Initial Treatment for Ovarian Cystadenoma

Diagnostic Evaluation

The American College of Radiology recommends initial evaluation of suspected ovarian cystadenoma using transvaginal and/or transabdominal ultrasound to characterize the mass 1
Additional imaging with MRI may be performed if ultrasound findings are indeterminate, as suggested by the American College of Radiology 1, 2
Serum CA-125 and other tumor markers should be measured to help differentiate between benign and malignant processes, according to the American College of Radiology 3
A comprehensive assessment of the entire abdomen should be performed to rule out metastatic disease, as recommended by the British Journal of Cancer 4

The British Journal of Cancer suggests that cystectomy (ovarian-sparing surgery) is preferred for young patients desiring future fertility, and is appropriate for unilateral, benign-appearing masses 4, 5, 6
Unilateral salpingo-oophorectomy is indicated when cystectomy is not feasible due to size or involvement of the entire ovary, and may be necessary if recurrence occurs after cystectomy, as stated by the British Journal of Cancer 4
Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) is the standard treatment for post-menopausal women or those not desiring future fertility, according to the British Journal of Cancer and Praxis Medical Insights 4, 6, 7

Fertility preservation should be prioritized when possible for young patients, and cystectomy is preferred over oophorectomy when technically feasible, as recommended by the British Journal of Cancer 4, 6
For postmenopausal women, TAH-BSO is the standard treatment for women not desiring fertility preservation, as stated by the British Journal of Cancer 4, 6
For suspected malignancy, complete surgical staging should be performed, including collection of ascitic fluid or peritoneal lavage for cytology, exploration of the entire abdominal cavity, infracolic omentectomy and appendectomy, assessment of pelvic and para-aortic lymph nodes, and peritoneal biopsies, as recommended by the British Journal of Cancer and Praxis Medical Insights 4, 6, 7

Incomplete staging may lead to missed malignancy, as approximately 30% of patients are upstaged after complete surgical staging, according to the Journal of the National Comprehensive Cancer Network 9
Mucinous cystadenomas can be very large and fill the entire abdominal-pelvic cavity, as noted by the Journal of the National Comprehensive Cancer Network 8