Dear Dr.Suverchala and Curofians! Greetings! Let me argue my case of preserving ovaries intact in Hysterectomy . Why do women need ovaries for a lifetime !? I did a research of some sort to come to this conclusion and I strongly believe that you shall also agree with me. My apologies, if I am harsh with my comments. The vast majority of hysterectomies are performed in India are on flimsy benign indications and sometimes very trivial, supposedly with a fond hope to improve quality of life. As the surgical procedure itself is generally associated with few complications, it has become a popular choice of the patients and lucrative(sic) one for the medical profession In india. There are long-term adverse effects of hysterectomy by itself on the pelvic floor, leading to vulval prolapse, urinary incontinence, bowel dysfunction, sexual function and pelvic fistula formation. These sequelae often occuring a long time after the surgical procedure and severely impair quality of life. Retrospective studies have shown that those young women who underwent early hysterectomy have been observed to have early menopause and decreased QOL, much more evident with those women who also had both ovaries removed for some cause. The percentage of women who require reoperation after hysterectomy with ovarian conservation is low, with residual ovary syndrome occurring at a low rate of approximately 2.8%. EvenThough asymptomatic cystic ovarian tumors or cysts are relatively prevalent (6.6%) in postmenopausal women.These cysts do not undergo transformation to cancer, however, and in most cases do not need to be removed. Another study reported that only 0.75% of women developed ovarian cancer after hysterectomy and ovarian conservation performed by the vaginal or abdominal route. Performing oophorectomy to avoid future surgery appears unfounded. Prophylactic surgery should be performed only if there is evidence that it clearly benefits the patient. Recent evidence suggests that there may be long-term health benefits and longer survival for women who choose ovarian conservation at the time of hysterectomy for benign disease. However, bilateral salpingo-oophorectomy is advisable for women who have a high risk of ovarian and breast cancer because of gene mutations. But the decision about oophorectomy for other women is unfounded. Bilateral oophorectomy at the time of hysterectomy for benign disease has been commonly requested by the ignorant patients. Although the lifetime risk of ovarian cancer is 1.4% Nevertheless, the lifetime risk of ovarian cancer among women withBRCA1mutations the risk is 36% to 46%, and for BRCA2mutations the risk is 10% to 27%.. Some educated women with a family history of ovarian cancer may wish to have their ovaries removed because of concerns about the possibility of developing ovarian cancer. Then such a request can be entertained only, after a full discussion with her and family, of her specific risk for ovarian and breast cancers and the risks and benefits of the surgery , Oophorectomy appears to be associated with long-term health risks. It immediately reduces blood levels of ovarian estrogens and androgens. Even after menopause, the ovaries continue to produce significant amounts of testosterone and androstenedione, which undergo peripheral conversion to estrone by skin, muscle, and fat cells. Evidence indicates that endogenous estrogens are beneficial to the cardiovascular system and for long-term health and reduce cognitive impairment or dementia risk by 50%. Bilateral oophorectomy before 50 years of age was associated with increased risks of all-cause mortality, CHD, and stroke. After oophorectomy, women had a markedly reduced risk of ovarian cancer; however, they had higher risks of lung cancer and total cancer mortality . Oophorectomy has been shown to increase the risks of Parkinson disease and anxiety or depression. Estrogens and androgens inhibit bone resorption, and androgens stimulate bone formation.The women who undergo bilateral oophorectomy have an increased risk of osteoporosis because of the reduction in hormone levels. About 90% of surgically induced menopausal women experience mood changes, a decline in feelings of well- being, decreased sexual desire, sleep disturbances, and headaches.Over time, vaginal dryness, painful intercourse, bladder dysfunction, and symptoms of depression may occur, to say in few words, their QOL suffers. Endogenous bioavailable testosterone and estrogen in postmenopausal women are partly protective against the loss of muscle strength that predisposes these women to falls and against the continuing loss of bone mineral density that increases the risk of fractures.Therefore, even in older women, these ovarian hormones may have benefit, So these women need these ovaries for life. If we are worried about the ovarian Cancers then other strategies may be taken to decrease the risk of ovarian cancer, including 1. Taking OCs for 5 or more years decreases the risk of ovarian cancer by 50%,and 2. Tubal ligation decreases the risk by 34%. 3. Hysterectomy alone decreases the risk of ovarian cancer by 33%.
Choosing to remove healthy ovaries is often done to reduce the risk of ovarian cancer.however removing the ovaries at the time of hysterectomy should be looked at on a case to case basis.age and menopause to be considered. Endogenous estrogen produced in body is linked to several protection benefits that are lost when ovaries are removed. If women at 40-45 not attained menopause undergoes EO have double the risk of heart attacks and osteoporosis and decrease sexual function. When hyst done for benign condition like fibroid ovary removal not reqd unless diseased. If ovaries are removed before menopause she should bo on HRT. IN my view dr doing surgery is best person to decide knowing her history of breast cancer in family and explaining the risk of removing or preseving ovaries.
Mam, TAH,+ BSO can be done.,if age is more than 40yrs. , Because cyst formation is more common if only ovaries are left.some doctors do oophorectomy on one side. ,In these cases ovarian cysts are more common. 3. In cases where hysterectomy is needed in young women, look for the ovaries while doing hysterectomy,whether they are healthy or not. 5.start calcium and photo isoflavones.
