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When normal cysts become abnormal

Every woman who is menstruating produces an ovarian cyst each month. But they don't normally grow to dimensions that make the newspapers. Dr. John Currie, who removed a 180-pound ovarian cyst from a West Virginia woman last week at Johns Hopkins Hospital, said the cysts form normally in the ovaries as the woman's egg develops inside them, then they rupture and release the egg during ovulation.

Occasionally, though, they continue to grow, pressing into surrounding organs. Sometimes they are cancerous, and finding them early by pelvic examination or sonogram can mean the difference between life and death.

"If a woman suspects she has a cyst, she should go to the first appointment (with a gynecologist) she can get," Currie said. Every woman should have a gynecological examination each year, "including a pelvic exam." Unfortunately, he said, too many women are afraid to go to a gynecologist, even when they suspect something is wrong. "Three out of four women who have ovarian cancer don't have it taken care of until it is well advanced," he said.

Ovarian cancer is "very difficult to cure," Currie said, and the fourth-biggest cause of cancer death in women.

The National Center for Health Statistics estimates that 12,500 women in the United States will die of ovarian cancer this year. About 21,000 new cases will be reported, and only 38 percent of those patients will survive five years after diagnosis.

Normal ovarian cysts can grow as large as two inches before shrinking again and disappearing. If they grow beyond that in menstruating women, Currie said, they may require surgery or drugs to remove or shrink them. Beyond four inches, they should be removed surgically.

In women older than 50 and no longer menstruating, any ovarian cyst bigger than two inches is "worrisome," he said.

Without a pelvic exam, however, a woman may not become aware of an ovarian cyst until it grows to two or three inches and begins to cause pain or discomfort, often during sexual intercourse.