Several questions about ovarian teratoma and pregnancy

Recently, there have been some concentrated questions about ovarian teratoma, especially about the impact of teratoma on pregnancy, which has caused confusion among many "expectant mothers". Now some representative questions are listed below for your reference. Through the following questions, I hope to solve many patients' doubts. In addition, it is recommended that "expectant mothers" do a good physical examination before pregnancy, especially gynecological examination, which is very important. Be sure to consider conception after a gynecological examination, TCT examination (to rule out cervical lesions), and ultrasound examination (to rule out pelvic masses). This is very critical for a smooth pregnancy.

1. What is ovarian teratoma? How does ovarian teratoma occur?

Ovarian teratoma is a common type of ovarian germ cell tumor. It originates from the germ cells in the ovarian tissue and can be divided into mature (benign) and immature (malignant) teratomas according to their degree of differentiation. Mature teratomas are the most common and account for the vast majority of ovarian teratomas. The main feature is that the tumor contains a variety of components, such as hair, skin, oil, bones, teeth, brain tissue, etc.; while the internal structure of malignant teratomas is unclear.

After the operation, the patient's family can see hair, teeth, bones and soy milk-like substances in a pile of tissues. These are typical manifestations of teratoma. In fact, it is a skin sac growing on the ovary, which is a mass formed by these components.

The cause of ovarian teratoma is still unclear, but it is now believed to be related to abnormal differentiation of germ cells.

2. Is surgery necessary after an ovarian teratoma is discovered? Will not having surgery affect pregnancy? Can it be treated with medication?

Whether surgery is needed after the discovery of ovarian teratoma depends on the specific situation. Generally speaking, the most important means of preoperative differential diagnosis of gynecological tumors are ultrasound examination and tumor marker examination. Teratomas are more likely to be mixed masses, and the disease that needs to be differentiated most from mixed masses is pelvic malignant tumors. If the size of the mass does not exceed 3 cm, the boundaries are relatively clear, the ultrasound shows typical teratoma manifestations such as the "dough sign", and the tumor marker results are within the normal range, and there is a plan to get pregnant in the short term, then it can be temporarily not treated under close observation, which generally does not affect conception. Ultrasound examinations should be strengthened during pregnancy. If there is no obvious increase, it can be left for later treatment. If the ultrasound examination results are atypical, or the tumor markers are abnormally elevated, or the mass exceeds 5 cm or larger, it is easy to cause ovarian cyst pedicle torsion and lead to acute abdomen, which requires emergency surgery, and even causes necrosis and requires removal of one side of the appendages. It is strongly recommended to surgically remove the mass before pregnancy, and it can also clarify the diagnosis. Drug treatment of teratoma is ineffective.

3. What effect does pregnancy have on teratoma? Will it grow or shrink?

Pregnancy generally does not have much effect on the growth of teratoma. However, due to the uneven density of teratoma, it is easy for the pedicle to twist due to activity, which is one of the common acute abdominal diseases in gynecology. Excessive or prolonged twisting can easily lead to necrosis of the appendages and require surgical removal, especially in the early stages of pregnancy, which can easily lead to miscarriage. After pregnancy, due to the enlargement of the uterus in the pelvic cavity, the tumor is squeezed out, or the pelvic cavity is suddenly empty after delivery, which can easily induce torsion. Therefore, pre-pregnancy treatment is recommended for larger teratomas. In addition, abdominal pressure during pregnancy may also cause teratoma rupture, causing abdominal pain and other symptoms, which makes diagnosis and treatment difficult.

4. How should I deal with ovarian teratoma found during pregnancy? Can I have surgery? Does anesthesia have any effect on the fetus?

Some patients do not have a careful examination before pregnancy, and they find that they have an adnexal mass after they become pregnant. At this time, they need to be treated with extra caution. Generally speaking, for patients in early pregnancy, if the mass is relatively large (more than 5 cm), or it is impossible to determine whether it is benign or malignant, surgery is recommended. You can choose to have the surgery after 3 months of pregnancy. The chance of miscarriage at this time is relatively small. Generally speaking, the cyst can be removed minimally invasively through laparoscopic surgery. It is recommended that the surgery be performed before 18 to 20 weeks, when the uterus is not too large to affect the surgical field of view. Whether the surgery uses general anesthesia or combined spinal-epidural anesthesia (a type of local block anesthesia), it is safe for the fetus.

5. Can the ovarian teratoma be removed during delivery? Are there any risks in doing so?

Of course, if the lump is not discovered until the late pregnancy, or is considered to be a benign lump in the early stage, close observation until the late pregnancy can also be performed at the same time as cesarean section. The risk is that the pedicle may twist or rupture during the observation process, causing abdominal pain and requiring surgery; a very small number of patients may delay treatment because the tumor is malignant.

6. For patients who want to get pregnant in the future, will the surgery have any impact on pregnancy? How long after surgery can I get pregnant?

Nowadays, ovarian teratoma surgery is mostly performed by laparoscopic minimally invasive surgery. The surgery only removes the tumor and preserves the normal ovarian tissue as much as possible. This can minimize the impact of the surgery on pregnancy. Generally speaking, it will not have much impact on conception. After the surgery, you can consider pregnancy after resting for 2 to 3 months.

7. Do I need to take medication after surgery?

No medication is required after ovarian teratoma surgery. Regular check-ups are sufficient, usually an ultrasound examination every 3 to 6 months.