blood count should focus on the hematocrit and hemoglobin levels to evaluate for anemia caused by acute bleeding. […] Cancer antigen 125 (CA125) is a protein present on the cell membrane of healthy ovarian tissues and ovarian carcinomas. […] Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation.

• #2

  https://www.nhs.uk/conditions/ovarian-cyst/

  If a GP thinks you may have an ovarian cyst, you’ll probably be referred for an ultrasound scan, carried out by using a probe placed inside your vagina. […] If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks, or a GP may refer you to a doctor who specialises in female reproductive health (gynaecologist). […] If there’s any concern that your cyst could be cancerous, the doctor will also arrange blood tests to look for high levels of chemicals that can indicate ovarian cancer. […] But having high levels of these chemicals does not necessarily mean you have cancer, as high levels can also be caused by non-cancerous conditions, such as: endometriosis, a pelvic infection, fibroids, your period.

• #2 Ovarian Cysts: Symptoms, Types & Treatment in Akron, Ohio

  https://www.summahealth.org/medicalservices/womens/gynecological-services/ovarian-cysts

  Laparoscopy. This is a surgical procedure using a thin, light-tipped device inserted into the abdomen. During this surgery, cysts or tumors can be detected and a small piece of tissue can be removed (biopsy) to test for cancer. […] Blood test. If there is a possibility the growth may be cancerous, your physician may 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.

• #2 Ovarian Cysts: Symptoms, Types & Treatment in Akron, Ohio

  https://www.summahealth.org/medicalservices/womens/gynecological-services/ovarian-cysts

  Ovarian Cyst Diagnosis Your doctor or physician may conduct any or all of the following tests to determine if the cyst is cancerous and to assist in developing a treatment plan: […] Ultrasound. Sound waves are used to create an image of the ovaries, which can help your physician determine the size and location of the cyst or tumor, and if it is fluid-filled, solid or mixed. […] Other imaging tests. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are highly detailed imaging scans your doctor can use to find any ovarian tumors and determine whether they’ve spread as well as how far they may have spread. […] Hormone levels. Your doctor may take a blood test to check the levels of several hormones, such as luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol and testosterone.

• #2 Ovarian cyst – Wikipedia

  https://en.wikipedia.org/wiki/Ovarian_cyst

  Most ovarian cysts are not malignant; however, some do become cancerous. […] A widely recognised method of estimating the risk of malignant ovarian cancer based on initial workup is the risk of malignancy index (RMI). […] It is recommended that women with an RMI score over 200 should be referred to a centre with experience in ovarian cancer surgery. […] If the cyst is asymptomatic and appears to be either benign or normal, then delaying surgery, in the hope that it will prove unnecessary, is appropriate and recommended.

• #2 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. […] Referral to a gynecologic oncologist is recommended for the following patients: Postmenopausal patient with elevated CA125, imaging findings consistent with malignancy, ascites, a nodular or fixed mass, or evidence of metastases. […] The prognosis for benign cysts is excellent. […] Most malignant ovarian tumors are epithelial ovarian cystadenocarcinomas. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven.

• #2 Patient education: Ovarian cysts (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ovarian-cysts-beyond-the-basics

  If imaging tests find that you have an ovarian cyst, your health care provider might order blood tests to help determine the nature of the cyst. […] Depending upon your age, symptoms, test results, and family history, your health care provider may recommend either watchful waiting or surgery. […] Ovarian cysts do not always require treatment. In people who still have monthly periods, ovarian cysts often resolve on their own within one to two months without treatment. […] If a cyst is large, causing pain, or appears suspicious for cancer, treatment usually involves surgery to remove the cyst or the entire ovary. […] If surgery is needed to remove an ovarian cyst, the procedure is usually done in a hospital or surgical center. Whether the surgery involves removing only the cyst or the entire ovary depends upon your age and what is found during the procedure.

• #2 Evaluation of Ovarian Cysts | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/od1.html

  High-frequency gray-scale transvaginal ultrasonography is recommended as the imaging modality of choice. […] Elevated CA 125 levels (greater than 200 U per mL [200 kU per L] in premenopausal women and greater than 35 U per mL [35 kU per L] in postmenopausal women) have the greatest positive predictive value (49 percent in premenopausal women and 98 percent in postmenopausal women). […] Laparoscopic surgery may be beneficial for evaluating and treating benign cysts, although it is contraindicated in patients with high suspicion for ovarian cancer.

