RISK FACTORS FOR OVARIAN CYSTADENOCARCINOMA INCLUDE STRONG FAMILYHISTORY, ADVANCING GAE, WHITE RACE, INFERTILITY, NULLIPARITY, A H/O BREAST CANCER & BRCA GENE MUTATIONS.
MEDICAL CARE :
Many patients with simple ovarian cysts based on ultrasonography findings do not require treatment.
In a postmenopausal patient, a persistent simple cyst smaller than 5 cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonography examinations. Some evidence suggests that cysts up to 10 cm can be safely followed in this way.
Premenopausal women with asymptomatic simple cysts smaller than 8 cm on sonograms in whom the CA125 value is within the reference range may be monitored with a repeat ultrasonographic examination in 8-12 weeks. Hormone therapy is not helpful for suppressing ovarian stimulation by gonadotropins.
Surgical Care:
Persistent simple ovarian cysts larger than 5-10 cm and complex ovarian cysts should be removed surgically.
Reserve a laparoscopic approach for patients who have undergone a thorough workup and are thought to not have malignant disease. Such patients include those considered to have a dermoid or endometrioma, those with functional or simple cysts that are causing symptoms and have not resolved with conservative management, and those presenting with acute symptoms. In all cases, one should be able to remove the cyst intact.
A laparotomy should be performed on patients thought to have a significant risk for malignant disease and on patients with benign-appearing cysts that cannot be removed intact laparoscopically.
Whether performing a laparoscopy or laparotomy, the goals are as follows:
To confirm the diagnosis of an ovarian cyst
To assess whether the cyst appears to be malignant
To obtain fluid from peritoneal washings for cytologic assessment
To remove the entire cyst intact for pathologic analysis, including frozen section, which may mean removing the entire ovary
To assess the other ovary and other abdominal organs
Excision of the cyst alone, with conservation of the ovary, may be performed in patients who desire retention of their ovaries for future fertility or other reasons. Included are endometrioma, dermoid, and functional cysts.
If the ovarian cyst is benign, removal of the opposite ovary should be considered in postmenopausal women, in perimenopausal women, and in premenopausal women older than 35 years who have completed their family and are considered at increased risk for subsequent development of ovarian carcinoma. These issues should be discussed with the patient preoperatively.