When my mother or sister has breast cancer, should I undergo genetic testing? 5/21 Experts have the answer>>

Chocolate cyst is a common gynecological disease, causing dysmenorrhea, chronic lower abdominal pain and infertility. It is a disease that belongs to endometriosis, which is what should have only been Endometrial glands that appear in the uterus grow on tissue or organs where they shouldn't. When the glands grow on the ovaries, the tumors that form are called chocolate cysts.

Why is there chocolate-like sticky substance on the cyst? This is because when a woman menstruates, not only does menstrual blood flow out, but the cysts on the ovaries are also bleeding. However, since there is no pipe to flow out of the body, the menstrual blood can only accumulate in the cysts, so it will form over time. A sticky substance similar to chocolate.

Approximately 5 to 10% of women suffer from endometriosis (adenomyosis, chocolate cysts), so this disease is extremely common.

There are many theories on the causes of chocolate cysts, but currently the most accepted one is reflux of menstruation. The problem is that most women experience reflux of menstrual flow into the pelvic cavity when menstruation comes, but why do only a few women develop chocolate cysts? At present, scientists believe that it may be related to the immune function of the pelvic cavity. Studies have found that women with chocolate cysts have functional defects in their pelvic immune cells.

The second reason may be related to metaplasia of cells in the pelvic cavity, that is, the original normal cell type is converted into endometrial gland cells, leading to endometriosis. .

Symptoms and surgical treatment of chocolate cyst

Chocolate cyst is a benign tumor of the ovary, with a low chance of becoming malignant (less than 1%). The main symptoms include dysmenorrhea, infertility, chronic lower abdominal pain (due to adhesion in the pelvic cavity), and acute abdominal pain (due to the sudden rupture of a cyst). Once a woman enters menopause, the threat of this disease is greatly reduced, so the treatment method is also related to the age of the patient.

As long as women have dysmenorrhea or chronic lower abdominal pain, they should seek treatment from a professional obstetrician and gynecologist. How to treat chocolate cysts must be determined according to the patient's condition:

1. Dysmenorrhea: If the patient has dysmenorrhea as the main symptom, when the chocolate cyst is not large (less than 3 cm) , you can consider drug treatment, giving oral analgesics. Once the analgesic effect is not good, consider giving menstrual drugs or oral contraceptives to increase the analgesic effect.

However, if the chocolate cyst is large (more than 5 cm), laparoscopic surgery is recommended to remove the tumor lining of the chocolate cyst from the ovary. This approach will not damage the normal ovary, and is suitable for those who want to preserve it. For women with childbearing or ovarian function, general surgeons will adopt this method.

2. Infertility: There are many examinations for infertility, and laparoscopy is only one of them. Since chocolate cyst is a chronic inflammatory disease, in addition to tumors on the ovaries, it often affects the fallopian tubes, causing adhesion and obstruction of the fallopian tubes.

Therefore, if a woman is infertile due to endometriosis, she should discuss with her obstetrician and gynecologist whether the chocolate cyst should be treated first to increase the chance of pregnancy.

3. Chronic lower abdominal pain: The main reason is that the chocolate cyst has been there for a long time, causing chronic inflammation, which causes multiple adhesions in the pelvic cavity, causing chronic pelvic pain. Severe pain can even cause pain. Waking up in the middle of the night (I have seen multiple cases).

Laparoscopy is generally recommended to deal with this kind of situation. If the adhesion seen is not serious, it can be treated on the spot. However, if the adhesion in the pelvic cavity is too serious, it must be treated with the patient according to the situation. Discuss whether to perform laparotomy (the approach must be determined based on each patient's condition).

4. Acute lower abdominal pain: Most of the time, the cyst suddenly ruptures, and the tumor contents infiltrate into the abdominal cavity, causing acute inflammation, resulting in acute abdominal pain. In such a situation, surgery can only be performed.

Chocolate cysts are often confused with ovarian cancer

The diagnosis of chocolate cysts before surgery is almost always based on ultrasound, coupled with ca125 examination. About 25 to 40% of patients with chocolate cysts will have elevated ca125.

The trouble is, the ultrasound findings of ovarian cancer are sometimes very similar to those of chocolate cysts, and even the proportion of elevated ca125 levels are similar.

During surgery for ovarian cancer, we do not want the tumor to rupture during the operation, because once it ruptures, the cancer cells will spread to the abdominal cavity; once the cancer cells encounter a good growth environment, they will easily continue to grow. The situation became unmanageable. Since chocolate cyst is a benign disease, even if it ruptures during surgery, as long as it is cleaned, there will generally be no major sequelae.

Proper preoperative evaluation is therefore very important. To avoid being misdiagnosed as a chocolate cyst, it turns out to be ovarian cancer during surgery. Therefore, if a woman is diagnosed with a chocolate cyst and is recommended for surgery, she should discuss it with the attending physician. The chocolate cyst must be removed carefully during the surgery to avoid rupture and subsequent risks.

Foreign studies have pointed out that if the chocolate cyst exceeds 10 centimeters, the chance of malignancy increases. Patients should discuss the surgical method with the doctor (because the laparoscope is easier to break during surgery, resulting in inclusion material penetrates into the pelvic cavity).

In addition, chocolate cysts have also been found to be more likely to develop into ovarian cancer later. Among the pathological types of ovarian cancer, clear cell subtype and endometrioid cell subtype are most closely related to chocolate cysts. A study just published in the famous "British J Cancer" in 2014 clearly pointed out: Chocolate cysts will indeed increase the chance of ovarian cancer. Therefore, women diagnosed with chocolate cysts should undergo routine ovarian cancer screening after surgery.