Can a Ganglion Cyst Become Cancerous?

Introduction 

Ganglion cyst (GC) also called bible cysts is a synovial cyst fluid filled sac that develops on the wrists. GC affects people of all ages, and are the most common type of neoplasm of the hand or wrist. While the cause of ganglion cyst is unclear, the development of the lump is considered to stem from repetitive microtrauma to the hand – which results in degeneration of the connective tissue. 

Cancers develop from deleterious changes to the sequences of the DNA. These changes could be due to genetic inheritance or random spontaneous mutations as a result of radiation (e.g. ultraviolet rays from the sun), endogenous chemical reactions like reactive oxygen species (ROS) due to chemical metabolisms in cells, or other exogenous process such as viral infections (cervical cancer), tobacco smoke (lung cancer),  etc. 

Although appears as lumps, ganglion cysts are not cancerous nor can be cancerous. Similar to benign tumors, ganglion cysts are asymptomatic, however, patients may experience pain, tenderness, decreased muscle tone, etc Unlike benign tumors, ganglion cysts can not progress to become malignant cancerous tumors. 

About 70% of ganglion cysts are found on the dorsal part of the hand, and are usually located in the scapholunate ligament. Close to 20% of the cysts are on the volar or palm of the hand, and the remaining 10% can occur on other parts of the hand including close to the fingertips, volar retinaculum of the wrist, etc. Ganglion cysts comprise approximately 60 – 70% of all soft tissue neoplasms of the hand. It occurs in individuals of all ages, however, it mostly affects people between the ages of 20 – 40 years, and it affects more women than men [5], with women three times more likely to develop ganglion cysts than men [1]. 

Etiology 

Although the exact cause of ganglion cyst is unknown, experts believe that ganglion cyst is a continuous micro-damage to the capsular or ligamentous structures of the synovial joint. This damage activates the fibroblast cells in the connective tissues to produce hyaluronic acid that accumulates to form the jellylike content of the cyst [1]. 

Ganglion cysts usually occur in gymnasts and other professionals who are involved in stressful, repetitive movement at the wrist joint. The cysts typically appear as a lump of about 1cm to 3cm in size, and are mostly part of the underlying connective tissue, rather than the skin. When the cyst is on the palmar (volar ganglion) side of the hand, the swelling can cause injury to the ulnar nerve, and may also press on the radial artery, thereby resulting ischemia (reduced blood flow to the hand).

Other explanations for the cause of ganglion cyst suggest that the damage to the joint caused the breakdown of tendon sheath or capsule, thereby forming small cysts that develop into large mass typical of ganglion cysts. [2]

Symptoms

The symptoms of ganglion cysts are typically mild. Symptoms of ganglion cyst are swelling of the hand or wrist, pain in the joint or hand due to swollen tissues impinging on nerves of the wrist, weakness in hand muscles (in severe cases), dissatisfaction with cosmetic appearance, and tingling sensation [3][4]

Diagnosis

Ganglion cyst is very easy to diagnose. Doctors or clinicians will perform a physical examination of the affected hand (or body part). Ultrasound imaging can be used to provide a better view of the cyst. Ultrasound can be used to determine whether the cyst is fluid filled or if it has become a solid mass. Ultrasound image of the hand can also distinguish the ganglion cyst from vascular malformation. This is important to prevent puncturing the radial nerve during treatment.

Magnetic resonance imaging (MRI) can often be used to visualize the lump. MRI imaging can help to identify small cysts that are hidden by a large cyst, or to distinguish a cyst from a tumor. X-rays images will not show reveal cysts, however, the X-ray can be used to rule out other conditions such as arthritis in the joint. [1]

Treatment

After a ganglion cyst has been identified and diagnosed, the physician may advise the patient to observe or monitor the cyst. Many cyst usually disappear after some time. Also, inactivity or resting the wrist may reduce the swelling and alleviate the pain.

When the swelling persists, the fluid in the cysts can be drained out by a syringe (needle aspiration). The care provider will make sure to immobilize the wrist by splinting, and prescribing steroids for pain management and to prevent inflammation. Often times, the fluid in the cyst may be drained on multiple clinic visits. Aspiration has about 50 percent success rate, and it is a lower success rate for cysts that are in the volar aspect or close to the fingertips.

In more severe cases of ganglion cyst or in cases of recurring cysts are aspiration, surgery is recommended. Surgical removal or excision of ganglion cysts is an outpatient procedure. It involves excising the inflamed capsule including the tendon sheath (which is considered as the root of the ganglion). Surgical excision of the cyst has less recurrence rate compared to needle aspiration. [6]

Citation

1. Ganglion Cyst – StatPearls – NCBI Bookshelf. (2019, February 24). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470168/
2. Ganglion Cyst Basics. (2007, January 1). Retrieved from https://www.webmd.com/a-to-z-guides/ganglion-cyst#1\
3. Ganglion Cyst of the Wrist and HandOrthoInfoAAOS. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/ganglion-cyst-of-the-wrist-and-hand/

      4. Amber Erickson Gabbey. (n.d.). Ganglion Cysts: Symptoms, Causes, and Treatment. Retrieved from https://www.healthline.com/health/ganglion-cysts#symptoms

5. Kuliński, S., Gutkowska, O., Mizia, S., & Gosk, J. (2017). Ganglions of the hand and wrist: Retrospectivestatistical analysis of 520 cases. Advances in Clinical and Experimental Medicine, 26(1), 95-100. doi:10.17219/acem/65070
6. Ganglion Cysts. (n.d.). Retrieved from https://www.assh.org/handcare/hand-arm-conditions/ganglion-cyst

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.