1.    A cyst that is being monitored does not get smaller or go away after a few months.

2.    The growth is a tumor (benign or cancerous) and not a cyst.

3.    The growth causes complications, such as severe pain, acute abdominal pain due to ovarian torsion, rupture of the growth, or bleeding from the growth.

If the growth is not cancerous, removing it should resolve all symptoms. An endometrioma, also known as a chocolate cyst, is caused by endometriosis and the condition cannot be resolved simply by removing the cyst. Recurrence is possible in this case.

If the growth is cancerous (early stage), a cystectomy or oophorectomy may be done in conjunction with other cancer treatments, such as chemotherapy.

1. There are two main types of surgery to remove ovarian cysts or tumors:
2. Open ovarian cystectomy (the removal of ovarian cysts) or oophorectomy (the removal of the ovaries) are done under general anesthesia and involve an incision in the abdomen, similar to that done for a Cesarean section. If possible, the doctor will leave the ovaries intact. The doctor will discuss the details of the surgery with you in advance.
3. Laparoscopic ovarian cystectomy is a minimally invasive procedure where small incisions are made in the abdomen to insert a small camera and surgical instruments to record images that are then displayed on a monitor. If the cyst is large or there are multiple cysts or if the cyst has ruptured or if there are complications, such as a suspected malignancy, an open procedure may need to be performed.

Once you and your doctor have decided that surgery is the appropriate choice for you, the procedure will be scheduled. Before the day of the surgery, you will receive instructions regarding preparing for surgery as follows:

1. Arrive at the hospital at least four hours before the procedure.
2. Avoid food and water for at least eight hours before the procedure or as recommended by the doctor to prevent aspiration while under general anesthesia. Be sure to get enough sleep the night before the procedure.
3. Do not wear any make-up or paint your nails before coming to the hospital. This allows the medical staff to better assess your circulation visually during and after the surgery.
4. Do not bring any jewelry or valuables to the hospital to prevent any loss. Removable dentures and contact lenses have to be removed before entering the operating room.
5. The doctor will assess your readiness for the surgery by ordering blood tests as well as chest x-ray and electrocardiogram (EKG) before the day of the procedure.
6. The doctor will give you recommendations regarding medication that you are currently taking. Some may need to be stopped for a period before surgery, such as blood-thinning medication, aspirin, and certain supplements that can cause excessive bleeding. The doctor will determine which medication to discontinue and which you can still take up until the time of surgery, usually with a small sip of water.
7. Avoid smoking for at least one week before the procedure.
8. A friend or family member should stay with you while you are admitted at the hospital.

1. The patient will receive intravenous nutrition until they are able to eat on their own. When the bowels begin moving, the doctor will allow the patient to sip some water. Then they will move on to a liquid diet and then a soft diet. Patients can usually eat normally one day after the procedure.
2. The doctor will leave a urinary catheter in.
3. In case of a laparoscopic procedure, after the procedure the patient may experience some shoulder and chest pain as well as abdominal discomfort and bloating. This is due to the carbon dioxide that is introduced into the abdomen to allow the doctor to better visualize the organs. These symptoms will go away on their own. If they persist, please let the doctor know.
4. If you experience any pain or nausea after the procedure, please let a nurse know so they can give you medication to alleviate your discomfort.

1. Excessive bleeding during or after the procedure.
2. ​Infection of the incision, the bladder, or the blood.
3. Bladder or bowel injury.
4. Reaction to anesthesia.
5. Blood clots.
6. Scarring.

1. Avoid driving for at least one month after the procedure in an open surgery and at least two weeks for a minimally invasive procedure.
2. ​Avoid traveling by plane for at least one to two weeks after the surgery, but please talk to your doctor before making any travel arrangements.

1. Keep all scheduled doctor appointments and see your doctor before your appointment if you notice any signs of infection at your incisions, such as swelling, redness, warmth to the touch, bleeding, etc., or if you have a fever.
2. Resume activities slowly. Avoid lifting heavy objects for four to six weeks.
3. You may return to work after six to eight weeks.
4. Avoid douching and sexual intercourse for at least six weeks after the procedure.
5. If you are constipated, eat fruit, vegetables, and drink plenty of juice. Take laxatives as prescribed by the doctor.

1. See your doctor as soon as possible if you experience any of the following:
2. High fever.
3. Swelling, redness, and/or bleeding at the incision.
4. Severe pain that is not managed by medication.
5. Vaginal bleeding.
6. Nausea and/or vomiting.

Both procedures have high success rates at 90 to 95%, depending on the patient’s health and medical condition.
 
What if the procedure is not performed?
       The growth will get larger and, if cancerous, can metastasize to other parts of the body.
 
Alternatives

1. If the cyst is small, between five to seven centimeters or less, the doctor may simply wait and see if the cyst shrinks or disappears on its own. This can take between two weeks to three months. The doctor may prescribe oral contraceptives for a month and then schedule a follow-up appointment to see if there are any changes.
2. If the cyst is larger than five to seven centimeters, the doctor will usually recommend surgery.
3. For menopausal women who have small cysts (smaller than five centimeters), a blood test for cancer markers (CA 125) is recommended. If the results are normal, surgery may not be necessary, and the cyst will simply be monitored.

 
Important Information

1. Symptoms that may indicate a cancerous growth include loss of appetite, weight loss, a fast-growing tumor, a fast-growing abdomen, and signs of metastasis, such as back pain.
2. If a physical examination and ultrasound or computerized tomography (CT) scan show fluid in the abdomen/spleen along with cysts in both ovaries, the lymph nodes in the abdomen are often enlarged or growths are found on other nearby organs. Blood tests may reveal high cancer markers.
3. However, the symptoms above are not necessarily confirmation of cancer. Diagnosis will depend on the results of biopsy of the growths.
4. Complications of ovarian growths include ovarian torsion, which is commonly found when the growth is larger than six centimeters, bleeding, rupture, and infection. These complications cause severe and acute abdominal pain, possibly with fever. If you experience these symptoms, see your doctor immediately.