Understanding Cysts and Cancer Screening: Expert Insights from Dr. An Penam

Cysts are common findings in medical imaging, often causing anxiety and confusion among patients. Whether detected in the breast, ovaries, kidneys, liver, or thyroid, cysts can raise questions about their nature, potential risks, and the need for treatment. To clarify these concerns, we spoke with Dr. An Penam, a leading oncologist in Asia with decades of experience in cancer diagnosis and treatment. Dr. An shares his expert insights on cysts, their management, and important cancer screening guidelines.

What Are Cysts?

Dr. An explains that a cyst is essentially a collection of fluid, often benign and harmless. “Most cysts are non-cancerous,” he says, “and generally, there is nothing to worry about.” However, he emphasizes that the approach to cysts depends on their location and characteristics.

Ovarian Cysts: When to Be Concerned

Among the various types of cysts, ovarian cysts require more careful attention. “Ovarian cysts are very common,” Dr. An notes, “but it is important to differentiate the types.” The key factor is the nature of the cyst wall. A thin-walled cyst is usually benign and does not require intervention. In contrast, a thick-walled cyst raises concern because malignancy can sometimes develop in the cyst wall.

Dr. An advises that ovarian cysts should be monitored regularly, typically every three to six months, to observe any changes in size or wall thickness. “Cysts should not grow,” he says. If a thick-walled cyst enlarges or if blood tests reveal elevated cancer markers, further evaluation is necessary. In such cases, surgical removal may be considered to determine whether the cyst is malignant.

When Should Ovarian Cysts Be Removed?

Surgery is generally reserved for cysts that show suspicious features or significant growth. “We try not to remove cysts unnecessarily,” Dr. An explains. “For example, breast cysts often do not need surgery, even if a patient has multiple cysts.” Removing cysts without clear indication can cause unnecessary harm and expense.

However, if an ovarian cyst is thick-walled, enlarging, or associated with raised cancer markers, surgery becomes a prudent option. This approach balances caution with the need to avoid overtreatment.

The Importance of Consistent Monitoring

Patients with ovarian cysts often seek multiple opinions, which can lead to confusion. Dr. An stresses the importance of comparing ultrasound images over time, regardless of which doctor performs the scan. “If the cyst size fluctuates—getting bigger and smaller—there is usually no cause for concern,” he says. But persistent growth or thickening of the cyst wall warrants further investigation.

Size Alone Is Not an Indication for Surgery

Interestingly, Dr. An points out that the size of a cyst is not always a reason for removal. “Some patients naturally have very large thin-walled cysts that are benign,” he explains. Therefore, size alone does not dictate the need for surgery.

Safety of Procedures and Symptoms to Watch For

Patients often worry about the safety of procedures like aspiration or the risk of cyst rupture. Dr. An reassures that aspiration of cysts, such as breast cysts, is safe and can relieve discomfort. Even if a cyst ruptures, it is generally not a cause for alarm, as the body can manage it effectively.

However, if a cyst becomes large enough to cause symptoms—such as frequent urination due to bladder pressure—removal may be considered to improve quality of life.

Breast Cysts: No Surgery Needed

Breast cysts are common and typically benign. Dr. An is clear: “Breast cysts do not need to be operated on.” Ultrasound helps distinguish cysts (fluid-filled) from solid lesions. Solid lesions may require biopsy to rule out cancer, but cysts usually do not.

Aspiration can be performed in the clinic to relieve pain or discomfort caused by engorged cysts. This simple procedure involves inserting a needle to drain the fluid and can be done without anesthesia.

Biopsy and Imaging in Breast Lesions

While cysts cannot be biopsied, solid breast lesions can be evaluated through needle biopsy. Dr. An explains that ultrasound and mammography are used to classify breast lesions. The BI-RADS system is commonly applied to mammography findings to assess cancer risk, with categories ranging from benign (1 and 2) to suspicious (4) and confirmed malignancy (5).

When to Seek a Second Opinion

Patients often wonder if they need multiple opinions. Dr. An acknowledges this is a difficult question. “Trust is key,” he says. If a patient feels confident in their doctor’s explanation and treatment plan, a second opinion may not be necessary. However, if there is doubt or confusion, seeking additional opinions can be helpful.

Liver and Kidney Cysts: Usually Benign

Liver and kidney cysts are also common incidental findings on ultrasound. Dr. An reassures that these cysts are generally benign and do not require treatment, even if they grow large. Follow-up imaging may be done to monitor changes, but surgery is rarely needed.

Thyroid Cysts and Nodules

Thyroid cysts are common, and like cysts elsewhere, they are usually benign. Solid thyroid nodules, however, may require fine needle aspiration to rule out cancer. Aspiration of cystic thyroid lesions can relieve symptoms if the cyst causes a visible lump or discomfort.

Colorectal Cancer: Prevention and Early Detection

Dr. An also discusses colorectal cancer, a significant health concern. He explains that about 85% of colorectal cancers develop from polyps, which are benign growths in the colon lining. These polyps can take 7 to 10 years to become cancerous.

“Removing polyps during colonoscopy can prevent colorectal cancer,” Dr. An emphasizes. He recommends starting colonoscopy screening at age 40 and repeating it every 7 to 10 years if no polyps are found.

If polyps are detected and removed, a follow-up colonoscopy is advised within a year to ensure no new polyps have developed. This proactive approach has significantly reduced colorectal cancer incidence in countries with established screening programs.

Symptoms and Warning Signs of Colorectal Cancer

Dr. An advises patients to be vigilant for symptoms such as changes in bowel habits, blood in stools, and unexplained abdominal pain or bloating. While blood in stools can be caused by benign conditions like hemorrhoids, it should always be evaluated by a doctor.

Treatment and Prognosis of Colorectal Cancer

Early-stage colorectal cancer (stage 1) can often be treated successfully with surgery alone. For stage 2 or 3 cancers, chemotherapy may be recommended to reduce the risk of recurrence. Although stage 4 colorectal cancer has a poorer prognosis, some patients can still be cured with appropriate treatment.

The Value of Experience in Oncology

Dr. An shares that his approach to treatment is shaped by decades of experience. “Young doctors often follow textbooks strictly,” he says, “but experience allows you to improvise and tailor treatment to each patient’s unique situation.” This personalized care can improve outcomes, especially in complex cases.

Final Thoughts

Dr. An’s insights provide valuable guidance for patients facing cysts or cancer concerns. His emphasis on careful monitoring, avoiding unnecessary surgery, and early detection through screening highlights the importance of informed medical care.

Patients are encouraged to maintain regular check-ups, communicate openly with their doctors, and seek second opinions if uncertain. With advances in medical technology and expertise, many conditions once feared can now be managed effectively.