How to distinguish between benign and malignant ovarian cysts?

The distinction between benign and malignant ovarian cysts is mainly based on imaging features, tumor marker detection, and pathological examination. Clinical judgment should be comprehensively combined with the patient's age, symptoms, and growth rate.

1. Imaging examination

Ultrasound examination is the preferred method. Benign cysts are often characterized by a single chamber, thin wall, no papillary protrusions, and uniform internal echoes; Malignant cysts are commonly characterized by multilocular, thick walled, solid components or blood flow signals. CT or MRI can further evaluate the relationship between tumors and surrounding tissues, and malignant cases may have peritoneal implantation or lymph node metastasis. Dynamic observation of growth rate can also help distinguish between benign cysts that grow slowly and malignant ones that may significantly enlarge within 1-3 months.

2. Tumor marker

CA125 is a commonly used indicator. If it exceeds 35U/ml, one should be alert to the possibility of malignancy, but it may also be elevated in benign diseases such as endometriosis. The combination of HE4 and ROMA index can improve specificity, and AFP and hCG have implications for germ cell tumors. When CA125 levels increase in postmenopausal women, the probability of malignancy significantly increases, and it needs to be comprehensively judged in conjunction with other indicators.

3. Clinical Symptoms

Most benign cysts are asymptomatic or only have a feeling of bloating in the lower abdomen, while malignant cases may present with systemic symptoms such as ascites, weight loss, and decreased appetite. Acute abdominal pain may indicate cyst rupture or torsion of the pedicle, but it is not a malignant specific manifestation. Endocrine symptoms such as abnormal uterine bleeding may be associated with functional cysts or hormone secreting tumors.

4. Pathological features

Pathological examination after surgical resection is the gold standard, with regular arrangement of benign cyst cells and rare nuclear fission; Malignant individuals exhibit obvious cellular atypia, with pathological nuclear division visible. Borderline tumors are between the two and require multiple sampling points to exclude invasive lesions. Frozen sections can quickly provide preliminary diagnosis during surgery.

5. High risk factors

People with a family history of ovarian cancer or BRCA gene mutations have an increased risk, and infertility and late menopause are potential risk factors. Long term ovulation abnormalities may increase the probability of epithelial tumors, while oral contraceptives have a protective effect. Adolescent patients are more likely to have germ cell tumors, and new cysts after menopause require extra caution.

It is recommended to undergo regular gynecological examinations, especially for those with high-risk factors who should have ultrasound re examinations every 6-12 months. If sudden abdominal pain or cyst diameter exceeds 5 centimeters, seek medical attention promptly and avoid vigorous exercise to prevent torsion of the pedicle. Maintain a balanced diet, control weight within normal range, and reduce intake of high-fat foods. Moderate exercise can help improve pelvic blood circulation, but abdominal compression movements should be avoided. Psychological counseling is important for alleviating examination anxiety, and emotions can be regulated through mindfulness training and other methods.