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When ovarian cysts become a cause for concern

The symptoms of cysts can be vague. PHOTO: ISTOCK
The symptoms of cysts can be vague. PHOTO: ISTOCK

Ovarian cysts are surprisingly common among women and, in most cases, are not life-threatening and can resolve spontaneously without much symptoms. But when does it require medical attention?

At some point in their lives, most women do develop ovarian cysts — small, fluid-filled sacs that typically form during ovulation, and are located in or on the ovary. 

More often than not, these cysts are harmless and painless, and will go away on their own without the need for treatment. However, it becomes a problem when it does not go away or grows bigger. 

While most ovarian cysts do not present any symptoms, it might be time to schedule a medical check-up if you experience bloating or swelling of the abdomen, constipation or pain during bowel movements, irregular menstrual periods, as well as lower abdominal or pelvic pain before or during your menstrual cycle. 

Severe cases might be accompanied by nausea and vomiting. In such a scenario, your doctor may order an emergency pelvic ultrasound to rule out ovarian cancer. 

Types of ovarian cysts

Dr Cindy Pang, obstetrician and gynae-oncologist from Mount Elizabeth Novena Hospital, says there are different types of cysts.

Functional cysts occur as part of the menstrual cycle. These can cause problems sometimes in women in the reproductive age group. In the first half of the cycle – the follicle – which contains the developing egg, can grow up to 2cm before ovulation. After ovulation, the corpus luteal cyst or the egg shell will persist till the start of the next menstrual cycle. If all is good, this process goes on monthly. However, some patients may have hormonal problems leading to the follicle increasing in size, or there could be bleeding into the corpus luteal cyst. This can lead to water cysts and blood cysts forming.

Benign pathological cysts due to processes not related to ovulation can also form. For example, dermoid cyst – which contains hair or sebum and other tissue – can develop from the cells on the ovaries. Another example is endometriotic cyst, which are blood filled cysts due to the lining of the uterus growing on the ovary. These can increase in size and grow independent of the menstrual cycle. 

And then there are cancerous cysts. The lifetime risk of a woman getting ovarian cancer is one in 74 — or about 1.3 per cent. It can affect women of any age, but those who are older, have had breast cancer previously or have a family history of ovarian cancer, may be at a higher risk of developing the disease. The ultrasound will usually show sinister features like solid areas in the cyst and increase blood supply. 

The symptoms of cysts can be vague. A slowly growing cyst can cause symptoms with bloating or swelling of the abdomen, constipation or pain during bowel movements. There could be irregular menstrual periods, as well as lower abdominal or pelvic pain before or during your menstrual cycle.

If the cyst is leaking or twisting at the blood supply, which is medically known as ovarian cyst torsion, the presentation can be sudden with severe lower abdominal pain with nausea and vomiting. This is called an ovarian cyst accident. Surgical intervention is usually needed on an emergency basis as delay can cause the ovary and its surrounding tissue will be damaged, which may affect fertility.

When to consider a cystectomy

“If left untreated, the ovarian cyst may continue to grow, which could cause the patient to have an increased chance of ovarian cyst accident,” says Dr Pang. “Cystectomy involves the removal of cysts from your ovaries or its surface, while leaving the ovary intact. It can be performed as an open surgery or a keyhole surgery (laparoscopy).”

This surgical procedure can be offered by your doctor if you have persistent symptoms from the cyst, if the cyst is larger than 4cm to 5cm with risk of ovarian cyst accident, or if there is a risk or suspicion of cancer or cancerous change.  

Laparoscopic surgery is a minimally invasive surgical technique that makes several small incisions in your lower abdomen. It is also known as “keyhole surgery”. The incisions are 0.5cm to 1cm and high definition cameras allow the procedure to be done more precisely with small instruments. Recent laparoscopic developments have brought about a more advanced technique known as single incision laparoscopy — which involves making a small 3.5cm incision inside the belly button that, after healing, is barely noticeable.
 
Patients who opt for laparoscopic surgery can usually be discharged after two to three days, while open surgery patients normally require a few more days to rest. The best option of approach for the surgery will be discussed with the patient by the surgeon after taking into account the patient’s profile (e.g. previous surgeries, size of cyst) and the risk of the cyst (whether there is a high suspicion of cancer or if it is adhered to the surrounding organs).

No medical bill shock 

To provide that for its patients, private healthcare group Parkway Pantai has come up with its Price Guarantee Procedures (PGP) programme to generate a fixed price point on certain procedures like cystectomy. 

This ensures that patients are aware of the full costs of procedures upfront without having to worry about hidden costs, allowing them to make well-informed decisions on their course of treatment prior to admission.

Parkway Pantai utilises an artificial intelligence (AI)-powered tool to produce an overview of the patient’s final hospital bill — taking into account the average length of stay in a hospital, ward type, diagnosis and surgical procedures. 

PGP offers greater price transparency and certainty for patients, and even covers any related complications that may arise following the procedure for up to seven days. It is currently offered at four hospitals: Gleneagles Hospital, Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital and Parkway East Hospital

All self-paying and insured patients are eligible for PGP, which are offered by doctors participating in the programme.

Cystectomy is one of six operations that are eligible for PGP. Other surgeries under the programme include the removal of piles, breast lumps, gall bladder, thyroid or tonsils.

For more information, please call 6812-3789 or visit the hospital websites.

This article is for informational purposes only. Please refer to the specific procedures’ financial counselling forms for detailed programme inclusions and exclusions. Prospective patients should always seek independent medical advice.

References:

1) HealthXhange.sg (2016) Ovarian Cysts: Signs, Symptoms and Treatments [Online]. Available from: https://www.healthxchange.sg/women/urology/ovarian-cysts-signs-symptoms-treatments (Accessed: Dec 4, 2019)

2) Health Plus (2018) When Does an Ovarian Cyst Become a Threat? [Online]. Available from: https://www.gleneagles.com.sg/healthplus/article/when-ovarian-cyst-threat (Accessed: Dec 4, 2019)

3) Gleneagles Hospital (2019) Cystectomy (Ovarian Cysts Removal) [Online]. Available from: https://www.gleneagles.com.sg/specialties/medical-specialties/women-gynaecology/cystectomy (Accessed: Dec 4, 2019)

4) Health & Fertility Centre for Women (Ovarian Cysts Surgery Singapore) [Online]. Available from: https://www.healthfertility.com.sg/gynaecology/ovarian-cysts.html (Accessed: Dec 4, 2019)

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