* indication for hysterectomy is main criteria to decide whether to go for or not BSO. * Those having been donefor DUB only atleast one Ovary is to be preserved . * I have seen patient of 26 yrs of age of premature menopause & of 63 yrs of patient with regular cycle without any complain * For Abdo. Hysterectomy no visceral peritonisation should done if Ovary is to be preserved as it comprises vascular supply & later cause cyst. * For TLH, isolated meticulous cautrisation Of ovarian ligament is to be done
The deliemma over whether to preserve or remove ovaries at the time of hysterectomy has long been debated ... A thorough discussion of the advantages & disadvantages of oophorectomy should be undertaken in premenopausal women who are undergoing hysterectomy for benign diseases ... Benefits of oophorectomy are : 1) decreased risk of ovarian cancer 2) decreased risk of reoperation & 3) Lower risk of mortality from breast cancer when oophorectomy was performing before 45 years.. On the other there are numerous disadvantages of prophylactic oophorectomy: 1) Increased risk of fracture, CHD mortality & colorectal cancer 2)Cognitive impairment 3) Mood swings , irritability & hot flushes 4)Decline in sexual function & Overall there is decrease in QUALITY OF LIFE.. Prophylactic surgery should be performed only if the weight of the evidences establish that it clearly benefits the patients for example in women with germline mutation ( BRCA1 & BRCA2) & with family history of ovarian/ breast cancer ... Current guidelines from ACOG recommends BSO for women known to be at risk for ovarian cancer but ovarian preservation for those without such risks ...
I agree with Dr.Chakradhar Nannapaneni.While doing hysterectomy for young pts, we can preserve the ovaries if they are normal unless they have high risk of malignancy.In premenopausal nd postimenopausal age we can plan for oophorectomy depending on the reason for hysterectomy.
As per my experience same child bearing age only hysterectomy menopausal hysterectomy with oophrectomy bilateral oophrectomy helps in pt with breast cancer
It depends on age of the patient, pathology for which we are removing the uterus and condition of the patient. Yes it's always individualized. But in today's era it's better to discuss about removal or preservation of ovary with patients before surgery. Fallopian tubes are removed always when we remove uterus, though not during vaginal hysterectomy
I quite agree with you madam. In fact this question has been bothering me also, for a while. The most difficult moment for me,when I have to take a call is..patient young, hysterectomy indicated, cyst in one of the ovaries and the other ovary apparently normal. My question is, does it make sense to leave the normal looking ovary.. What is a logical option in this case??
If done for endometriosis or pid ovaries should be removed and if for myoma adenomyosis ovaries should be conserved but bilateral salpinjectomy should be done
Cases that would interest you
- Login to View the image
Friends today I am discussing about a very common problem faced by the females in there life at some stage of life. Menopause is the process through which a woman ceases to be fertile or menstruate. It is a normal part of life and is not considered a disease or a condition. Symptoms may occur years before a woman's final period. Some women may experience symptoms for months or years afterward. Despite being a natural process in the body of any woman, menopause can cause drastic changes that trigger severe symptoms. This article will explain the symptoms and causes of menopause, as well as how to diagnose and treat any symptoms that arise. Fast facts on menopause Menopause marks the end of a woman's fertility. Symptoms of menopause include night sweats, hot flashes, mood fluctuations, and cognitive changes. A reduction in estrogen levels can lead to the symptoms of menopause. There are a number of medical treatments and home remedies that can help with symptoms, including hormone replacement therapy (HRT) and self-management techniques. The average age of menopause in the United States (U.S.) is 51 years. Signs and symptoms Menopause hot flash woman fan Menopause is a natural change in the body. It causes symptoms such as hot flashes. While menopause is not a disease or disorder, it does trigger some profound changes in a woman's body. A diagnosis of menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms of menopause generally appear before the end of that one-year period. Irregular periods Changes to the menstrual pattern are the first noticeable symptoms of menopause. Some women may experience a period every 2 to 3 weeks. Others will not menstruate for months at a time. Lower fertility Perimenopause is the 3-to-5-year period before menopause. During the perimenopausal stage, a woman's estrogen levels will drop significantly. This reduces her chances of becoming pregnant. Vaginal dryness Dryness, itching, and discomfort of the vagina tend to occur during perimenopause. As a result, some women may experience dyspareunia, or pain during sex . Women experience this pain due to lowering estrogen levels. These lower levels cause vaginal atrophy. Vaginal atrophy is an inflammation of the vagina that happens as a result of the thinning and shrinking of the tissues, as well as decreased lubrication. A hot flash is a sudden sensation of heat in the upper body. It may start in the face, neck, or chest, and progress upward or downward. The skin may become red and patchy, and a woman will typically start to sweat. Her heart rate may suddenly increase, strengthen, or become irregular. Hot flashes generally occur during the first year after a woman's final period. Night sweats Hot flashes that occur during the sleep cycle are