HOW DOES THE DOCTOR EXAMINE THE TYPE OF COMPLEX CYST?

[Sarahh123]

I’ve recently found out that I have a 4.5 cm complex cyst and I was tested for CA-125 levels. My levels were normal BUT I am worried because the doctor still isn't clear what type of cyst do I have. His suspicion is between : chocolate, dermoid or hemorrhagic cyst. Does anyone knows if these types could be treated by medications, or removed by surgery?

[asoullessstatic]

So, chocolate cysts are cysts that are normally found deep within the ovary, they basically look like a cyst that is filed with this tar-like fluid that’s kinda the same colour as melted chocolate, hence the name chocolate cysts, these are also known as ovarian endometrioma. These cysts can be asymptomatic and cause someone no problems or they can give you lots of pelvic pain (especially on your period), and pain on intercourse. Generally, a chocolate cyst that is > 1 cm in diameter will need some form of surgical treatment.

A dermoid cyst on the other hand is cystic that contains epidermal cells ( a type of skin cells), some can develop secretory glands too and have a mix of lots of cell types and fluid rather than fluid on their own. Instead of coming from the ovary these cysts for from left over embryonic stem cells that have decide to grow. These cysts are normally very long lived, you can have them for decades sometimes before they become a problem as they grow very slowly. Again if the cyst is causing problems, surgical removal is favoured.

Hemorrhagic cysts are the result of ovulation. Normally, when you create the egg sack you get this little follicle which is filled with fluid and the egg. Sometimes it doesn’t burst properly, or it can develop without an egg in it and swell up, and this fluid is a mix of fluid and blood. It becomes a hemorrhagic cyst if that gets damaged or breaks open and it bleeds. The word hemorrhagic looks terrifying but its not a description of the amount of blood or anything it literally just means to bleed in medical terms, technically a papercut is a haemorrhage too. These cysts unless very large ( bigger than 10 cm) they will generally resolve themselves. The smaller it is the more likely to go away, so doctors may wait and see what it does and try and manage it with pain killers if you are in pain etc.

A complex cyst is just a description of how it appears on the ultra sound, it means the cyst isn’t completely black inside and hence doesn’t just contain fluid, but it doesn’t give you much information about the type of cyst it is. Sometimes it can be really hard to tell just on ultra sound what kind of cyst it is, and they have to do other tests or a small operation to put a camera into your belly to actually look at it directly and see what it is (this is normally a day procedure), so they know exactly what approach to take with it. All 3 cysts can cause very similar symptoms as well which makes it harder, also all 3 cysts are benign (non cancerous), hence the normal CA-125 levels (which is a blood test for cancer) confirm that so I wouldn’t worry too much about it. The type of cyst really just affects what kind of surgical approach they would make, the pain management for all 3 are pretty much identical.

[Sarahh123 in reply to asoullessstatic]

Thanks a lot for your answer. It is all so clear to me now.