Table of contents

Ovarian cysts

What's new

Added 2023 SOGC, 2021 ASCO, 2017 ESGO, 2016 RCOG, and 2016 ACOG guidelines for the evaluation and management of ovarian cysts.


Key sources

The following summarized guidelines for the evaluation and management of ovarian cysts are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023,2020), the American Society of Clinical Oncology (ASCO 2021), the American College of Obstetricians and Gynecologists (ACOG 2017,2016), the European Society of Gynaecological Oncology (ESGO 2017), the Royal College ...
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Classification and risk stratification

Risk assessment
As per ACOG 2017 guidelines:
Elicit a detailed personal and family history for breast, gynecologic, and colon cancer to help categorize patients based on their risk (average risk or high risk) of developing epithelial ovarian cancer.
Maintain an appropriate level of suspicion when potentially relevant signs and symptoms of ovarian cancer are present.
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Diagnostic investigations

History and physical examination: as per RCOG 2016 guidelines, elicit a thorough medical history with specific attention to risk factors and symptoms suggestive of ovarian malignancy and a family history of ovarian, bowel, or breast cancer in patients with suspected ovarian cancer.
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More topics in this section

  • Diagnostic imaging

  • Tumor markers

Surgical interventions

Indications for cystectomy: as per SOGC 2023 guidelines, do not perform removal of non-endometriosis ovarian cysts for the sole purpose of increasing fertility.
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Specific circumstances

Postmenopausal patients, diagnostic imaging: as per RCOG 2016 guidelines, obtain transvaginal pelvic ultrasound in the initial evaluation of ovarian cysts in postmenopausal patients.
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More topics in this section

  • Postmenopausal patients (tumor markers)

  • Postmenopausal patients (surveillance imaging)

  • Postmenopausal patients (further evaluation)

  • Postmenopausal patients (setting of care)

  • Postmenopausal patients (surgical management)

  • Postmenopausal patients (cyst fluid aspiration)

Follow-up and surveillance

Indications for referral: as per SOGC 2020 guidelines, refer patients with a personal history of infertility, endometriosis, or cancer, or a family history of cancer, to a gynecologic oncologist for further evaluation, if possible.
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More topics in this section

  • Surveillance imaging