Ovarian cysts / Ovarian cancers and pregnancy

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Ovarian cysts/ Ovarian cancers and pregnancy

The most common ovarian cysts of pregnancy are corpus luteum and follicle cysts which are related to ovulation. These are simple ovarian cyst. Almost all of these cysts disappear until 16th-20th weeks of gestation and the risk of malignity is very low in simple cysts smaller than 6 cm.

Further investigation may be required for persisting cystic masses that wouldn’t shrink. Measurement of CA-125 (tumor indicator) in blood is not advised by many because of the variable CA-125 levels in pregnancy and the fact that it may increase in multiple benign diseases. Large, persistent masses that are not thought to be cancerous may be followed and operated after childbirth.

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There is a risk of pain, rupture, infection and abscess development as a result of ovarian cysts spinning on its own axis. Operation is required in cases in which the cysts cause pain or other complications or detection of growth during follow-up, operation may be preferred during pregnancy, preferably in the second trimester. Apart from emergencies, the risk of miscarriage due to operation and the risk of malignity of the mass must be weighted. In complex and non-cystic ovarian masses, malignity should be primarily considered and because pregnant women are young, germ tumors are common apart from epithelial ovarian tumors. In presence of ovarian cancer, decision on the treatment option is made according to gestation week, tumor type and operation findings.

Among the pregnancy related ovarian masses, hyperstimulation (presence of multiple cystic formations due to induction of the ovaries during IVF treatment), teca luthein cysts (may be related to multiple pregnancy, trophoblastic disease and IVF treatment) and luteoma of the pregnancy may be listed. Laparoscopy is efficient and safe in treatment of symptomatic ovarian cysts.