How to distinguish between benign and malignant ovarian cysts?

The differentiation between benign and malignant ovarian cysts is mainly determined by imaging examination, tumor marker detection, and pathological biopsy. Benign cysts usually present with smooth cyst walls and no solid components, while malignant cysts may be accompanied by thickening of the cyst walls, papillary protrusions, or abnormal blood flow signals.

1. Imaging features

Ultrasound examination is the preferred method for distinguishing between benign and malignant. Benign cysts are often solitary, thin-walled, and undivided, such as simple cysts or corpus luteum cysts. Malignant cysts often have multilocular structures, irregular thickening of the cyst wall, accompanied by solid nodules or abundant blood flow signals. CT or MRI can further evaluate the relationship between cysts and surrounding tissues, and malignant cases may show peritoneal implantation or lymph node metastasis.

2. Tumor marker

CA125 is a commonly used marker for ovarian cancer, but it should be noted that endometriosis can also lead to its elevation. The combination of HE4 and CA125 can enhance specificity. The tumor markers of benign cysts are usually normal or mildly elevated. If CA125 exceeds 200U/mL or continues to rise, one should be alert to the possibility of malignancy.

3. Growth rate

Benign cysts grow slowly or remain stable, such as follicular cysts, which usually disappear on their own within 2-3 menstrual cycles. Malignant cysts may rapidly increase in the short term, especially in postmenopausal women. If new cysts exceed 5 centimeters in diameter and persist, close follow-up is necessary.

4. Clinical Symptoms

Most benign cysts are asymptomatic, with occasional lower abdominal pain or menstrual abnormalities. Malignant cysts may be accompanied by systemic symptoms such as bloating, weight loss, and decreased appetite. In the late stage, ascites or intestinal obstruction may occur. However, early ovarian cancer often lacks specific manifestations and is easily overlooked.

5. Pathological biopsy

Pathological examination after surgical resection is the gold standard for diagnosis. Benign cysts can have a single layer of epithelial cells, such as serous cystadenoma. The histological manifestations of malignant cysts include cellular atypia, increased mitotic figures, or interstitial infiltration, such as serous cystadenocarcinoma. Laparoscopic exploration can directly observe the morphology of cysts and take biopsies.

It is recommended to undergo regular gynecological examinations combined with ultrasound monitoring to monitor changes in cysts, and avoid vigorous exercise to prevent cyst torsion and rupture. The diet should be light and the intake of high estrogen foods should be restricted. If there is persistent abdominal pain, abnormal vaginal bleeding, or sudden weight loss, it is necessary to seek medical attention promptly. Postmenopausal women who discover ovarian cysts should undergo active evaluation and surgical intervention if necessary.