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Gynecology (Expert Forum)
large simple ovarian cyst
Answered by
Keith Downing, MD - Obstetrics, Gynecology
MA
This forum is for questions and support regarding gynecology issues such as: Cervical Disorders, Colposcopy, Cramps, Cystitis, Fallopian Tube Disorders, Menstruation, Ovarian Disorders, PAP Test, Pelvic Exam, PID, PMS, Surgery, Tests, Ultrasound, Uterine Disorders, Vaginal Disorders.
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large simple ovarian cyst
by lp65, May 14, 2008 01:43PM
Hi,
A week ago I admitted myself to the emergency room because I was experiencing a lot of pain on the lower right side of my abdomen. The pain was intermittent and more intense when I was walking around. A CT scan was performed and revealed that I had a ovarian cyst. Two days later, I saw my primary care physician who ordered an ultrasound. The ultrasound (both pelvic and transvaginal) revealed that the cyst is actually within the left ovary (not the right ovary as was expected), is rather large (10.2 x 8.8 x 10.4 cm), and appeared to be a simple cyst. The cyst has a single small thin septation within it that is approximately 2 mm. The right ovary appeared normal. The pain subsided after 3 days, and presently I am only experiencing a pressure feeling more towards my lower left side. I am 47 (almost 48) years old and am still mestruating regularly. After reviewing the ultrasound, my primary care physician recommended an evaluation by an OB/GYN. My appointment to see the OB/GYN is 9 days from now. I couldn't get an appointment sooner than this. Is it okay to wait this long or is this a more urgent matter? Also, I was wondering if my activities should be limited. Can I still bike ride and mow the lawn? I guess I am just worried that this cyst could burst and cause problems. How likely is it that the cyst will burst? Finally, I am aware that the cyst will have to be removed surgically since it is so large. What type of surgery would most likey be appropriate for this type of cyst? Is the cyst too large for laproscopic surgery? Thank you for taking the time to answer my questions. It is so difficult to speak with a doctor over the phone, and the receptionists are not trained to answer such questions. Thanks again.
A week ago I admitted myself to the emergency room because I was experiencing a lot of pain on the lower right side of my abdomen. The pain was intermittent and more intense when I was walking around. A CT scan was performed and revealed that I had a ovarian cyst. Two days later, I saw my primary care physician who ordered an ultrasound. The ultrasound (both pelvic and transvaginal) revealed that the cyst is actually within the left ovary (not the right ovary as was expected), is rather large (10.2 x 8.8 x 10.4 cm), and appeared to be a simple cyst. The cyst has a single small thin septation within it that is approximately 2 mm. The right ovary appeared normal. The pain subsided after 3 days, and presently I am only experiencing a pressure feeling more towards my lower left side. I am 47 (almost 48) years old and am still mestruating regularly. After reviewing the ultrasound, my primary care physician recommended an evaluation by an OB/GYN. My appointment to see the OB/GYN is 9 days from now. I couldn't get an appointment sooner than this. Is it okay to wait this long or is this a more urgent matter? Also, I was wondering if my activities should be limited. Can I still bike ride and mow the lawn? I guess I am just worried that this cyst could burst and cause problems. How likely is it that the cyst will burst? Finally, I am aware that the cyst will have to be removed surgically since it is so large. What type of surgery would most likey be appropriate for this type of cyst? Is the cyst too large for laproscopic surgery? Thank you for taking the time to answer my questions. It is so difficult to speak with a doctor over the phone, and the receptionists are not trained to answer such questions. Thanks again.
Doctor's Answer
by Keith Downing, MD, May 16, 2008 03:37PM
, May 16, 2008 03:37PM
Hello,
I can understand your concerns. I would limit your activity by refraining from rigorous exercise. Mowing the lawn and casual biking should be okay. The concern is less for rupture when the cyst is that size, but more so for torsion (the cyst twisting resulting in obstruction of its blood supply). Now, sometimes when a cyst becomes quite large it doesn't have space to twist or torse, but I've definitely seen cysts your size result in torsion. I suspect the symptoms you report were the result of intermittent torsion. Common symptoms of ovarian torsion are sudden onset, sharp lower abdominal pain (often one sided, but not always), and nausea and/or vomiting.
Regarding management: if you have no further pain you can wait to be seen. If you could get in earlier that would be great. The ob/gyn you meet will talk with you about surgical approaches (laparoscopic vs. laparotomy). They will also talk with you about whether this ovarian cyst could be a malignancy, how that can be determined, and if believed to be a malignancy at the time of surgery how you would want to proceed.
This is an involved discussion you should have with the person who will perform your surgery. Some of what they offer will be based on their experience and comfort level. Feel free to get a second or third opinion before proceeding if that will make you more comfortable.
Best regards,
Dr. Downing
I can understand your concerns. I would limit your activity by refraining from rigorous exercise. Mowing the lawn and casual biking should be okay. The concern is less for rupture when the cyst is that size, but more so for torsion (the cyst twisting resulting in obstruction of its blood supply). Now, sometimes when a cyst becomes quite large it doesn't have space to twist or torse, but I've definitely seen cysts your size result in torsion. I suspect the symptoms you report were the result of intermittent torsion. Common symptoms of ovarian torsion are sudden onset, sharp lower abdominal pain (often one sided, but not always), and nausea and/or vomiting.
Regarding management: if you have no further pain you can wait to be seen. If you could get in earlier that would be great. The ob/gyn you meet will talk with you about surgical approaches (laparoscopic vs. laparotomy). They will also talk with you about whether this ovarian cyst could be a malignancy, how that can be determined, and if believed to be a malignancy at the time of surgery how you would want to proceed.
This is an involved discussion you should have with the person who will perform your surgery. Some of what they offer will be based on their experience and comfort level. Feel free to get a second or third opinion before proceeding if that will make you more comfortable.
Best regards,
Dr. Downing
