Cystadenomas: What you need to know about these ovarian cysts

Cystadenomas are ovarian cysts that can sometimes grow to extremely large sizes, and in some cases, also become malignant. This article will examine the nature of ovarian cystadenomas as well as their symptoms and treatment. 

What are cystadenomas?

Cystadenomas are a type of cystic adenoma — meaning a cystic growth or tumor. They can form in various parts of the body, including in the ovaries. Ovarian cystadenomas are themselves benign by definition, but they can become cancerous over time in rare cases. [1] When this happens, they are called cystadenocarcinomas.  In general, epithelial (lining the external portion of organs and vessels) tumors of the ovary represent 65 to 75% of all ovarian tumors, and they may originate from the fallopian tube, endocervix, endometrium (uterine lining), or bladder epithelium.

Ovarian cystadenomas could reach an extremely large size before they are discovered. However, a large size does not necessarily indicate that a cystadenoma has become cancerous. Sometimes, cystadenomas can reach a diameter of 50 cm or more and weigh up to 100 kg. On average, the mucinous tumors measure 15 to 30 cm in diameter. 

Cystadenomas come in two types:

• Cystadenomas can be filled with a transparent, watery fluid, or can be filled with mucus. Fluid-filled cystadenomas are also known as serous cystadenomas. This type of cystadenoma can grow to an extremely large size, and may appear to be solid at first sight. These kinds of cystadenomas are most likely to appear towards the end of a woman's reproductive life or after it, specifically between the ages of 40 and 50. Between 15 and 25 percent of serous cystadenomas are bilateral, meaning they will appear on both ovaries. Twenty to 25 percent will become malignant. [2]
• Mucinous cystadenomas are filled with mucous. These kinds of ovarian cystadenomas are more common in younger women between the ages of 20 and 40. One of the problems with these cystadenomas is that they can grow to very large sizes (up to 30 cm!), in which case they will cause pain and discomfort. Though these cystadenomas only become malignant in five percent of cases, they can rupture and impair ovarian function. Mucinous cystademas are bilateral in five to 10 percent of cases. [1] Mucinous cystadenomas make up 15 to 20% of all epithelial tumors. 

And these tumors are divided into three different categories [1]:

• Benign. These tumors represent 40% of all benign ovarian neoplasia (meaning abnormal new tissue growth), reaching sizes between 15-30 cm in diameter, and they have a 10 year survival rate of 100%, meaning nobody dies as a direct result of these tumors.
• Borderline tumors or tumors with a low malignant potential. They have an extra-ovarian spread (meaning beyond the ovaries) of about 10% and the 10 year survival rate is about 60%.
• Malignant. These cancerous ovarian tumors are more frequent in people under the age of 20 years and over 60 years, representing 90% of all malignant ovarian tumors with a 10 years survival rate of about 30-40%.

Cystadenoma symptoms: How might you know you have an ovarian cyst?

Like other types of ovarian cysts, cystadenomas can be symptomless and may go unnoticed for a long time. Cystadenomas may be picked up during a routine gynecological checkup, an appointment you attend for other reasons such as pregnancy, or after the cystadenoma becomes so large it starts to cause symptoms.

The rupture of a cystadenoma may also lead to symptoms. Problems within the female reproductive system often lead to definitely alarming but non-specific symptoms that indicate there is "a problem". There are, on the other hand, no specific symptoms that will immediately let you and your healthcare providers know that you are dealing with cystadenomas.

• Pelvic pain is one of the main symptoms you can expect if you have an ovarian cystadenoma. The pain can be mild or excruciating, and anything in between.
• You may also notice changes in your menstrual cycle,  changes in the volume of flow of your period, and bleeding in between periods.
• Weight gain and abdominal bloating are possible in the case of large cystadenomas, and some women experience pain during sexual intercourse, bowel movements or strenuous physical exercise. These symptoms are always a reason to see your healthcare provider right away.

Making an appointment with your family doctor is fine, as is heading for the emergency room if you are dealing with heavy symptoms. You could also see your gynecologist.

If further diagnostic tests indicate that you are dealing with cystadenomas, you will need to see a specialist. Diagnostic tests include an ultrasound, X-ray, and laparoscopy. Women who are dealing with pelvic pain at the moment might like to read more about other possible reasons for this. Read more here: What causes ovary pain?

Treating cystadenomas

Cystadenomas do need to be removed, but several procedures are available depending on your personal situation and the condition of the cysts.

The preferable procedure is an ovarian cystectomy, which literally means surgically removing the ovarian cyst. This procedure leaves the rest of your ovary intact. Usually, the procedure is done with the use of laparoscopy, making it minimally-invasive. When that is not possible, a partial oophorectomy might be offered to you. [3]

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In this case, the affected portion of the ovary is surgically removed along with the cystadenoma. A more invasive cyst will require a complete oophorectomy in which the whole ovary is removed along with the cyst. If your cystadenoma is unilateral, this will only affect one ovary and leave the other ovary in good working order, meaning that women of reproductive age will often still be able to get pregnant. In the case of a ruptured or large cystadenoma, or in the case of other complicated like hemorrhage, a salpingo-oophorectomy may be needed. [4]

This procedure removes both the ovary and the fallopian tube located on the same side. Women who have serious complications or are already post-menopause may find their best option is having a hysterectomy (in which the uterus is removed) as well as having their ovaries and fallopian tubes removed. [5] Depending on your condition, your healthcare team will discuss the options with you and offer you a choice between several procedures or simply explain what needs to be done to protect your health.