• #2 Diagnosis and management of ovarian cyst accidents – PubMed

  https://pubmed.ncbi.nlm.nih.gov/19299205/

  Ovarian cyst accidents include cyst rupture, haemorrhage and torsion. […] Suspected adnexal torsion should always be managed with early laparoscopy and de-torsion of the twisted tube or ovary. […] Ovarian cyst rupture and haemorrhage usually occur in association with physiological (functional) cysts and are generally self-limiting. […] Laparoscopy may be necessary in cases where the diagnosis is in doubt or for haemodynamic compromise. […] Ultrasound is the first-line investigation and is diagnostic in the case of haemorrhage. […] Typical ultrasound findings have been described for ovarian torsion, including an enlarged oedematous ovary with peripheral displacement of follicles. […] Recurrent cyst rupture or haemorrhage should be prevented by suppression of ovulation, usually with the combined oral contraceptive. […] Fixation of the ovary by a variety of techniques should be considered to prevent recurrent torsion.

• #2

  https://www.nhs.uk/conditions/ovarian-cyst/treatment/

  In most cases, ovarian cysts disappear in a few months without the need for treatment. […] Whether treatment is needed will depend on: its size and appearance, whether you have any symptoms, whether you’ve had the menopause if you are postmenopausal there is a slightly higher risk of ovarian cancer. […] In most cases, a policy of „watchful waiting” is recommended. […] If you have been through the menopause you may be advised to have ultrasound scans and blood tests every 4 months for a year, as you will have a slightly higher risk of ovarian cancer. […] Surgery may be recommended if the cyst is still there. […] Large or persistent ovarian cysts, or cysts that are causing symptoms, usually need to be surgically removed. […] Surgery is also normally recommended if there are concerns that the cyst could be cancerous or could become cancerous.

• #2 Guidance for the Diagnosis and Management of Ovarian Cysts – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/guidance-for-the-diagnosis-and-management-of-ovarian-cysts/3/

  Ovarian cysts 3 cm in diameter are considered normal and typically resolve without complication.34 However, if an ovarian cysts ruptures or bleeds, hemodynamic stability monitoring and ultrasound should be conducted. […] Significant bleeding on ultrasound or unstable patients should be admitted to an inpatient service for close monitoring, volume replacement, and, if warranted, referral for surgery.35 […] For patients at low risk for cancer whose ovarian cysts appear benign, a follow-up ultrasound 3- to 6-months after the initial ultrasound is recommended (Table 3).4,40 In women whose cyst contains malignant features, a repeat ultrasound is recommended 6 weeks after the initial ultrasound.20 Surgery may be necessary to accurately evaluate the tissue morphology if the cyst cannot be differentiated as benign or malignant, or in the case of malignant-appearing cysts.41,42

• #2 Guidance for the Diagnosis and Management of Ovarian Cysts – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/guidance-for-the-diagnosis-and-management-of-ovarian-cysts/3/

  In all postmenopausal women, biomarkers CA 125 and HE4 should be assessed during the initial ultrasound.31 […] Cysts found to be growing, symptomatic, or malignant require surgical consultation. Surgery is recommended in this population when the cyst appears malignant, preferably after the first trimester. […] In patients of adolescent age or younger, ultrasounds should be performed monthly until the cyst has resolved.43 […] Malignant-appearing cysts may be further evaluated with magnetic resonance imaging. If surgery is warranted in a pregnant patient, the recommendation is to wait until after the first trimester and perform the surgery laparoscopically rather than open surgery whenever feasible.44 […] In a study of 15,735 postmenopausal women, serial transvaginal ultrasounds were used to assess the presence of simple cysts and the development of subsequent ovarian cancer.

• #2 Investigation and management of an ovarian mass

  https://www.racgp.org.au/afp/2015/january-february/investigation-and-management-of-an-ovarian-mass

  Although ultrasonography is the best mode of imaging we have for assessment of ovarian pathology, its sensitivity and specificity for the diagnosis of ovarian cancer is only 8691% and 6881% respectively. […] The International Ovarian Tumor Analysis (IOTA) Group has developed a list of characteristics for benign and malignant masses. […] Any patient with an M-rule should be referred to a gynaecologist. […] The presence of ascites has a positive predictive value of 95% for ovarian cancer. […] Serum Ca125 is a glycoprotein antigen and is the most widely used tumour marker in the assessment of ovarian masses. […] In premenopausal women, Ca125 should be measured only if the ultrasound appearance of a mass raises suspicion of malignancy. […] It is unreliable in differentiating malignant from benign, as Ca125 35 U/ml has a sensitivity and specificity for ovarian cancer of 80% (potentially as low as 5060%).

