A 50 year old female my neighbours housemaid presented with complaints of abdominal fullness to general practitioners/surgeon in last few months. Her reports are attached during the course. One of the surgeon has made a provisional diagnosis of Ovarian CA with metastasis. As per P/A done by JR reveals an immobile lump approx 10cm with tenderness in left lower abdomen. Kindly give your valuable comments so that I can help her out in the best possible way.

21 yrs old with adenexl cyst . ca 125 markedly raised . suggest management's . reports attached. at young age possibly of germ cell ovarian cancer are high too. Any knowledge on the prognosis ?

Friends today I am discussing about female problem Uterine fibroids. Uterine fibroids are non-cancerous tumors that grow from the muscle layers of the womb. These benign growths of smooth muscle can vary from the size of a bean to being as large as a melon. They are also known as leiomyomas and myomas. Fibroids affect around 30 percent of all women by the age of 35 years, and from 20 to 80 percent by the age of 50 years. They usually develop between the ages of 16 to 50 years. These are the reproductive years during which estrogen levels are higher. Fast facts on fibroids: Here are some key points about fibroids. More information is in the main article. Fibroids are most common during the reproductive years. It is unclear exactly why they form, but they appear to develop when estrogen levels are higher. Most people experience no symptoms, but they can include lower backache, constipation, and excessive or painful uterine bleeding leading to anemia. Complications are rare, but they can be serious. Types Fibroids Fibroids are non-cancerous tumors that appear in the tissues around the womb. There are four types of fibroid: Intramural: This is the most common type. An intramural fibroid is embedded in the muscular wall of the womb. Subserosal fibroids: These extend beyond the wall of the womb and grow within the surrounding outer uterine tissue layer. They can develop into pedunculated fibroids, where the fibroid has a stalk and can become quite large. Submucosal fibroids: This type can push into the cavity of the womb. It is usually found in the muscle beneath the inner lining of the wall. Cervical fibroids: Cervical fibroids take root in the neck of the womb, known as the cervix. The classification of a fibroid depends on its location in the womb. Symptoms Around 1 in 3 women with fibroids will experience symptoms. These may include: heavy, painful periods, also known as menorrhagia anemia from heavy periods lower backache or leg pain constipation discomfort in the lower abdomen, especially in the case of large fibroids frequent urination pain during intercourse, known as dyspareunia Other possible symptoms include: labor problems pregnancy problems fertility problems repeated miscarriages If fibroids are large, there may also be weight gain and swelling in the lower abdomen. Once a fibroid develops, it can continue to grow until menopause. As estrogen levels fall after menopause, the fibroid will usually shrink. Causes It remains unclear exactly what causes fibroids. They may be related to estrogen levels. During the reproductive years, estrogen and progesterone levels are higher. When estrogen levels are high, especially during pregnancy, fibroids tend to swell. They are also more likely to develop when a woman is taking birth control pills that contain estrogen. Low estrogen levels can cause fibroids may shrink, such during and after menopause. Genetic factors are thought to impact the development of fibroids. Having a close relative with fibroids increases the chance of developing them. There is also evidence that red meat, alcohol, and caffeine could increase the risk of fibroids, and that an increased intake of fruit and vegetables might reduce it. Being overweight or obese increases the risk of fibroids. Childbearing lowers the risk of developing fibroids. The risk reduces each time a woman gives birth. Diagnosis As fibroids often do not show symptoms, they are usually diagnosed during routine pelvic examinations. The following diagnostic tests can detect fibroids and rule out other conditions: A doctor can create ultrasound images by scanning over the abdomen or by inserting a small ultrasound probe into the vagina. Both approaches may be needed. An MRI can determine the size and quantity of fibroids. A hysteroscopy uses a small device with a camera attached to the end to examine the inside of the womb. The device is inserted through the vagina and into the womb through the cervix. If necessary, the doctor can take a biopsy at the same time to identify potentially cancerous cells in the area. A laparoscopy may also be performed. In a laparoscopy, the doctor makes a small opening in the skin of the abdomen and inserts a small tube with a lighted camera attached through the layers of abdominal wall. The camera reaches into the abdominopelvic cavity to examine the outside of the womb and its surrounding structures. If necessary, a biopsy can be taken from the outer layer of the womb. Treatment Birth control medication an be used to shrink fibroids. Birth control medication can be used to shrink fibroids. Treatment is only recommended for those women experiencing symptoms as a result of fibroids. If the fibroids are not affecting quality of life, treatment may not be necessary. Fibroids can lead to heavy periods, but if these do