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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 of Obstetricians and Gynaecologists (RCOG 2016), and the British Society for Gynaecological Endoscopy (BSGE/RCOG 2011).


1.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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2.Diagnostic investigations

History and physical examination: 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

3.Diagnostic procedures

Cyst fluid aspiration
Consider performing aspiration of an adnexal mass in patients with tubo-ovarian abscess.
Do not perform aspiration of cyst fluid for diagnosis in patients with suspected cancer. Consider performing aspiration of an adnexal mass only for diagnosis of suspected advanced ovarian cancer planned to undergo neoadjuvant therapy.

4.Surgical interventions

Indications for cystectomy: do not perform removal of non-endometriosis ovarian cysts for the sole purpose of increasing fertility.
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5.Specific circumstances

Pregnant patients: consider obtaining imaging monitoring in most pregnant patients with adnexal masses, as these masses appear to have a low risk of malignancy or acute complications.

More topics in this section

  • Postmenopausal patients (diagnostic imaging)

  • 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)

6.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