called night sweats. Most women say their hot flashes do not last more than a few minutes. However, studies have confirmed that moderate-to-severe night sweats and hot flashes may pose a problem for around 10.2 years. Disturbed sleep It can be difficult for women to fall asleep and stay asleep as they progress through menopause. In some cases, night sweats can lead to discomfort during the night and difficulty sleeping. Sleep disturbance may also be caused by insomnia or anxiety. Urinary problems Menopause can disrupt a woman's urinary cycle. Women tend to be more susceptible to urinary tract infections (UTIs) during menopause, such as cystitis. They may also find that they also need to visit the toilet more often. Emotional changes Women can experience depression and low mood during menopause. Hormonal changes can often trigger depressed feelings and mood swings. In many cases, these emotional symptoms also go hand-in-hand with sleep disturbance. Women may also experience low libido, or sex drive, as a result of these emotional changes. Problems focusing and learning Menopause can affect cognitive functions, such as concentration. Some women may also experience short-term memory problems and difficulty focusing for long periods. Other effects Other symptoms of menopause include: a buildup of fat in the abdomen, sometimes leading to overweight and obesity hair loss and thinning hair breast shrinkage Without treatment, symptoms usually taper off over a period of 2 to 5 years. However, symptoms can persist for longer. In some cases, vaginal dryness, itching, and discomfort can become chronic and eventually get worse without treatment. Complications Menopause can lead to the development of complications, including: Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease. Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing osteoporosis. Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause. Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk. Treatment HRT menopause pills Treatment for menopausal symptoms can range from hormone replacement therapy to self-management. During menopause, women can pursue a number of treatments to maintain comfort. Most women do not seek medical advice during this time, and many women require no treatment. However, a woman should visit a doctor if symptoms are affecting her quality of life. Women should choose the type of therapy dependent on their menopausal symptoms, medical history, and personal preferences. Hormone replacement therapy (HRT) Women can keep the symptoms of menopause at bay by supplementing their estrogen and progestin levels. Hormone replacement therapy can be received through a simple patch on the skin. This patch releases estrogen and progestin. HRT is highly effective for many of the symptoms that occur during menopause. There are benefits to HRT, but be conscious of the risks: Benefits of HRT HRT effectively treats many troublesome menopausal symptoms. It can help prevent osteoporosis. HRT can lower the risk of colorectal cancer. Risks of HRT HRT raises the risk of breast cancer, ovarian cancer, and uterine cancer. It increases the risk of coronary heart disease risk and stroke. Hormonal therapy slightly accelerates loss of tissue in the areas of the brain important for thinking and memory among women aged 65 years and over. Medicines There are other medicines available to help reduce the effects of menopause. Low-dose antidepressants Selective serotonin reuptake inhibitors (SSRIs) have been shown to decrease menopausal hot flashes. Drugs include: venlafaxine (Effexor) fluoxetine (Prozac, Sarafem) paroxetine (Paxil, others) citalopram (Celexa) Drug treatment for hot flashes Hot flashes can be treated using gabapentin, available under the brand name Neurontin, and clonidine, which is often sold as Catapres. Clonidine can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes, but unpleasant side effects are common, including constipation, dry eyes, and nightmares. Vaginal estrogen may be applied to the area as a tablet, ring, or cream. This medication effectively treats vaginal dryness, dyspareunia, and some urinary problems. Moisturisers are available over-the-counter. Causes Aging woman A woman's estrogen levels drop during the aging process. A reduction in levels of the hormones estrogen and progesterone triggers the effects of menopause. Estrogen regulates menstruation, and progesterone is involved with preparing the body for pregnancy. Perimenopause begins when the ovaries start producing less of these two hormones. By the time a woman reaches her late thirties, the ovaries start producing less progesterone and estrogen. Fertility starts to decline long before the onset of any menopausal or perimenopausal symptoms. The ovaries produce less estrogen and progesterone over time until they shut down completely. Menstruation will then stop completely. This change is gradual in most women, but some find that their menstrual cycle continues as normal and then suddenly stops. Ovaries tend to stop producing eggs after the age of 45 years, but they may cease production before then. This is known as premature menopause. Although rare, this can occur at any age. A number of underlying conditions can cause premature menopause, including: enzyme deficiencies Down's syndrome Turner's syndrome Addison's disease hypothyroidism Certain surgeries and procedures may also lead to premature ovarian failure, such as: surgery to remove the ovaries surgery to remove the womb radiotherapy to the pelvic area chemotherapy to the pelvic area There is no way to prevent menopause, but its symptoms and effects can be managed. Diagnosis A doctor should be able to diagnose menopause or perimenopause in a woman using her age, questions about her menstrual patterns, and