Should Teratomas Be Removed? Insights on Ovarian Tumors

Should a teratoma be excised?

Hello Doctor: Last year, in May and June, I was diagnosed with a 3 cm teratoma on my left ovary, which has been monitored for over a year without any growth.
Recently, I had an examination and it seems that a 2 cm tumor has developed on my right ovary.
The clinic doctor mentioned that it can be removed, but a certain general hospital only detected the one on the left.
I occasionally experience mild pain on both sides, but I'm not sure if it's related to the tumors.
Should I consider having them removed? Thank you.

Kelly, 10~19 year old female. Ask Date: 2019/07/03

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you are still very young.
There is a 3 cm teratoma on your left ovary, which has been monitored for about a year and has not grown.
My recommendation is to continue with observation.
You may experience occasional mild pain on both sides, which may not necessarily be related to the tumor, so continued observation is sufficient.
Wishing you good health.

Reply Date: 2019/07/03

More Info

When it comes to teratomas, particularly ovarian teratomas, the decision to remove them often hinges on several factors, including their size, symptoms, and potential for complications. Teratomas are a type of germ cell tumor that can contain various types of tissues, such as hair, muscle, and even teeth. They can be classified as mature (benign) or immature (malignant), with mature teratomas being more common and generally less concerning.

In your case, you mentioned that you have been monitoring a 3 cm teratoma on your left ovary for over a year without significant growth, and a new 2 cm mass has been detected on your right ovary. The fact that the left teratoma has remained stable in size is a positive sign, as many benign teratomas do not require immediate surgical intervention if they are asymptomatic and not growing. However, the presence of pain, even if it is intermittent, raises some concerns.

Here are some considerations regarding the removal of teratomas:
1. Size and Symptoms: Generally, teratomas larger than 5 cm are more likely to be symptomatic and may pose a risk for complications such as torsion (twisting of the ovary), rupture, or malignancy. Since your left teratoma is 3 cm and the right is 2 cm, they are still relatively small, but the pain you are experiencing could indicate that they are causing some irritation or pressure.

2. Potential for Complications: As mentioned, teratomas can lead to complications like torsion, which can cause severe pain and may require emergency surgery. If there is a risk of torsion or if the teratomas are causing significant discomfort, surgical removal may be warranted.

3. Surgical Options: If surgery is recommended, the typical approach is laparoscopic surgery, which is minimally invasive and allows for quicker recovery. During the procedure, the surgeon can assess the teratomas and determine whether they are benign or malignant. If they are benign, the surgeon may opt to remove only the tumor while preserving the healthy ovarian tissue, which is especially important if you are considering future pregnancies.

4. Monitoring vs. Surgery: If the teratomas are stable and not causing significant symptoms, some doctors may recommend a watchful waiting approach with regular follow-up ultrasounds. However, if there is any uncertainty regarding their nature or if they start to grow, surgical intervention may be the best course of action.

5. Impact on Fertility: If surgery is necessary, preserving ovarian tissue is crucial for maintaining fertility. Most women can still conceive with one healthy ovary, so if the teratomas are removed while leaving the healthy ovarian tissue intact, your chances of future pregnancies remain good.

In conclusion, while the decision to remove teratomas should be made in consultation with your healthcare provider, considering factors such as size, symptoms, and potential complications is essential. If you are experiencing pain and there is uncertainty regarding the nature of the masses, surgical evaluation may be the best option to ensure your health and peace of mind. Always discuss your concerns and options thoroughly with your gynecologist or a specialist in reproductive health to make an informed decision that aligns with your future family planning goals.

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