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Ovarian cyst or ovarian cancer? An oncologist helps to demystify

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Written by Dr. Lilian Gien

Q: My doctor says I have an ovarian cyst and referred me to a gynecologic oncologist. Why an oncologist? Does this mean it’s cancer?

A: Cysts are fluid-filled sacs that can grow undetected on the ovaries. Many women have cysts on their ovaries that they cannot feel, and that come and go with their menstrual cycle. Usually you can’t feel a cyst unless the ovary twists or the cyst ruptures, or grows big enough that you can feel it.

The cyst or mass on your ovary may have been detected through ultrasound. Your care team will examine that ultrasound to look for clues if the cyst is likely benign – non-cancerous – or if it has characteristics suspicious for cancer. Clues that tell us if it is a benign cyst are: it is simple-looking and fluid-filled, no solid growths, and it has no extra blood flow to it.

Clues that make us more suspicious of this mass would be that it appears more complex in the ultrasound image, there are areas that have solid appearance and there is increased blood supply flowing to it.

If the cyst looks benign, a gynecologist may advise you to watch your cyst through a series of ultrasound tests over a few months. Or, they may suggest the cyst be removed in a surgery. A general gynecologist can remove a cyst. If there are clues that this mass could be cancer, you will be referred to a cancer surgeon (a gynecologic oncologist) for further examination and consultation. The cancer surgeon can remove the mass, and if it is determined to be cancer, can also remove lymph nodes to see if the cancer has spread. If there is cancer in other areas that are found during surgery, it will be removed.

Getting referred to a gynecologic oncologist doesn’t mean you have ovarian cancer. It means your care team saw something suspicious and wants to provide you the best care with an opinion from someone who can suggest the best plan of action. If it is determined that the cyst is likely benign, it may be suggested that you return to your general gynecologist for observation or removal.

In the meantime, you could ask your doctor: “What features do you see on my image that has made you decide to refer me to a gynecological oncologist?”

Ovarian cancer is a rare but tricky cancer. Symptoms are very non-specific, even when it is advanced and already spread — bloating, abdominal pain, feeling really full after eating, weight loss. Often, there are no symptoms. In these instances, imaging tests can determine if the cancer has spread and where. If you have any of the above symptoms, talk to your family doctor.

One helpful thing you can do is know your family history. Have women in your immediate family had breast or ovarian cancer? About 15 to 20 per cent of women diagnosed with ovarian cancer have the BRCA gene. If a woman has the BRCA gene, other family members may also have this gene, which increases the risk of developing breast or ovarian cancer. Talk to your family, and to your family doctor about your history.

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Dr. Lilian Gien