not cause major problems, one may choose not to have treatment. During menopause, fibroids often shrink, and symptoms often become less apparent or even resolve completely. When treatment is necessary, it can take the form of medication or surgery. The location of the fibroids, the severity of symptoms, and any future childbearing plans can all affect the decision. Medication The first line of treatment for fibroids is medication. A drug known as a gonadotropin-releasing hormone agonist (GnRHa) causes the body to produce less estrogen and progesterone. This shrinks fibroids. GnRHa stops the menstrual cycle without affecting fertility after the end of treatment. GnRH agonists can cause menopause-like symptoms, including hot flashes, a tendency to sweat more, vaginal dryness, and, in some cases, a higher risk of osteoporosis. They may be given before surgery to shrink the fibroids. GnRH agonists are for short-term use only. Other drugs may be used, but they may be less effective when treating larger fibroids. These include: Non-steroidal anti-inflammatory drugs (NSAIDs): These include mefenamic and ibuprofen, which is available to buy online. Anti-inflammatory medications reduce the production of hormone-like lipid compounds called prostaglandins. Prostaglandins are associated with crampy periods, and they are thought to be associated with heavy menstrual periods. For those with fibroids, an NSAID may be effective at reducing fibroid pain, does not reduce bleeding from fibroids, and does not affect fertility. Birth control pills: Oral contraceptives help regulate the ovulation cycle, and they may help reduce the amount of pain or bleeding during periods. Levonorgestrel intrauterine system (LNG-IUS): This plastic device is placed inside the womb. It then releases a hormone called levonorgestrel over an extended timeframe. The hormone stops the inside lining of the womb from growing too fast, which reduces menstrual bleeding. Adverse effects include irregular bleeding for up to 6 months or longer, headaches, breast tenderness, and acne. In some cases, it can stop periods. Surgery Severe fibroids may not respond to more conservative treatment options, and surgery may be necessary. The treating doctor may consider the following procedures: Hysterectomy: A hysterectomy is the partial or total removal of the womb. This is considered for treating extremely large fibroids or excessive bleeding. A total hysterectomy can prevent the return of fibroids. If a surgeon also removes the ovaries and fallopian tubes, side effects can include reduced libido and early menopause. Myomectomy: This is the removal of fibroids from the muscular wall of the womb. It can help women who still want to have children. Women with large fibroids, or fibroids located in particular parts of the womb, may not benefit from this surgery. Endometrial ablation: Removing the lining inside of the womb may help if fibroids are near the inner surface of the womb. Endometrial ablation may be an effective alternative to a hysterectomy for some women with fibroids. Uterine artery embolization (UAE), more specifically uterine fibroid embolization (UFE): Cutting off the blood supply to the area shrinks the fibroid. Guided by fluoroscopic X-ray imaging, a chemical is injected through a catheter into the arteries supplying blood to any fibroids. This procedure reduces or removes symptoms in up to 90 percent of people with fibroids but is not suitable for women who are pregnant and typically not for those who still wish to have children. MRI-guided percutaneous laser ablation: An MRI scan is used to locate the fibroids. Fine needles are then inserted through the skin and body tissues of the patient and pushed until they reach the targeted fibroids. A laser fiber device is inserted through the needles. A laser light is sent through the device to shrink the fibroids. MRI-guided focused ultrasound surgery: An MRI scan locates the fibroids, and high energy ultrasound waves are delivered to shrink them. Natural treatments There is no proven natural treatment for fibroids. However, keeping weight down through exercise and a healthful diet may help to moderate estrogen levels. Complications In severe cases, fibroids can lead to infertility Fibroids do not normally result in complications, but if they occur, they can be serious and even life-threatening. Complications may include: Menorrhagia, also called heavy periods: This can sometimes prevent a woman from functioning normally during menstruation, leading to depression, anemia, and fatigue. Abdominal pain: If fibroids are large, swelling and discomfort may occur in the lower abdomen. They may also cause constipation with painful bowel movements. Pregnancy problems: Preterm birth, labor problems, and miscarriages may occur as estrogen levels rise significantly during pregnancy. Infertility: In some cases, fibroids can make it harder for the fertilized egg to attach itself to the lining of the womb. A submucosal fibroid growing on the inside of the uterine cavity may change the shape of the womb, making conception more difficult. Leiomyosarcoma: This is a rare form of cancer that is thought by some to be able to develop inside of a fibroid in very rare cases. Other serious complications include acute thromboembolism, deep vein thrombosis (DVT), acute renal failure, and internal bleeding. Homeopathic Medicines for Uterine Fibroids Thlaspi Bursa Pastoris, Calcarea Carb, Belladonna, Sepia Officinalis, Ustilago Maydis, Sabina Officinalis, Trillium Pendulum, Kali Carbonicum, Erigeron Canadensis and China Officinalis and Ferrum Met are the top remedies used in the treatment of uterine fibroids. 