Imaging tests for ovarian cysts - National Business Group on Health

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Imaging tests for ovarian cysts
When you need them—and when you don’t
M
any women have repeated ultrasound
exams to make sure a cyst on their ovary
doesn’t turn into cancer. But most of the
time that’s not necessary. Here’s why.
Follow-up tests usually aren’t helpful for
low-risk cysts.
Most ovarian cysts are small fluid-filled sacs that
form on the ovaries. They generally don’t cause
symptoms, though they are sometimes found
during routine pelvic exams. Women often form
such cysts as part of their menstrual cycle, and
about 20 percent of postmenopausal women also
develop fluid-filled cysts. Described as “simple”
because they contain nothing but fluid, these
common cysts rarely turn out to be cancerous in
a woman of any age. But if your doctor discovers
one, it should be evaluated with a vaginal ultrasound. That’s a test in which a slender instrument is placed in the vagina and sound waves
are used to create pictures. If that test confirms
that the cyst looks benign—meaning it’s unlikely to turn into cancer—a small simple cyst can be
safely ignored as long as it’s not causing symptoms such as pelvic pain.
Follow-up tests can pose risks.
An ultrasound exam doesn’t expose you to radiation and is relatively inexpensive, so repeating it
may seem harmless. But many women become
anxious about being called back a few weeks or
months later to prove again that their cyst isn’t
cancer. And by then, a woman may be in a new
menstrual cycle, so the old cyst may have gone
away on its own and a new cyst has formed,
generating yet another follow-up test and more
worry. Such exams can sometimes even lead to
unnecessary surgery to remove a cyst or ovary.
For instance, some doctors take out cysts that
persist or look bigger on subsequent tests, including cysts that would never become cancer.
The risks of surgery include pain, bleeding, and
infection.
They can be a waste of money.
A vaginal ultrasound can cost from $250 to $580
without health insurance, and an operation to
remove an ovarian cyst can range from $7,000 to
$10,000, according to health.costhelper.com.
So when are follow-up tests warranted?
Additional imaging tests and sometimes even
surgery may be justified for larger simple cysts,
other kinds of cysts, and cysts that aren’t clearly
identified as benign or malignant on the initial
ultrasound. Cysts that are suspicious for cancer
don’t need follow-up imaging but should be
promptly removed, preferably by a gynecologic
oncologist—a surgeon who specializes in treating
ovarian cancer.
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09/2012
Consumer Reports’ Advice
How to manage
ovarian cysts
Although most cysts are harmless, the
following advice can address concerns
you might have about ovarian cancer.
• Get a high-quality vaginal
ultrasound. Radiologists, ob-gyns, and
Registered Diagnostic Medical Sonographers can perform the test. They should
be accredited by the American College of
Radiology or the American Institute of
Ultrasound in Medicine. If the entire cyst
can’t be seen on the vaginal scan, an
abdominal ultrasound should be added.
• Consider birth control pills. They
can prevent new cysts from forming but
don’t make existing cysts go away.
• Report symptoms.
Call a doctor if if you have
sudden, severe lower
abdominal pain, especially
with nausea or vomiting.
That may mean a cyst has
burst or twisted an ovary.
• Have the right
operation. A benign cyst can usually be
removed with laparoscopy, a procedure
that involves two or three very small cuts
in the abdomen. A cyst that might be
cancer requires surgery using a larger cut.
• Know the signs of ovarian cancer.
They include a swollen or bloated
abdomen, pressure or pain in the
abdomen, difficulty eating, or feeling
full quickly. Those symptoms usually
stem from something else, but if they
don’t go away, are frequent, or get worse,
tell a doctor.