Should surgery be performed for an ovarian cyst in this case?

Patient's question:

B examination results on August 14th: The position, size, and shape of the uterus were normal, with uniform muscle wall echoes. The endometrial thickness was about 14 mm. No abnormal echo masses were observed in the left upper part of the uterus. A cystic echo measuring 5042 mm was seen in the left adnexal area, with clear boundaries and poor internal sound transmission. Fine and weak floating light spots were visible. No normal findings were observed in the right adnexal area. Point-like blood flow signals were seen around the cystic mass.
Detailed examination on September 14th: The endometrial thickness was about 17 mm, with the same results as above. The cystic mass measured 4845 mm and was suspected to be a chocolate cyst.
Detailed examination on October 14th at another hospital: A mass image measuring approximately 5038 mm was observed in the left adnexal area, with a round shape and homogeneous, solid-like internal echoes. Dense small light spots were visible inside. It appeared similar to a cyst, with slightly thick walls, smooth texture, and clear boundaries. The cyst walls

Doctor's answer:

Generally speaking, if the diameter of an ovarian cyst is less than 5 centimeters and there is no evidence of a tumor, it is often a functional cyst. Close follow-up is recommended, which means having a thorough check-up every 2-3 months. The follow-up interval can then be adjusted based on the situation. If the cyst does not grow or shrink after 4-6 weeks, the likelihood of it being a functional cyst is higher. If the cyst decreases significantly, especially if it is larger than 5 centimeters, or if there is sudden lower abdominal colicky pain, it may be a neoplastic cyst or a recurrence or rupture of the cyst. In such cases, surgery should be performed to confirm its benign or malignant nature, and removal may be necessary if needed.

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