1. Thlaspi Bursa Pastoris – For Uterine Fibroids with Prolonged Menses Thlaspi Bursa is one of the top grade medicines for treating uterine fibroids with prolonged menses. The menses continue for 10-15 days. Menses appear very frequently as well. The next menstrual cycle appears even before recovery from the periods has occurred. Menstrual bleeding is profuse, with the presence of large clots. Violent uterine colic during menses may also arise. Cramping pain in the uterus during menstruation in uterine fibroids cases is also suggestive of use of Thlaspi Bursa Pastoris. 2. Calcarea Carb – For Heavy Periods from Uterine Fibroids Calcarea Carb is a very useful medicine for treating heavy periods from uterine fibroids. Menses continue for long and may even appear early. Vertigo during menses may arise. Leucorrhea of thick, milky or yellow color is another complaint that may attend. 3. Belladonna and Sepia Officinalis – For Uterine Fibroids where Menses are Painful Belladonna and Sepia Officinalis are well-indicated medicines for uterine fibroids where the menses are painful. Belladonna is best prescribed where there is cramping pain in the uterus during menses, the menses are bright red in colour and profuse. Use of Sepia Officinalis is recommended in case of griping, burning or bearing down pains during menses. Menses start early and are quite copious. Fainting and chilliness during menses may attend. Sepia Officinalis is also indicated for treating painful intercourse in uterine fibroids cases. 4. Ustilago Maydis – For Uterine Fibroids with Dark Menstrual Bleeding Ustilago Maydis is a highly suitable medicine for uterine fibroids where menstrual bleeding is dark. Clots may also be present in menstrual blood. Uterine bleeding may be stringy in nature. 5. Sabina Officinalis – For Uterine Fibroids where Clots Pass with Menstrual Blood In the case of menstrual bleeding with clots in uterine fibroid cases, Sabina Officinalis is a significant medicine. The slightest motion increases menstrual bleeding. Pain from sacrum to pubis is another attending feature. During menses, pain in the uterus may be present that gets better by lying on the back. Uterine pain may extend to the thighs. Other symptoms include foul, acrid, corrosive, yellow leucorrhoea. 6. Fraxinus Americana – Excellent Homeopathic medicine for uterine fibroids with bearing down sensation Fraxinus Americana is a top grade medicine for uterine fibroids which is mostly recommended when the major indicating feature is a bearing down sensation in the pelvis from uterine fibroid. 7. Trillium Pendulum and Kali Carbonicum – For Uterine Fibroids with Back Pain during Menses In uterine fibroid cases with back pain during the menstrual cycle, Trillium Pendulum comes highly recommended. The pain may radiate to the hips from the back during menses. Tight binding of the back and hips provides relief. Menstrual bleeding is bright red and gushing. The slightest movement worsens uterine bleeding. Trillium Pendulum is also indicated for inter-menstrual bleeding every two weeks. Another attending feature is faintness from uterine bleeding. Kali Carbonicum is selected when there is violent back pain during menses. The pain gets better from sitting and pressure. The menstrual flow is also copious. 8. Erigeron Canadensis – For Frequent Urination in case of Uterine Fibroids Erigeron Canadensis is a beneficial medicine for treating frequent urination in case of uterine fibroids. In some cases, painful urination may also arise. The attending features are excessive menstrual bleeding which is bright red in colour. Erigeron Canadensis is also used for inter-menstrual bleeding from slight exertion. 9. China Officinalis and Ferrum Met – For Uterine Fibroids with Heavy Bleeding and Anaemia Both China Officinalis and Ferrum Met are effective medicines for treating uterine fibroids with heavy bleeding and anaemia. Among them, China Officinalis works best when there is profuse, dark menstrual bleeding, clots in menstrual blood, exhaustion and anaemia. Fainting spells may also arise. Ferrum Met is best used where the symptoms include pale, watery, heavy and prolonged menses leading to anaemia. Menstrual flow worsens from the slightest movement. Lower back pain or abdomen pain during menses may be observed.

A 45 yr female patient admitted for and pain before one week. on admission clinical examination is as follows. -USG abdomen pelvis results is 1. Gross ascitic 2. Lt kidney not visualised. 3. Uterus is Normal. 4 Urinary bladder is normal. -CT abdomen pelvis with contrast 1. Gross ascitic 2. Lt kidney not visualised 3. bilateral minimal plural effusion -Pathology CBC BSL-R LFT RFT Vidal HIV HBsAg ESR Ascitic fluid culture Urine-R All Pathology test is with in Normal. but CA125 test is positive result is- >1000. ECG- WNL. CXR-Bilateral minimal plural effusion. TB test is Normal. Now we are confuse because how to rule out a final diagnosis. Kindly suggest any other help full method for diagnosis and treatment.

A 30-year-old woman with, hematuria and anemia was presented with skin spots. Ultrasound of abdomen detected normal kidneys; at the pelvis, there was a big mass with size of 25 cm from pubis to umbilicus. Suggest the treatment for the same?