Ovarian Cysts & Benign Tumors
In the US, a woman has a lifetime risk of 5-10% of undergoing surgery for a suspected ovarian neoplasm/mass (cyst or tumor). Out of this group, 13-21% of women are diagnosed with ovarian cancer. Thus most ovarian masses are benign. The most common ovarian mass in a menstruating woman is a functional simple ovarian cyst that resolves by her next menstrual cycle. In a post-menopausal woman, the most common ovarian mass is a non-cancerous cystadenoma. Most ovarian cysts/tumors are discovered on physical exam or imaging when a patient has no symptoms. However, sometimes these masses cause pain and a patient seeks help from her doctor. Abnormal or large masses on ovaries and/or tubes can be detected on different imaging techniques such as ultrasound (sonogram), CT scan and MRI. The goal of evaluation is to rule out cancer. Management decisions are often based on patient’s age, family history, patient’s symptoms, imaging studies, and blood testing results.
Masses with a low risk of cancer are often managed conservatively without surgery unless the patient is having pelvic pain or other associated symptoms. If risk of cancer is low and surgery is indicated, this can usually be done via laparoscopic excision of benign ovarian tumors. If there is a moderate-high suspicion of cancer, surgery is indicated regardless of whether or not the patient is experiencing symptoms. Usually if cancer is expected, evaluation and surgery are performed by a gynecological oncologist.
In cases where the risk of cancer is unclear, surgical excision is usually indicated. The surgical approach (laparoscopic vs. laparotomy/open surgery) depends on the size and consistency of the mass, patient’s history of previous abdominal surgeries, indications for the procedure, as well as the surgeon’s level of skill and comfort. The vast majority of cases at AMIGS are done laparoscopically. Other surgeon’s may choose to perform “open surgery” (laparotomy) requiring a significant abdominal incision. Some surgeons may reason against the laparoscopic approach in these cases because they fear that if the mass turns out to be cancerous and inadvertent spillage occurs, that this will advance the stage of cancer. However, spillage may occur both during laparotomy and laparoscopy. There is no guarantee that spillage will not occur even in an open case. In order to decrease/prevent the risk of spillage, an experienced laparoscopic surgeon will place the mass into a special laparoscopic sac after it is excised. Then the contents of the sac are securely removed through the laparoscopic incision and sent for frozen section (quick pathology test) while the patient is still asleep. If pathology discovers cancer, then laparoscopy is usually converted to laparotomy and definitive surgery for cancer is performed. In rare cases, we may choose to perform an open procedure.
The advantages of a laparoscopic procedure are many. Patients usually go home the same day, the recovery time is much faster and less painful, and the cosmetic outcome is better. After May 2010 we will also have the option of performing Robotic Surgery.