• #3 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain. […] Ovarian cancer can occur in a premenarchal patient, and symptoms suggestive of an adnexal mass should not be ignored in that population. […] More severe, frequent symptoms of shorter duration may also indicate cancer. […] Transvaginal ultrasonography should be the first imaging test used to identify and characterize an adnexal mass. […] CA 125 testing alone should not be used to differentiate between a benign and a malignant adnexal mass. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive.

• #3 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. It is the imaging of choice when attempting to differentiate between benign or malignant mass. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation. […] Surgical indications include suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, and suspected malignancy. […] Patients at high risk for ovarian malignancy should have their case reviewed with a gynecologic oncologist for further assessment and determination of optimal surgical management. Specific guidelines can help gynecologists differentiate when to refer patients with an adnexal mass.

• #3

  https://www.nhs.uk/conditions/ovarian-cyst/

  If a GP thinks you may have an ovarian cyst, you’ll probably be referred for an ultrasound scan, carried out by using a probe placed inside your vagina. […] If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks, or a GP may refer you to a doctor who specialises in female reproductive health (gynaecologist). […] If there’s any concern that your cyst could be cancerous, the doctor will also arrange blood tests to look for high levels of chemicals that can indicate ovarian cancer. […] But having high levels of these chemicals does not necessarily mean you have cancer, as high levels can also be caused by non-cancerous conditions, such as: endometriosis, a pelvic infection, fibroids, your period.

• #3 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. […] Referral to a gynecologic oncologist is recommended for the following patients: Postmenopausal patient with elevated CA125, imaging findings consistent with malignancy, ascites, a nodular or fixed mass, or evidence of metastases. […] The prognosis for benign cysts is excellent. […] Most malignant ovarian tumors are epithelial ovarian cystadenocarcinomas. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven.

• #3 Ovarian Cysts Workup: Approach Considerations, Procedures, Laboratory Tests

  https://emedicine.medscape.com/article/255865-workup

  The definitive diagnosis of all ovarian cysts is made based on histologic analysis. Each cyst type has characteristic findings. […] No laboratory tests are diagnostic for ovarian cysts. However, the following laboratory tests can aid in the differential diagnosis and in the diagnosis of cyst-related complications: Urinary pregnancy test – Should always be performed in all women of childbearing age with abdominal pain or similar complaints. […] Keep in mind the possibility of cancer when managing an ovarian cyst. Cancer antigen 125 (CA125) is a protein expressed on the cell membrane of normal ovarian tissue and ovarian carcinomas. A serum level of less than 35U/mL is considered normal, although in some laboratories, the upper limit of normal may be lower than this. […] While CA125 values are elevated in 85% of patients with epithelial ovarian carcinomas overall, the value is elevated in only 50% of patients with stage I cancers confined to the ovary.

• #3 Investigation and management of an ovarian mass

  https://www.racgp.org.au/afp/2015/january-february/investigation-and-management-of-an-ovarian-mass

  Although ultrasonography is the best mode of imaging we have for assessment of ovarian pathology, its sensitivity and specificity for the diagnosis of ovarian cancer is only 8691% and 6881% respectively. […] The International Ovarian Tumor Analysis (IOTA) Group has developed a list of characteristics for benign and malignant masses. […] Any patient with an M-rule should be referred to a gynaecologist. […] The presence of ascites has a positive predictive value of 95% for ovarian cancer. […] Serum Ca125 is a glycoprotein antigen and is the most widely used tumour marker in the assessment of ovarian masses. […] In premenopausal women, Ca125 should be measured only if the ultrasound appearance of a mass raises suspicion of malignancy. […] It is unreliable in differentiating malignant from benign, as Ca125 35 U/ml has a sensitivity and specificity for ovarian cancer of 80% (potentially as low as 5060%).

• #3 Evaluation of Ovarian Cysts | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/od1.html

  Cysts that are characterized as complex adnexal masses or as persistent, thin-walled cysts should be evaluated for possible ovarian cancer. […] Testing for cancer antigen (CA) 125 may be useful in women with these cysts, particularly in postmenopausal women. […] The risk of ovarian cancer algorithm analyzes changes in CA 125 levels to provide greater sensitivity and specificity than a single value alone. […] However, only 50 percent of stage I epithelial cancers secrete CA 125 at the time of diagnosis. […] When combined with CA 125 measurement, biomarker HE4 increases the sensitivity by 22 percent and specificity by 90 percent. […] A risk of malignancy index has been created using menopausal status, ultrasound results, and CA 125 level in a single scale. […] The index has a sensitivity of 85 percent and specificity of 97 percent in determining the difference between benign and malignant pelvic masses.