feedback about any physical signs. The test works by measuring anti-Müllerian hormone (AMH) in the blood, according to the U.S. Food and Drug Administration. This hormone is a marker of ovarian function. Used with other clinical evaluations and laboratory findings, it can give a better idea of a woman's menopausal status than was previously possible. The test may also help those who have symptoms of perimenopause, which is the stage before menopause. At this stage, too there may also be adverse health impacts. Early menopause is associated with a higher risk of: osteoporosis and fracture heart disease cognitive changes vaginal changes loss of libido mood changes Another types of test is for follicle-stimulating hormone (FSH). During menopause FSH levels rise. However, FSH is also not always a reliable indicator of menopause, as levels tend to fluctuate during menopause and perimenopause. Under certain circumstances, a doctor may order a blood test to determine the estrogen level. Low thyroid activity can cause similar symptoms to those seen in menopause, so a doctor may recommend a blood test to determine the level of thyroid-stimulating hormone. Self-management It is often possible to manage the symptoms of menopause without medical intervention. Exercise Exercise during menopause can have a range of benefits, including preventing weight gain, reducing cancer risk, protecting the bones, and boosting general mood. Pilates, for example, has shown great benefit in reducing all menopausal symptoms not related to the urinary system and genitals, including sleep problems and hot flashes. Women should exercise earlier in the day during menopause to avoid causing any interruptions to their sleep cycle. Kegel exercises can be useful for preventing urinary incontinence. These are exercises to strengthen the pelvic floor. Practicing 3 or 4 times a day can lead to a noticeable improvement in symptoms within months. Nutrition It is important to maintain a healthful and varied diet when managing the bodily effects of menopause. Researchers found that omega-3 may ease psychological distress and depressive symptoms. Omega-3 is available in foods such as oily fish. Supplements are also available. Women experiencing menopause should eat a well-balanced diet that includes: vegetables fruits whole grains unsaturated fats fiber unrefined carbohydrates Try to consume between 1,200 and 1,500 milligrams (mg) of calcium and plenty of vitamin D each day. Deep breathing techniques, guided meditation, and progressive relaxation can also help limit sleep disturbance. Stress can aggravate hot flashes and night sweats, so avoiding known stressors and practicing relaxation techniques can help these symptoms. Other steps to self-manage menopause symptoms There are a few ways for a woman to comfortably accommodate the effects of menopause: Avoid tight clothing. Limit the consumption of spicy food, caffeine, and alcohol. Stay sexually active to reduce vaginal dryness. Keep stress levels to a minimum, and get plenty of rest. Maintain a cool and comfortable temperature in the bedroom at night to minimize night sweats. Wake up and go to sleep at the same times every day to regulate the sleep cycle. Smoking can exacerbate symptoms, so avoiding it is important. Staying active and healthy and responding to symptoms rapidly can help a woman maintain a good quality of life during menopause. Primary Homoeopathic Remedies Graphites A woman who is chilly, pale, and sluggish—with trouble concentrating, and a tendency toward weight gain during or after menopause—is likely to respond to this remedy. Hot flushing and sweats at night are often seen. A person who needs this remedy may also have a tendency toward skin problems with oozing cracked eruptions, and be very slow to become alert when waking in the morning. Lachesis mutus This remedy relieves hot flashes from menopause, especially when hot flashes are relieved by sweating or the occurrence of periods. Sepia This remedy can be helpful if a woman's periods are sometimes late and scanty, but heavy and flooding at other times. Her pelvic organs can feel weak and sagging, and she may have a craving for vinegar or sour foods. Women who need this remedy usually feel dragged-out and weary, with an irritable detachment regarding family members, and a loss of interest in daily tasks. Exercise, especially dancing, may brighten up the woman's mood and improve her energy. Sulphur This remedy is often helpful for hot flashes and flushing during menopause, when the woman wakes in the early morning hours and throws the covers off. She may be very anxious, weep a lot, and worry excessively about her health. A person needing Sulphur often is mentally active (or even eccentric), inclined toward messy habits, and usually feels worse from warmth. Other Remedies Belladonna This remedy relieves hot flashes with profuse sweating and head congestion. Calcarea carbonica This remedy may be helpful to a woman with heavy flooding, night sweats and flushing (despite a general chilliness), as well as weight gain during menopause. People who need this remedy are usually responsible and hard-working, yet somewhat slow or plodding and can be easily fatigued. Anxiety may be strong, and overwork or stress may lead to temporary breakdown. Stiff joints or cramps in the legs and feet, and cravings for eggs and sweets are other indications for Calcarea. Glonoinum This relieves sudden hot flashes with throbbing headaches or congestion, aggravated by heat. Ignatia Ignatia is often helpful for emotional ups and downs occurring during menopause. The woman will be very sensitive, but may try to hide her feelings—seeming guarded and defensive, moody, or hysterical. Headaches, muscle spasms, and menstrual cramps can occur, along