Are cysts of concern
Doctor's letter : Cysts
EXPLANATION Cysts are cavities filled with fluid. These occur in many organs in the human body and are usually not of concern. They arise in the ovaries of women of childbearing age in every menstrual cycle because they occur depending on the hormonal balance. Usually, however, they regress after a period of fertility.
Cysts are usually benign. But doctors recommend examining cysts very carefully to rule out ovarian cancer.
SYMPTOMS Cysts are often one to six inches in size. However, the sizes range from a few millimeters to 50 centimeters. If the cavities are very small, they do not cause severe discomfort. At most, pulling, unilateral pelvic pain can occur.
Even if they get bigger, it doesn't always have to be a problem. "Cysts can grow to a considerable size, more than ten to 15 centimeters, without causing any greater discomfort," says Herbert Mecke, Director of the Clinic for Gynecology at the Vivantes Auguste Viktoria Clinic.
If symptoms occur, it is usually when the cysts have become very large: Menstrual cycle disorders, painful menstrual bleeding, irregular bleeding, back pain, pain when defecating, constipation, nausea and vomiting, difficulty urinating, increase in waist size and pain during sexual intercourse are possible .
Acute, severe abdominal pain is most common when one or more cysts burst. However, this is relatively seldom the case - and even then in most cases it is not dangerous. Only if a blood vessel is injured in this case can dangerous bleeding occur and emergency surgery is necessary.
CAUSES Doctors differentiate between three groups of cysts on the ovary - each according to their causes.
The first group are the so-called functional cysts that belong to every menstrual cycle. Under the influence of the female sex hormone estrogen, these form in the ovaries during the menstrual cycle, burst when ovulating and then disappear again on their own. These are rarely larger than six centimeters, says Mecke.
The second group are benign neoplasms, such as cystomas or cysts caused by endometriosis (see page 50). The cystomas contain a watery or slimy liquid, the endometriosis cysts are filled with a brownish, viscous secretion from menstrual blood, which is why they are also known as "chocolate cysts". Untreated, they can grow to a size of 15 centimeters.
Finally, cysts that cause discomfort or do not resolve can also be an indication that a malignant tumor may be in the ovaries.
Diagnosis Differentiating what type of cyst is on the ovary can be difficult. The gynecologist can identify the type of cyst with the help of palpation and imaging, mainly ultrasound scans. “Magnetic resonance and computed tomography only help in exceptional cases,” says Mecke.
Sometimes it is necessary to wait a monthly cycle or two to see if a cyst will resolve on its own in patients of reproductive age. Then it is a functional cyst.
If the examination does not produce exact results, a laparoscopy may be necessary, in which tissue samples are taken from the cysts in order to rule out a tumor.
THERAPYTreatment depends on the type and size of the cyst and the age of the patient. In young women, doctors usually wait to see whether the cysts regress on their own and initially only check their growth. Regular check-ups are especially necessary for cysts that form in women after the menopause.
A new formation of the cavities can be prevented by hormones. Doctors often then prescribe the pill or other drugs that affect the hormonal balance. Operations are rather the exception. "Functional cysts should only be operated on in the event of complications or severe symptoms, for example due to a rupture of the cyst," says chief physician Mecke.
The so-called “chocolate cysts” as a result of endometriosis, on the other hand, have to be surgically removed. The laparoscopy is available as a minimally invasive procedure for this. The operation is carried out through small incisions on the abdomen, through which only millimeter-sized, long-handled instruments are inserted into the body cavity with which the operation is carried out.
The doctor can easily peel out the cavities, which are often wrapped in a hard shell in the wall of the ovary, without damaging the tissue, says Mecke. The patient lies on the operating table under general anesthesia. The lower abdomen is inflated with carbon dioxide to provide the surgeon with a clear operating area for the endoscopes. Chief physician Mecke operates the cysts on the ovaries with long-handled instruments and a camera that are pushed through three small incisions into the patient's abdomen. First it is opened and the viscous secretion it contains is sucked off.
The surgeon then cuts the now empty shell of the cyst and detaches it from the ovary. With the help of a small gripper, he pulls the remains of the tissue out of the abdomen. Then the ovary is sutured again. “There is no risk to fertility,” says Mecke. "On the contrary, that's how we get it."
If cysts are suspected to be caused by a cancerous tumor in the ovary, doctors may have to completely remove the ovary, even in young women.
The editors of the magazine "Tagesspiegel Kliniken Berlin 2016" compared the Berlin clinics that treat this disease. For this purpose, the treatment numbers, the hospital recommendations of the outpatient doctors and the patient satisfaction were compiled in clear tables in order to make it easier for the patient to choose a clinic. The magazine costs 12.80 euros and is available in the Tagesspiegel shop.
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