Cysts

Although all cysts are similar in structure, they can form anywhere in the body and under any circumstance. As such, every cyst merits medical examination, because some are completely benign while others can be potentially life-threatening. And just as cysts can produce a range of outcomes, they can produce a range of symptoms. In this regard, some are asymptomatic and may not even be noticed, while others can induce intense pain and interfere with organ function. In short, even if a growth appears harmless, it is still wise to seek advice from a primary care physician.

What is a cyst?

Cysts are simple in structure and can be thought of as akin to a bubble. Each one consists of a cell sac, filled with fluid, gas or semi-solid matter (if there is pus present inside the cyst, it is usually referred to as an abscess). Cysts can develop to any shape or size, from microscopic to large enough to push aside internal organs. The only consistent feature from cyst to cyst is that they involve an abnormal amalgamation of cellular material, so at the cellular level, they do not resemble their surroundings.

There are numerous risk factors associated with cyst development. Genetic factors are implicated in most cyst formations, at least to an extent. However, cysts often develop in response to injury, infection or any other disruption to the body’s tissues. Because there are so many factors involved, it is difficult to forecast who will suffer from cysts.

Cysts can develop in almost all of the body’s tissues, so there are hundreds of classifications. Some of the most common (and concerning) types of cysts include:

1. Sebaceous cyst – Sebaceous cysts are readily apparent with nothing more than a simple visual examination. They form near hair follicles and are filled with sebum, which is the oil produced by glands under the skin. Given their proximity to hair follicles, they are usually found on the face, back or neck, and they can be of any size. Sebaceous cysts are rarely more than a nuisance, though if they enlarge enough, they can become tender and a cosmetic frustration.

However, true sebaceous cysts are rare. Other cysts that are near the epidermis, like epidermoid and pilar cysts, are much more common and often referred to as sebaceous cysts. Neither epidermoid nor pilar cysts contain sebum, though.

2. Breast cyst – Where sebaceous cysts are rarely a cause for worry, breast cysts should be examined as soon as possible. The large majority of breast cysts are benign and the result of hormonal changes in women as they pass through their 30s and 40s. However, breast cysts can also be precancerous or cancerous, and early detection is critical here.

Most patients describe breast cysts as feeling like a water balloon and possessing distinct edges, which make them easier to image. While they don’t often produce symptoms, breast cysts can be painful. If they are, treatment is normally indicated. Determining whether the cyst is benign or potentially cancerous is done with imaging (ultrasound or mammogram) or with aspiration.

3. Ovarian cysts – There are many varieties of ovarian cysts and, again, while most are benign, some are capable of becoming cancerous or producing severe symptoms. Most ovarian cysts are actually the products of normal ovulation, and many women of childbearing age develop tiny cysts every month as a part of this cycle. In postmenopausal women, the prevalence rate of ovarian cysts is around 16 percent.

The vast majority of cysts will develop and pass without the patient even noticing. Symptoms to pay attention to, though, include abdominal pain (particularly during intercourse), uterine bleeding (irregular periods or abnormal spotting), bloating or pressure in the abdomen, more frequent or painful urination, fatigue, headaches, nausea, vomiting and weight gain.

If these symptoms do not resolve after a short period of time, or if they are severe enough to cause distress, imaging diagnosis will likely be necessary. This can be done using ultrasound, MRI or CT scanning, and imaging is usually paired with endocrinological testing.

4. Chalazia – A chalazion is similar to a stye in appearance and often follows one. Both affect the eyelid and cause noticeable inflammation. However, while a stye is typically painful and tender, a chalazion is normally not painful. They can progress to a much larger size, though.

Chalazia are benign but treatment should be responsive. Because they are in close proximity to the eye, chalazia can pose a threat to the patient’s vision if swelling is unchecked. It’s even possible for a chalazion to result in astigmatism, due to increased pressure on the cornea. Symptoms to look for, in addition to noticeable swelling, include eyelid heaviness, increased tearing and conjunctiva redness.

Treatment beyond warm compress application is only indicated if the chalazion does not settle within a few months or if the swelling is threatening the eye. In this case, steroid injections or surgery may be opted for.

5. Ganglion cyst – Ganglion cysts are benign growths that develop from tendon or joint sheaths located on the wrist. Over months, the cyst may appear to migrate from the back of the wrist to the front, though this is only rarely accompanied by pain or other symptoms. Numbness is the only other noted symptom of any significance, though carpal tunnel syndrome can develop as a complication of a ganglion cyst.

Ganglion cysts have no known cause, though participation in gymnastics appears to be a significant risk factor. This has led researchers to believe that they could develop along weakened areas of the tendon sheath, resulting in fluid pushing out and creating a sac.

Diagnosis is simple, given their location and pliable nature (which is consistent among all ganglion cysts). Treatment is usually only indicated if the cyst is causing pain or numbness, as most will resolve on their own in time.

How do doctors deal with cysts?

Primary care physicians are an important source of advice regarding cysts because every cyst is different. Where they are located, their size, their structure, the patient’s age and family health history, and the cyst’s progression over time will all be considered by the physician. In weighing all these factors, the doctor will determine the best course of treatment. For cysts that are obviously benign, the best course of action is usually treating any symptoms.

If there is cause for concern, the physician may recommend draining the cyst to alleviate symptoms or surgery. A biopsy may be ordered if precancerous or cancerous cysts are suspected.

Cysts come in many forms, most of them not worth much concern. But because a cyst can indicate another health problem, or one that is developing, they should not be ignored. Fortunately, primary care physicians are experts at assessing the nature of a patient’s cyst and what to do following diagnosis.