with irregular periods. A heavy feeling in the chest, a tendency to sigh and yawn, and sudden outbursts of tears or laughter are strong indications for Ignatia. Lilium tigrinum A woman likely to respond to this remedy feels hurried, anxious, and very emotional — with a tendency to fly into rages and make other people "walk on eggs." She often has a sensation of tightness in her chest, and a feeling as if her pelvic organs are pressing out, which can make her feel a need to sit a lot or cross her legs. Natrum muriaticum A woman who needs this remedy may seem reserved, but has strong emotions that she keeps inside. She often feels deep grief and may dwell on the loss of happy times from the past or brood about hurts and disappointments. During menopause, she can have irregular periods accompanied by backaches or migraines. A person who needs this remedy usually craves salt, and feels worse from being in the sun. Pulsatilla A person who needs this remedy is usually soft and emotional, with changeable moods and a tendency toward tears. Women are very attached to their families and find it hard to bear the thought of the children growing up and leaving home. They usually feel deeply insecure about getting older. A fondness for desserts and butter can often lead to weight problems. Changeable moods, irregular periods, queasy feelings, alternating heat and chills, and lack of thirst are common. Aggravation from stuffy rooms and improvement in open air may confirm the choice of Pulsatilla. Staphysagria A person who needs this remedy usually seems mild-mannered, shy, and accommodating, but has many suppressed emotions. Women around the time of menopause may become depressed, or have outbursts of unaccustomed rage (even throwing or breaking things). Many people needing Staphysagria have deferred to a spouse for many years, or have experienced abuse in childhood.Dr. Rajesh Gupta7 Likes13 Answers
- Login to View the image
ABC OF : ENDOMETRIOSIS. MAY BE USEFUL. ***** ENDOMETRIOSIS :- MORE THAN 1 MILLION CASES PER YEAR (INDIA)....... TREATABLE BY A MEDICAL PROFESSIONALS....... REQUIRES A MEDICAL DIAGNOSIS....... LAB TESTS OR IMAGING OFTEN REQUIRED....... CHRONIC: CAN LAST FOR YEARS OR BE LIFELONG....... ** CONSULT A DOCTOR FOR MEDICAL ADVICE....... *** ENDOMETRIOSIS is an estrogen-dependent disease wherein endometrial-like tissue is found outside the uterus inducing a chronic inflammatory response....... Pelvic organs (esp ovaries) & peritoneum are frequently affected....... *** SYMPTOMS :- MAIN CLINICAL FEATURES INCLUDE: CHRONIC PELVIC PAIN (found in 70-80% of patients) DYSPAREUNIA (suggests deep posterior infiltration) INFERTILITY (21% prevalence rate) OTHER SYMPTOMS may include severe dysmenorrhea, pain on ovulation, noncyclical pelvic pain, cyclical bowel or bladder symptoms w/ or w/o abnormal bleeding or pain, chronic fatigue, or dyschezia....... IN ADOLESCENTS, endometriosis is the most common cause of SECONDARY DYSMENORRHOEA....... Although it is vital to consider the patient's complaints affecting physical, mental & social well-being, it should be noted that patients w/ endometriosis may be completely ASYMPTOMATIC (w/ 2-22% prevalence rate)....... ***** DIAGNOSIS :- Diagnosis of endometriosis is made after taking the PATIENT'S HISTORY & doing PHYSICAL EXAMINATION LABORATORY TESTS, LAPAROSCOPY, & IMAGING studies are performed as well to confirm diagnosis. *** PATIENT'S HISTORY :- Should include: Age (reproductive year, most commonly at 25-29 yr old) In utero exposure to environmental toxins like diethylstilbestrol which increases the incidence of endometriosis Family history of endometriosis (7x higher risk than w/ no family history) *** PHYSICAL EXAMINATION :- Ideally done during early menses because endometrial implants are likely to be largest & deep infiltrating, hence more easily detectable Diagnosis is more definite if deeply infiltrative nodules are found on the uterosacral ligaments or in pouch of Douglas, &/or lesions are directly seen in the vagina or cervix Note that there may be no abnormal findings on physical exam For patients who are not sexually active, a rectal-abdominal exam may be better tolerated than a vag-abdominal exam A cotton swab can be inserted into the vagina to document patency & exclude complete or partially obstructive anomalies such as a transverse vaginal septum, imperforate or microperforate hymen, or an obstructed hemivagina OTHER FREQUENT FINDINGS : Pain w/ uterine movement or pelvic tenderness Tender, enlarged adnexal masses Fixation of adnexa or uterus in a retroverted position *** LABORATORY TESTS :- Urinalysis & urine culture to identify pain originating in the urinary tract (eg cystitis, stones) Pregnancy test & tests for sexually transmitted infection (STI) like gonorrhea, chlamydia, when appropriate....... *** LAPAROSCOPY :- Gold standard for diagnosis, unless lesions are visible in the vagina May also be used for therapeutic purposes Should not be done during or w/in 3 mth of hormonal treatment to avoid under-diagnosis Biopsy & histopathologic study of at least one lesion is ideal 3 cardinal features (ie ectopic endometrial glands, ectopic endometrial stroma, & hemorrhage into adjacent tissue) should be present In adolescents, features of endometriosis may be atypical (ie clear vesicles & red lesions) A negative laparoscopy does not exclude the diagnosis of endometriosis Depending on the severity of the disease found, it is best to remove the endometriotic lesion at the same time Differential diagnoses (eg endosalpingiosis, mesothelial hyperplasia, hemosiderin deposition, hemangiomas, adrenal rests, inflammatory changes, splenosis & reactions to oil-based radiographic dyes) can be excluded by biopsy Laparoscopic Classification (based on location, extent & severity of lesions) : Stages based on American Fertility Society (AFS) Minimal disease (stage I) - characterized by isolated implants & no significant adhesions Mild endometriosis (stage II) - consists of superficial implants <5 cm in aggregate, scattered on the peritoneum & ovaries; with no significant adhesions Moderate disease (stage III) - exhibits multiple implants, both superficial & invasive; peritubal & periovarian adhesion may be evident Severe disease (stage IV) - characterized by multiple superficial & deep implants, including large ovarian endometriomas; filmy & dense adhesions are usually present Severity of symptoms does not match w/ the above stages....... *** IMAGING STUDIES :- ** Transvaginal Sonography (TVS) Considered the 1st-LINE IMAGING TOOL to examine suspected endometriosis Should be performed to determine whether a pelvic mass or structural anomaly is present USEFUL IN DIAGNOSING OR EXCLUDING RECTAL ENDOMETRIOSIS May IDENTIFY an ovarian endometrioma & help identify other structural causes of pelvic pain, such as ovarian cysts, torsion, tumors, genital tract anomalies & appendicitis DISTINGUISHES endometrioma from other ovarian cysts w/ 83% sensitivity & 89% specificity Ovarian endometrioma may be diagnosed in premenopausal women w/ findings of ground glass echogenicity & 1-4 compartments & absence of papillary structures w/ blood flow ** MAGNETIC RESONANCE IMAGING (MRI) : May be helpful in some cases to better define an abnormality suspected by sonography Detects ovarian endometrial cysts w/ 90% sensitivity & 98% specificity Provides exact location of deep retroperitoneal lesion May be used as part of pre-op workup, but should not be used as 1st-line ** MISCELLANEOUS TESTS : Serum CA-125 Women w/ endometriosis may have HIGH serum CA-125 concentration NO VALUE AS DIAGNOSTIC TOOL in endometriosis ALSO ELEVATED in ovarian epithelial neoplasia, myoma, adenomyosis, acute PID, ovarian cyst, pregnancy....... ** BIOPSY : May be considered in suspected endometriosis lesions & endometriomas to help confirm the diagnosis & exclude possible malignancy In patients w/ endometriosis, prevalence of ovarian cancer is <1% *** TREATMENT :- Management of endometriosis includes medical therapy w/ first-line agents oral contraceptives & progestins....... Second-line agents include Danazol, gonadotropin-releasing hormone (GnRH) agonists, Levonorgestrel intrauterine system, & aromatase inhibitors....... Supportive therapy w/ nonsteroidal anti-inflammatory drugs (NSAIDs) may be given to provide pain relief....... Surgery should only be done in women w/ endometriosis-related pain after medical treatment has failed....... Combined medical/surgical therapy is medical therapy given before &/or after surgery.......Dr. Puranjoy Saha22 Likes20 Answers
- Login to View the image
46 yr male... multiple space occupying lesion liver....fnac done...it's malignant...AFP is 6.06, CA125= 126Dr. Richa Kumar2 Likes19 Answers
- Login to View the image
Cancer in the Ovaries - Causes, Symptoms, Treatment & Prevention medindia.net Sep 20, 2017 12:00 PM What is Ovarian Cancer? ￼ Ovarian Cancer It refers to cancer of ovaries. It is called the "Silent killer", as it is difficult to detect this cancer in the early stages. Ovarian cancer starts when cells inside, near or on the outer layer of the ovaries grow abnormally out of control. Ovarian cancer is the 5th most common cancer in women and the most common cause of gynecologic cancer deaths. The lifetime risk for developing ovarian cancer in women is less than 2%; this risk is higher in women with a strong family history of ovarian and breast cancer. Cells are the basic units of all living organisms and form organs when they are grouped together. The term cancer indicates an uncontrollable division and growth of cells of a particular organ. The cancer cells thus produced are immature and non-functioning; they crowd out the normal functioning cells and cause disease of the body organ. What are Ovaries and What is their Function? The female reproductive system consists of internal organs such as the uterus, cervix, vagina, ovaries and fallopian tubes. The external structures include the breasts and labia. The ovaries are two small almond shaped organs that lie on either side of the uterus in a depression called the ovarian fossa. They are connected to the uterus by fallopian tubes which are hollow muscular tubes. The ovaries’ primary function is to store the ova (eggs) which a female child is born with; these ova reach maturity at puberty and every month one ovum is released during menstruation. The ova pass through the fallopian tubes into the uterus. The ovaries also produce estrogen and progesterone which are the female hormones. They regulate menstruation and development of sex organs. What are the Different Types of Ovarian Tumors? Ovaries contain 3 different types of cells: the epithelial cells, the germ cells and the stromal cells. Tumors can develop in any of these cells.Epithelial tumors: Epithelial tumors originate from the epithelial cells; this forms the outermost layer of the ovary. Epithelial cancers account for 90% of all ovarian cancers.Germ cell tumors: These tumors develop from the cells that produce the eggs.Stromal cell tumors: Ovarian stromal cells are structural tissue cells that hold the ovary together and produce the female hormones. Tumors arising from these stromal cells are called stromal tumors. Germ cell tumors and stromal tumors are quite rare. Other related cancers are - Primary peritoneal cancer is cancer that develops in cells from the peritoneum or abdominal lining. It is very similar in appearance, symptoms, and spread like the ovarian epithelial cancer as well as in treatment methods. Fallopian tube cancer is cancer that starts in the