• #3 Guidance for the Diagnosis and Management of Ovarian Cysts – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/guidance-for-the-diagnosis-and-management-of-ovarian-cysts/3/

  Ovarian cysts 3 cm in diameter are considered normal and typically resolve without complication.34 However, if an ovarian cysts ruptures or bleeds, hemodynamic stability monitoring and ultrasound should be conducted. […] Significant bleeding on ultrasound or unstable patients should be admitted to an inpatient service for close monitoring, volume replacement, and, if warranted, referral for surgery.35 […] For patients at low risk for cancer whose ovarian cysts appear benign, a follow-up ultrasound 3- to 6-months after the initial ultrasound is recommended (Table 3).4,40 In women whose cyst contains malignant features, a repeat ultrasound is recommended 6 weeks after the initial ultrasound.20 Surgery may be necessary to accurately evaluate the tissue morphology if the cyst cannot be differentiated as benign or malignant, or in the case of malignant-appearing cysts.41,42

• #3 Guidance for the Diagnosis and Management of Ovarian Cysts – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/guidance-for-the-diagnosis-and-management-of-ovarian-cysts/3/

  In all postmenopausal women, biomarkers CA 125 and HE4 should be assessed during the initial ultrasound.31 […] Cysts found to be growing, symptomatic, or malignant require surgical consultation. Surgery is recommended in this population when the cyst appears malignant, preferably after the first trimester. […] In patients of adolescent age or younger, ultrasounds should be performed monthly until the cyst has resolved.43 […] Malignant-appearing cysts may be further evaluated with magnetic resonance imaging. If surgery is warranted in a pregnant patient, the recommendation is to wait until after the first trimester and perform the surgery laparoscopically rather than open surgery whenever feasible.44 […] In a study of 15,735 postmenopausal women, serial transvaginal ultrasounds were used to assess the presence of simple cysts and the development of subsequent ovarian cancer.

• #4 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. It is the imaging of choice when attempting to differentiate between benign or malignant mass. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation. […] Surgical indications include suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, and suspected malignancy. […] Patients at high risk for ovarian malignancy should have their case reviewed with a gynecologic oncologist for further assessment and determination of optimal surgical management. Specific guidelines can help gynecologists differentiate when to refer patients with an adnexal mass.

• #4

  https://www.nhs.uk/conditions/ovarian-cyst/

  If a GP thinks you may have an ovarian cyst, you’ll probably be referred for an ultrasound scan, carried out by using a probe placed inside your vagina. […] If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks, or a GP may refer you to a doctor who specialises in female reproductive health (gynaecologist). […] If there’s any concern that your cyst could be cancerous, the doctor will also arrange blood tests to look for high levels of chemicals that can indicate ovarian cancer. […] But having high levels of these chemicals does not necessarily mean you have cancer, as high levels can also be caused by non-cancerous conditions, such as: endometriosis, a pelvic infection, fibroids, your period.

• #4 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. […] Referral to a gynecologic oncologist is recommended for the following patients: Postmenopausal patient with elevated CA125, imaging findings consistent with malignancy, ascites, a nodular or fixed mass, or evidence of metastases. […] The prognosis for benign cysts is excellent. […] Most malignant ovarian tumors are epithelial ovarian cystadenocarcinomas. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven.

• #4 The Radiology Assistant : Roadmap to evaluate ovarian cysts

  https://radiologyassistant.nl/abdomen/unsorted/roadmap-to-evaluate-ovarian-cysts

  Step 3 To aid in selecting the proper work-up, the final step is to determine whether a patient falls into a low-risk category (i.e. premenopausal women without additional risk factors) or a high-risk category (i.e. post-menopausal or premenopausal with additional risk factors). […] Based on these steps we can determine further management: ignore, follow-up with US, further evaluation with MRI or excision. […] Role of Ultrasound For characterization of ovarian masses, ultrasound is often the first-line method of choice, especially for distinguishing cystic from complex cystic-solid and solid lesions. […] Role of MRI For complex lesions, primary evaluation with ultrasound is often followed by further evaluation with MRI. Even with MRI it is often not possible to make an accurate diagnosis of neoplastic subtype. By using MRI as an adjunct to sonography a delay in the treatment of potentially malignant ovarian lesions is prevented. This is not only beneficial to the small number of women who do have ovarian cancer, but also a proven cost-effective approach to the management of sonographically indeterminate adnexal lesions.

