Ovarian Cyst

Simple Cysts

  • Most are benign and found incidentally

  • Reassure patients, repeat pelvic U/S in 12 months if low risk and

    • Premenopausal with cyst < 5 cm

    • Postmenopausal with cyst < 1 cm

  • Obtain MRI with contrast if unable to reassure (see above) or for patients who do not meet referral criteria (see below); also consider in cysts with features concerning for malignancy

  • Refer to gynecology for

    • Symptomatic cysts, e.g. presence of abdominal/pelvic pressure or pain

    • Cysts > 6 cm

Features Concerning for Malignancy

  • Patients with a family history of breast or ovarian cancer

  • Presence of intra-abdominal/pelvic ascites

  • Cysts with

    • Thick septations (2-3 mm)

    • Solid regions that are not hyperechoic

    • Septations or solid regions with blood flow

  • Elevated CA 125 levels ( i.e. > 35 U/mL)

    • May correlate with advanced cancer

    • Should NOT be obtained routinely

Notes

  • Simple ovarian cysts do not increase future risk of malignancy

  • Median age for diagnosis of ovarian cancer is 63 years

Source: Incidental ovarian cysts: When to reassure, when to reassess, when to refer. Cleveland Clinic Journal of Medicine. 2013 August; 80(8):503-514