fallopian tubes and is also similar to the ovarian epithelial cancer in terms of symptoms and treatment methods. What are the Risk Factors for Ovarian Cancer? The exact cause of development of ovarian cancer is still unknown. Risk factors have been found for epithelial ovarian cancers which are mentioned below; these do not apply for the other types of ovarian cancer. ￼ Age: Ovarian cancer is mainly seen in post-menopausal women, usually over 50 years of age.Reproductive history: Women who have never been pregnant or who have had their first full term pregnancy after 35 years of age are at a higher risk.Obesity: Women who are obese, with a BMI of > 30 are at an increased risk.Endometriosis is a condition when tissue that usually lines the inside of the uterus grows outside it, like in the ovaries or fallopian tubes.Drugs: Some studies have found that taking clomiphene citrate (a drug used in infertility treatment) for more than a year; taking male hormonal drugs (e.g. danazol) or post-menopausal women taking estrogen only hormonal replacement therapy (HRT) for more than 5 years increased risk of developing ovarian cancer.Assisted reproductive technologies like in-vitro fertilizationFamily history of ovarian cancer: The risk of developing ovarian cancer increases if the woman’s first degree relative has had ovarian cancer. The risk increases with the number of relatives affected (both on the maternal and paternal side of family).Family cancer syndromes: There is a link between developing ovarian cancer and family history of other cancers such as breast cancer, colorectal cancer, prostate cancer, pancreatic cancer and other cancers. This is due to change (mutation) in the gene causing cancers; this gene is inherited among family members. Hereditary ovarian and breast cancer syndrome are caused by inherited mutations mainly in BRCA1 and BRCA2 genes; these mutated genes are also responsible for fallopian tube, pancreatic and peritoneal cancers. The lifetime ovarian cancer risk with BRCA1 mutation is between 35-70% and with BRCA2 mutation is 10-30%.Talcum powder: Using talcum powder over the genital area or on sanitary napkins (maybe due to the asbestos that used to be added to talcum powder prior to 1970s) has been shown to cause a slight increased risk of developing ovarian cancer.Smoking has been related to increased risk of developing mucinous ovarian cancer.Some of the ways to lower your risk factors are as follows:Women who have had their first full term pregnancy before 26 years of age or who had multiple full term pregnancies are at a lower risk to develop ovarian cancer.Breastfeeding helps to lower ovarian cancer risk as it prevents ovulation.Using birth control pills or depot injection also lowers ovarian cancer risk as it inhibits ovulation.Research has shown that women who had tubal ligation or a hysterectomy with conservation of ovaries are at a lower risk to develop ovarian cancer. Further studies are still needed to corroborate this fact. ￼ What are the Different Stages of Ovarian Cancer? Staging is the process of finding the extent of spread of cancer and is important as it will guide the diagnosis, treatment and the prognosis of the disease. Staging is done with the help of imaging and during surgery.Stage 1: The cancer is within the ovary/ovaries and/or the fallopian tube/tubes.Stage 2: The cancer is in one or both ovaries and/or fallopian tubes and has spread to other organs in the pelvis (uterus, urinary bladder, sigmoid colon or rectum).Stage 3: The cancer has spread beyond the pelvis to the lining of the abdomen or has spread to the lymph nodes in the back of the abdomen.Stage 4: The cancer has spread to distant organs like liver, spleen, lungs, brain or skin. What are the Signs and Symptoms of Ovarian Cancer? Ovarian cancer usually causes symptoms when the cancer has spread beyond the ovaries, although in some patients even early stage cancer can cause symptoms. They include:Abdominal bloatingUpper or lower abdominal painFeeling full despite eating smaller amounts of foodLoss of appetiteLoss of weightAcid refluxNausea, vomitingUrinary frequency or urgencyFatigueVaginal bleeding after menopauseMenstrual changesLow back painPainful sexual intercourseDiarrhea or constipationAbdominal swelling due to fluidAbdominal or pelvic mass (not fibroids) ￼ How is Ovarian Cancer Diagnosed? If any of the symptoms are severe and occur frequently (more than 12 times/month), and is a change from a woman’s normal self, ovarian cancer needs to be ruled out.Medical history: A detailed history of symptoms, risk factors and family history should be taken.Physical examination: A detailed physical examination of the abdomen and pelvis helps to identify any tumorous growths or fluid in the abdomen.Imaging studies: A transvaginal ultrasound and an ultrasound of the abdomen are performed to identify pelvic or abdominal masses. MRI or CT scan of the abdomen and pelvis is performed to identify the extent and spread of the disease. A CT scan of the chest and/or positron emission tomography (PET) scan are performed to check if the cancer has spread to chest and other parts of the body.Tumor markers: Tumor markers or biomarkers are proteins found in abundance in cancer cells when compared to healthy cells. CA 125 (Cancer Antigen 125) is a protein found in ovarian cancer cells and is measured by a blood test. Some germ cell tumors cause increased levels of tumor markers such as Alpha fetoprotein (AFP), Beta HCG (human chorionic gonadotrophin) and /or LDH (Lactate Dehydrogenase).Some stromal cell cancers can increase the levels of estrogen, progesterone and a substance called inhibin.Blood tests include complete blood picture, liver function tests, kidney function tests and ESR.Laparoscopy: This is a procedure