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Management of Ovarian Cysts in Postmenopausal Women (GTG 34 - Jul 2016),…

- - - - NOT recommended except for purposes of symptom control in advanced malignancy unfit to undergo surgery or further intervention
      - Diagnostic cytological examination of ovarian cyst fluid has poor sensitivity of 25% in distinguishing between benign and malignant
      - Approximately 25% of cysts will recur within 1 year of aspiration
      - May induce spillage and seeding of cancer cells in peritoneal cavity, affecting stage and prognosis
    - - Suitable for women with RMI <200 (low risk), symptomatic, non-simple features, >5cm, multilocular, bilateral
      - Bilateral salpingo-oophorectomy preferred over cystectomy (due to risk of cyst rupture)
      - Full-staging laparotomy will be required if malignancy evident during the operation or final histology
      - Surgical specimen should be removed intact without intraperitoneal spillage in a laparoscopic retrieval bag via the umbilical port. Associated with less post-operative pain and quicker retrieval time.
      - Avoid extending accessory ports: Reduces post-operative pain, incidence of incisional hernia, ad incidence of epigastric vessel injury
    - - Women at high risk of malignancy (RMI =/>200)
      - If malignancy is revealed during laparoscopy or subsequent histology, a full staging procedure will be required and the woman shoud be referred to a cancer centre
      - Should be performed through a midline incision and include:
        
        Laparotomy
        
        Cytology: Ascites or washings
        
        TAH BSO + omentectomy
        
        Biopsies from suspicious areas
      - Always consider borderline ovarian tumours as a possible diagnosis. Up to 20% appear as simple cysts on ultrasound but majority will have suspicious ultrasound findings.