A diagnosis involving an ovarian cyst, particularly one described as “septated,” often causes concern. While this terminology suggests a more complex structure than a simple fluid-filled sac, the vast majority of ovarian cysts, including those with internal divisions, are benign. The presence of internal walls prompts careful evaluation by medical professionals, but it does not automatically indicate a dangerous condition. Understanding the specific nature of a septated cyst helps provide a clear perspective on this common finding.
Defining Septated Ovarian Cysts
An ovarian cyst is a fluid-filled sac or pocket that develops on or within the ovary. Cysts are common and often form as a normal part of the menstrual cycle. A simple cyst has a smooth, thin wall and a single chamber filled with clear fluid (unilocular).
A septated ovarian cyst is a type of complex cyst defined by the presence of one or more internal walls, or septa. These septa are thin membranes that divide the cyst into multiple compartments, creating a multilocular structure. This internal architecture is visible during imaging, typically an ultrasound. While simple cysts are almost universally benign, septations place a cyst into the complex category, necessitating closer examination. These complex structures are often non-cancerous classifications like serous cystadenoma or mucinous cystadenoma.
Evaluating the Potential Risks
The primary concern regarding a septated cyst is the potential for malignancy, although the risk is low for most patients. Septations raise greater concern than simple cysts because internal complexity can sometimes be a feature of cancerous tumors. However, septated cystic tumors without solid areas or papillary projections have a very low risk of malignancy, often less than 1%.
Risk assessment focuses on specific characteristics visible during imaging, beyond just the presence of septations. Features that increase the risk profile include thick septations (greater than 3 millimeters), the presence of solid components, or nodular projections growing inward from the cyst wall. Cysts exhibiting internal blood flow, or vascularity, detected by a Doppler flow study, are also viewed with suspicion.
The majority of septated cysts are benign, falling into categories like persistent functional cysts or benign neoplastic tumors. Non-cancerous causes of septation also include endometriomas, which are associated with endometriosis, or cysts that have bled internally.
Diagnosis, Monitoring, and Treatment Options
Diagnosis and Monitoring
Once a septated cyst is identified, the initial step is a detailed pelvic ultrasound, often using transvaginal access for better resolution. The ultrasound provides information about the cyst’s size, the thickness of the septa, and the presence of solid areas. Color Doppler is frequently used to assess blood flow within the internal structures, which helps differentiate benign from higher-risk lesions.
A blood test for the tumor marker CA-125 is also commonly performed, especially in postmenopausal women or when imaging suggests a complex mass. While CA-125 levels above 35 units/mL can indicate ovarian cancer, they are frequently elevated by benign conditions such as endometriosis, uterine fibroids, or menstruation, limiting its specificity. The ultrasound results, CA-125 level, and the patient’s menopausal status are combined into a risk index to guide management.
Treatment Options
For smaller septated cysts with reassuring features and normal CA-125 levels, the standard approach is expectant management, often called “wait and see.” This involves serial monitoring with follow-up ultrasounds, typically scheduled three to six months apart, to check for spontaneous resolution or stability. Surgical intervention is usually recommended if the cyst is large, causes significant symptoms, or displays high-risk features like papillary projections or thick septa. Surgery may involve a minimally invasive laparoscopy or a traditional laparotomy, aiming to remove the cyst while preserving the ovary when possible.