KAILUA KONA, HAWAII — The proliferation of CT scans by internists and other physicians has brought an increasing number of incidental findings of postmenopausal ovarian cysts, Dr. William J. Hoskins said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.
Before the widespread use of CT scans and ultrasonography, “we thought that postmenopausal women didn't get ovarian cysts, and if they did, they were bad” cysts. “Now we know that finding a simple ovarian cyst in a postmenopausal patient is a relatively common thing,” he said.
Clinicians also have learned that it's okay to follow simple ovarian cysts less than 6 cm in diameter in postmenopausal women because if the cyst stays stable or decreases in size, the chances of its being a malignancy are extraordinarily small, said Dr. Hoskins, professor of obstetrics and gynecology at Mercer University, Savannah, Ga. No one really knows how long to follow a small cyst, but most experts suggest 1 year, he added.
Check it after 6 weeks, and again at 3 months, 6 months, and 1 year. If it grows or changes from a simple to a complex cyst, conventional wisdom—based on relatively good data—suggests that the patient needs surgery, Dr. Hoskins said.
The “vast majority” of simple postmenopausal cysts on the ovaries will be 2–3 cm in size and will not need any treatment, he said at the meeting, which was sponsored by Boston University.
One study that examined asymptomatic, postmenopausal women every 3 months for 1 year found that 17% had an ovarian cyst on the initial examination and 24% had a cyst sometime during the study, Dr. Dolores H. Pretorius said during a question-and-answer session after Dr. Hoskins' talk.
“Clearly, the ovary is still dynamic and still changes” in postmenopausal women, and small, simple ovarian cysts should not be removed but followed every 3 months for changes.
“If it's getting bigger or if we've had a lot of diastolic flow on Doppler on that cyst, then we worry about it,” said Dr. Pretorius, professor of radiology and director of imaging at the University of California, San Diego.
In premenopausal women, an unsuspected ovarian mass larger than 8 cm calls for cystectomy.
If the mass is found during surgery for other indications, get the consent of the patient's spouse or a relative before cystectomy, Dr. Hoskins said.
An incidental ovarian mass smaller than 8 cm in a premenopausal woman may be managed with observation unless it is suspicious for cancer, he said.
In 2004, an estimated 25,580 women developed ovarian cancer and 16,090 women died of the disease.