OVARIAN CYST

 

Definition:

·         Ovarian cyst is a tumour of the ovaries ,many of which are benign,80% are classified as epithelial and include serous, mucinous, endometrial and mesonephroid lesions

Risk factors

·         Age Ovarian cyst increases in incidence ad age advances ,it common between 45and 60 years

·         Hormones estrogen and progesterone have been noted to be carcinogenic but appear to influence the process of   carcinogenesis

·         Inactivity

·         Obesity resulting from excessive intake of energy foods

·         Infectious agents commonly the viruses and bacteria as seen in STIs

 Causes

·         There is no clearly known cause but multiple factors as mentioned above are said to trigger the onset of cancer

 Pathophysiology of Ovarian Cyst (35 minutes)

·         Benign cysts and tumors  develop from a variety of physiologic imbalances

·         Elevated  levels of luteinizing hormone may  cause hyper stimulation of the ovaries

·         Follicular cysts depend on  gonadotropin for growth and generally occur during the menstrual years and resolve spontaneously

·         Simple cysts commonly occur menopause

·         There is an increased rate of growth of cystic cells that interferes with normal functioning

 Classification

·         Ovarian cysts are classified according to the cells they affect as follows:

·         Follicular cysts

• Are the most common form of ovarian cysts which are usually multiple ,ranging in size from  a few millimeters to as large as 15cm in diameter
• Depend on gonadotrophin for growth
• Occur during menstrual years and usually resolve spontaneously
• Many cause menstrual irregularities if blood estrogen gets elevated

·         Corpus luteum cysts

• Less common variety
• Associated with normal  ovarian function or elevated progesterone
• Average diameter is 4cm
• Appear purplish-red from bleeding within the corpus luteum
• May cause delayed menstrual bleeding from progesterone secretion and hypermenorrhea is common

·         Theca-lutea cysts

• Are the least common ,which are usually bilateral  and produce significant enlargement of the ovaries of up to 30cm in diameter
• They develop from prolonged or excessive stimulation by gonadotropins
• Associated with hydatidiform mole 50% of time and with chorio-carcinoma 10% of the time

·         Epithelial tumors

·         Serous tumors: Found in all age groups. can be extremely large, filling the pelvis or abdomen

·         Mucinous tumor: Occur in second and third decade of life, they can be bilateral and can reach spectacular size the largest form.

·         Endometrial tumors: Are small purplish blue lesions. They are large tumors called chocolate cysts because they contain a brownish fluid. They have a very low malignancy potential

·         Mesonephroid tumors: Usually multifocal, they involve peritoneal surfaces and may cause intestinal or urinary complications

They are characterized by papillary proliferation without mitotic activity

Signs and symptoms

·         Most of the ovarian cysts are asymptomatic for a long time and are discovered on routine medical examination.

·         The signs are unspecific such as menstrual irregularities  especially when there is hormonal imbalance exists

·         Dull, unilateral ,lower quadrant pain may occur as the cyst grows in size, but overt pain is unusual

 Diagnostic Procedures (10 minutes)

·         Palpation of the reproductive organs   during pelvic examination reveals a palpable mass or enlargement of the ovary, any  mass palpated in a postmenopausal woman  requires further investigation because ovaries normally atrophy after menopause

·         Ultrasonography is done to distinguish between functional and neoplastic cysts

·         CT scan capable of distinguishing  solid tumors ,cysts and ascites is done

·         Laparoscopy is done to confirm the diagnosis

Treatments and Nursing Care (45 minutes)

Medications

·         Oral contraceptives are prescribed to shrink the cyst

·         Symptomatic medicines ,analgesics are given to reduce the pain and discomfort

Surgical treatments:

·         Surgery is recommended only when the cyst is bigger than 8cm,or occurs after menopause or before puberty.

·         Cystectomy is done to remove the cyst

·         Pre-operative care:

• Give clear explanation of what is to done to the patient so that she understands
• Laboratory investigations of blood  for Hgb ,are done to ensure fitness of the patient for the operation
• Patient signs a consent form after she has understood and accepted to have the operation
• Patient fasts  6-8 hours before the operation
• Label the patient properly (name ward from, operation and site
• Check and record vital signs the morning before the patient is sent to theatre
• Escort the patient to theatre and hand her to the theatre nurse

·         Post operative care

• Receive the patient and make sure she is safe
• Check and record the vital signs
• Observe the wound and note its safety
• Administer prescribed medications like strong analgesics  to reduce pain

 Complications of Ovarian Cyst

·         May turn to be a malignant tumor

·         Infertility

·         Tubal obstruction from tumor extension.