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Cystadenomas in the ovaries are ovarian cysts filled with watery fluid or mucus. They do not affect the fertility of women in their reproductive years, but do need to be removed.

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 benign by definition, but they can become cancerous in rare cases. [1] When this happens, they are called cystadenocarcinomas.  In general, epithelial tumors of the ovary represent 65-75% of all ovarian tumors - and they may originate from tube, endocervix, endometrium or bladder epithelium.

They could reach extremely large size before they are discovered. However, their size does not necessarily indicate that they are cancerous. Sometimes they 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:

  • They 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 really large and may appear to be solid at first sight. They 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 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 15-20% of all epithelial tumors. 

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

  • benign
    • these tumors represent 40% of all benign ovarian neoplasia, reaching sizes between 15-30 cm in diameter and they have a 10 years survival rate of 100%)
  • borderline tumors or tumors with a low malignant potential
    • they have an extra-ovarian spread of about 10% and the 10 years survival rate is about 60%) 
  • and malignant
    • these tumors are more frequent 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

Like other types of ovarian cyst, cystadenomas can be symptomless and may go unnoticed for a long time. Cystadenomas may be picked up during a routine gynecological checkup, or after they become so large they cause symptoms. The rupture of a cystadenoma may also lead to symptoms. Problems within the female reproductive system often lead to definite alarming symptoms that indicate there is "a problem" there are no 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. It can be mild or excruciating, and anything in between. You may also notice changes in your menstrual cycle and the 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 removing the ovarian cyst. This procedure leaves the rest of your ovary intact. Usually, the procedure is done with laparoscopy. When that is not possible, a partial oophorectomy might be offered to you.[3]

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. 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 the ovary and fallopian tube. Women who have serious complications or are already post-menopause may find their best option is having a hysterectomy 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. 

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