Ovarian cysts are relatively common, affecting about 10% of women in their lifetimes. In most cases, these cysts are classified as simple, aren’t cancerous, and don’t cause symptoms, so treatment isn’t always required.
In some situations, however, patients may experience complex ovarian cysts, a less common type of cyst that may raise cancer risk.
This article covers the basics on complex ovarian cysts, including:
- What is a complex ovarian cyst?
- Symptoms
- Ovarian cyst testing
- What percentage of complex ovarian cysts are cancer?
- Complex ovarian cyst treatment
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at (877) 524-4673.
What Is a Complex Ovarian Cyst?
Ovarian cysts are small sacs that form on the surface of an ovary, or inside of the ovary itself. Most of the time, these cysts are filled with fluid, and they come and go on their own as a woman’s hormones shift, such as during menopause. These are called simple ovarian cysts. But when a cyst isn’t simply filled with clear fluid, it may be classified as a complex ovarian cyst.
“The majority of ovarian cysts are simple,” says Joshua G. Cohen, M.D., medical director of the Gynecologic Cancer Program at City of Hope® Orange County Lennar Foundation Cancer Center in Irvine, CA. “These simple cysts are almost like a tiny water balloon in the ovary. About 80% of ovarian cysts that we see in pre-menopausal patients come and go, and we never know that they're there.”
Complex ovarian cysts, however, typically have different features, such as:
- Septations: Walls inside the ovarian cyst that divide it into multiple components
- Solid matter: Solid nodules, or calcifications, are seen within the cyst
“These types of complexity can sometimes indicate there’s something more there than a cyst related to someone’s menstrual cycle,” Dr. Cohen says. “Many times, features of a complex ovarian cyst, such as small solid nodules, are just benign processes that are not worrisome. But they sometimes require removal or may indicate something more, such as a cell that may have transformed into malignant or cancerous process. So we always like to take a deeper look at complex cysts.”
Ovarian Cyst Symptoms
Most people don’t have symptoms of ovarian cysts. These cysts are sometimes discovered on routine imaging, such as ultrasound or magnetic resonance imaging (MRI) tests. If symptoms do occur, they may include:
- Abdominal pain
- Menstrual changes, such as spotting, heavy bleeding, or irregular cycles
- Bloating
- Constipation
- Urinary changes, such as pain when urinating
Ovarian Cyst Testing
If a patient has a complex ovarian cyst, the care team will perform a variety of tests to evaluate her risk level, Dr. Cohen says. For instance, the doctor will perform a physical exam and ask the patient about symptoms, as well as her family history. The care team may also order lab tests, such as:
CA-125 Test: This test evaluates whether a protein called CA-125 is elevated, which can be due to many reasons, including benign and cancerous conditions. An abnormal CA-125 result doesn’t always indicate ovarian cancer, but may prompt the care team to perform further testing.
CEA Test: This test looks for inflammatory markers in the blood, which can go up and down for a variety of reasons, including inflammation, infection, autoimmune conditions and potentially some cancers.
CA 19-9 Test: The cancer antigen 19-9 test may show elevated levels of this tumor marker in patients with a variety of benign and malignant conditions, such as pancreatitis or ovarian cancer.
Alpha-Fetoprotein (AFP) Test: This test looks for the AFP protein in the patient’s blood, which may be elevated in patients with certain cancers, including liver cancer and germ cell tumors.
Lactate Dehydrogenase (LDH) Test: This test evaluates whether the patient’s body is releasing higher levels of LDH in the blood, which could indicate damage to tissue in the body from a wide range of conditions.
HCG Test: This test measures the levels of human chorionic gonadotropin in the blood, which is elevated in pregnant patients and may also increase with other conditions, such as ovarian cancer or gestational trophoblastic disease.
“These blood tests each look for different factors, and we order them depending on our level of concern, meaning how much we’re concerned based on the imaging, whether a cyst looks complex and where the patient is in her menstrual life cycle (if she's pre-menopausal or post-menopausal,” Dr. Cohen says. “In addition to the blood tests, the patient’s age, her family history and other medical issues, we also take into consideration how the patient is feeling,” he adds.
What Percentage of Complex Ovarian Cysts Are Cancerous?
According to a 2018 study, having a complex ovarian cyst increased the risk of ovarian cancer eight-fold. That same study estimated that 6.5% of women with complex ovarian cysts who were 50 or older would have ovarian cancer within three years. This is compared to the overall risk of developing ovarian cancer, which is 1.1% in the general population. However, because complex ovarian cysts are relatively uncommon, larger studies are needed to confirm whether these risk levels are accurate.
“I advise all patients to know their family history, because not everyone is tested to evaluate their genetic predispositions to cancer,” Dr. Cohen said. “For example, if someone tells me their grandmother had breast cancer and their dad had pancreatic cancer, that tells me there could be a familial component to this.”
In those cases, Dr. Cohen says, he might order different blood tests or recommend that the patient meet with a genetic counselor to get a clearer view of her potential cancer risk level.
Complex Ovarian Cyst Treatment
Not all complex ovarian cysts require treatment. In some cases, the care team may monitor the cyst over time using imaging and blood testing. If the cyst is causing symptoms or the patient has significant risk factors for developing cancer, the care team may choose to perform minimally invasive surgery to remove the cysts from the patient’s ovary.
Because there’s no one-size-fits-all treatment protocol for complex ovarian cysts, it’s extremely important not only to know your family history, but to advocate for yourself, Dr. Cohen says.
“You should meet with your ob-gyn doctor and ask as many questions as you have,” he advises. “If you have concerns, talk to your primary care doctor. It's OK to say, ‘I'd like to know why you're not ordering certain tests, or why you are ordering certain tests.’”
“Patients should always feel comfortable advocating for themselves,” Dr. Cohen says. “If you're not getting answers to your questions after repeated attempts, that tells me that you probably need to move on and get a second opinion.”
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at (877) 524-4673.