Ovarian Cysts

OVARIAN CYSTS

The ovary is a common site for cysts, which may be simple en-largements of normal ovarian constituents, the graafian follicle, or the corpus luteum, or they may arise from abnormal growth of the ovarian epithelium.

Dermoid cysts are tumors that are thought to arise from partsof the ovum that normally disappear with ripening (maturation). Their origin is undefined, and they consist of undifferentiated embryonal cells. They grow slowly and are found during surgery to contain a thick, yellow, sebaceous material arising from the skin lining. Hair, teeth, bone, and many other tissues are found in a rudimentary state within these cysts. Dermoid cysts are only one type of lesion that may develop. Many other types can occur, and treatment usually depends on the type.

The patient may or may not report acute or chronic abdomi-nal pain. Symptoms of a ruptured cyst mimic various acute ab-dominal emergencies, such as appendicitis or ectopic pregnancy. Larger cysts may produce abdominal swelling and exert pressure on adjacent abdominal organs.

Polycystic ovary syndrome, a complex endocrine condition in-volving a disorder in the hypothalamic-pituitary and ovarian network or axis resulting in anovulation, occurs in women of childbearing age. Symptoms are related to androgen excess. Irreg-ular periods resulting from lack of regular ovulation, obesity, and hirsutism may be presenting complaints. Cysts form in the ovaries because the hormonal milieu cannot cause ovulation on a regular basis. Onset may occur at menarche or later. When pregnancy is desired, medications to stimulate ovulation are often effective. Women with polycystic ovary syndrome may develop insulin re-sistance and may be at higher risk for cardiac disorders in later life.

Medical Management

The treatment of large ovarian cysts is usually surgical removal. For cysts that are small and appear to be fluid-filled or physiologic in a young, healthy patient, however, oral contraceptives may be used to suppress ovarian activity and resolve the cyst. Oral con-traceptives are also usually prescribed to treat polycystic ovary syndrome. About 98% of cysts that occur in women aged 29 years and younger are benign. In women older than 50 years of age, only half of these cysts are benign. The postoperative nursing care after surgery to remove an ovarian cyst is similar to that after ab-dominal surgery, with one exception. The marked decrease in intra-abdominal pressure resulting from removal of a large cyst usually leads to considerable abdominal distention. This compli-cation may be prevented to some extent by applying a snug-fitting abdominal binder.

Some surgeons discuss the option of a hysterectomy when a woman is undergoing a bilateral ovary removal because of a sus-picious mass because it may increase life expectancy, avoid a later second surgery, and save on health care costs. It is preventive in that future cancer is avoided, as is benign disease that might re-quire hysterectomy. Patient preference is a priority in determin-ing its appropriateness.