• #4 Guidance for the Diagnosis and Management of Ovarian Cysts – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/guidance-for-the-diagnosis-and-management-of-ovarian-cysts/3/

  Women who had 1 cyst at baseline or developed simple cysts during the trial were not found to be at increased risk for ovarian cancer compared to their non-cyst counterparts (P =.85 and P .99, respectively).15 […] In another study of 1769 postmenopausal women, 6.6% were found to have simple cysts at baseline. Of those with simple cysts, 23.3% resolved spontaneously and no malignancies were found by the end of the study.45 […] Finally, in a study of 15,106 women aged 50 years, 18% were found to have ovarian cysts (69.4% resolved spontaneously), while 27 women were diagnosed with ovarian cancer at the resolution of this study; only 10 of the women had previously been diagnosed with ovarian cysts.46

• #5 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. It is the imaging of choice when attempting to differentiate between benign or malignant mass. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation. […] Surgical indications include suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, and suspected malignancy. […] Patients at high risk for ovarian malignancy should have their case reviewed with a gynecologic oncologist for further assessment and determination of optimal surgical management. Specific guidelines can help gynecologists differentiate when to refer patients with an adnexal mass.

• #5

  https://www.nhs.uk/conditions/ovarian-cyst/

  If a GP thinks you may have an ovarian cyst, you’ll probably be referred for an ultrasound scan, carried out by using a probe placed inside your vagina. […] If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks, or a GP may refer you to a doctor who specialises in female reproductive health (gynaecologist). […] If there’s any concern that your cyst could be cancerous, the doctor will also arrange blood tests to look for high levels of chemicals that can indicate ovarian cancer. […] But having high levels of these chemicals does not necessarily mean you have cancer, as high levels can also be caused by non-cancerous conditions, such as: endometriosis, a pelvic infection, fibroids, your period.

• #5 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. […] Referral to a gynecologic oncologist is recommended for the following patients: Postmenopausal patient with elevated CA125, imaging findings consistent with malignancy, ascites, a nodular or fixed mass, or evidence of metastases. […] The prognosis for benign cysts is excellent. […] Most malignant ovarian tumors are epithelial ovarian cystadenocarcinomas. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven.

• #5 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  The sensitivity of pelvic examination is low, further workup in symptomatic women should occur even with negative pelvic examination results. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. […] Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #6 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. It is the imaging of choice when attempting to differentiate between benign or malignant mass. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation. […] Surgical indications include suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, and suspected malignancy. […] Patients at high risk for ovarian malignancy should have their case reviewed with a gynecologic oncologist for further assessment and determination of optimal surgical management. Specific guidelines can help gynecologists differentiate when to refer patients with an adnexal mass.

• #6 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. […] Referral to a gynecologic oncologist is recommended for the following patients: Postmenopausal patient with elevated CA125, imaging findings consistent with malignancy, ascites, a nodular or fixed mass, or evidence of metastases. […] The prognosis for benign cysts is excellent. […] Most malignant ovarian tumors are epithelial ovarian cystadenocarcinomas. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven.

• #7 Ovarian Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560541/

  Due to the proximity of the transvaginal probe to the ovaries, the most common imaging modality used for an initial evaluation is transvaginal ultrasonography. It is the imaging of choice when attempting to differentiate between benign or malignant mass. […] Cyst size greater than 10 cm, complex multilocular mass, papillary excrescences or solid components, irregularity, thick septations, evidence of ascites, and increased vascularity on color doppler should raise suspicion for malignancy and requires further evaluation. […] Surgical indications include suspected ovarian torsion, persistent adnexal mass, acute abdominal pain, and suspected malignancy. […] Patients at high risk for ovarian malignancy should have their case reviewed with a gynecologic oncologist for further assessment and determination of optimal surgical management. Specific guidelines can help gynecologists differentiate when to refer patients with an adnexal mass.

• #7 Ovarian Cysts: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255865-overview

  Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex ovarian cysts should be considered for surgical removal. […] Referral to a gynecologic oncologist is recommended for the following patients: Postmenopausal patient with elevated CA125, imaging findings consistent with malignancy, ascites, a nodular or fixed mass, or evidence of metastases. […] The prognosis for benign cysts is excellent. […] Most malignant ovarian tumors are epithelial ovarian cystadenocarcinomas. […] The potential of benign ovarian cystadenomas to become malignant has been postulated but, to date, remains unproven.

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