in which a doctor can look at the insides of the abdominal cavity. This is useful to confirm the diagnosis and the spread of the cancer.Colonoscopy: If the cancer has been found to spread to the large bowel, a colonoscopy is done to confirm the diagnosis and remove it.Tissue biopsy: A definitive diagnosis of cancer can be made by taking a small tissue sample from the tumor during surgery and studying it under the microscope. In rare cases (when the woman cannot have surgery due to ill health or in advanced cancer) the biopsy can be obtained during laparoscopy (or colonoscopy) and also from an ultrasound or CT scan guided percutaneous biopsy procedure. There are some concerns that cancer cells can spread through this type of tissue biopsy.Paracentesis: In patients with ascites, a small sample of fluid is aspirated through a needle attached to a syringe and studied for cancer cells.Genetic tests to identify inherited mutations in genes such as BRCA1 and BRCA 2 can be offered to women with a strong family history of breast and ovarian cancer. How is Ovarian Cancer Treated? Most of the ovarian tumors are benign tumors, which are non-cancerous and do not spread beyond the ovaries. These are usually treated by removing a part or the full ovary. Tumors that are cancerous are called malignant tumors and can spread beyond the ovaries to distant parts of the body. These are usually fatal if not treated appropriately. There are various types of treatments; the choice of treatment depends on the type and staging of cancer. Surgery: Surgery is the main treatment for majority of ovarian cancers. The affected ovary/ovaries along with the fallopian tubes, uterus, cervix and omentum are removed. ￼ Chemotherapy: Chemotherapy is treatment of cancer by using two or more drugs. These are given intravenously or orally. Chemotherapy is often given after surgery to destroy any remnant cancer cells, to shrink the tumor or to relieve the patient of their symptoms. Gemcitabine, capecitabine, melphalan and other similar drugs are usually used. Targeted therapy: The metabolism of cancer cells is different from surrounding healthy cells. In targeted therapy, injected drugs attack only the cancer cells without destroying the healthy cells. Bevacizumab, olaparib, and rucaparib are commonly used. Radiation therapy: Radiation therapy refers to destroying cancer cells by using high energy X-rays / particles. Radiotherapy is now not so commonly used and is usually given to women who are in advanced stages of cancer, who cannot undergo surgery, who have cancer recurrence after surgery or to relieve symptoms. Hormone therapy: Hormone therapy is use of hormones or hormone blocking drugs to destroy cancer cells. Commonly used drugs are anastrazole, exemestane, tamoxifen and goserelin. Newer therapies involving use of cytokines, chromatin remodeling proteins and immunomodulators are being tested as treatment options. Once the treatment is completed, patients should see their doctor every 3 months; this is done to identify recurrence of ovarian cancer or development of a new cancer (breast cancer, colorectal cancer, or leukemia) early on. The patient is examined and investigations such as tumor markers and imaging studies are performed as necessary. Health Tips Eating a well-balanced diet rich in vegetables, fruits, whole grain products and limiting red meat intake has been shown to prevent various types of cancers.Stopping smoking is beneficial for a healthy life.Exercise helps to improve physical and mental health.Practicing relaxation therapies or meditation helps to control stress and anxiety. Report a problemDr. Tapan Kumar Sau4 Likes7 Answers
- Login to View the image
HORMONE REPLACEMENT THERAPY (HRT) HRT is a treatment used to relieve symptoms of Menopause.It replaces the hormones that are at a lower level as you approach menopause. COMMON SYMPTOMS. *Hot flushes-short,sudden feelings of heat,usually in the face,neck and chest,which can make the skin red and sweaty. *Night sweats. -hot flushes that occur in the night. *Difficulty sleeping. *Reduced sex drive. *Problems with memory and concentration. *Vaginal dryness and pain,itching or discomfort during sex. *Headache. *Mood changes. *Palpitations. *Joint stiffness,aches and pains. *Reduced muscle mass. *Recurrent UTI. BENEFITS OF HRT. *HRT relieves most of the menopausal symptoms like hot flushes, night sweats, mood swings ,vaginal dryness and reduced sex drive. CONTRA INDICATIONS FOR HRT. HRT not suitable in cases of *History of breast /ovarian /uterine cancer. *History of thromboembolism. *History of liver disease. TYPES OF HRT. 1)Only estrogen : women who have undergone hysterectomy and bilateral oophorectomy can take only estrogen,they don't need progesterone as there is no risk of endometrial cancer. 2)Cyclical HRT. Perimenopausal women with symptoms can take estrogen for 4 weeks and progesterone in the latter two weeks. 3)Continuous HRT.for post menopausal women.they take Continuous combination of estrogen and progesterone. Ex Tibolone. HRT can be taken in the following forms. *Cream /gel :placed either on skin or vagina in a case of vaginal dryness. *Tablets. *Skin patch. HRT is taken a the lowest dose till the symptoms are reduced.once there is relief of symptoms,they can be weaned off. ADDED BENEFITS OF HRT. *HRT prevents bone density loss ,preservesbone integrity and reduces the risk of fractures. *Reduces the risk of colon cancer. SIDE EFFECTS. *Breakthrough bleeding. *Breast tenderness. *Bloating ,nausea. HRT RELATED HEALTH RISKS. *Women who used. combined E&P for >>5 years are at increased risk of breast cancer. *Women >>60 years on combined HRT has a small increased risk of heart disease and stroke. * Increased risk of venous thromboembolism. (not seen with non oral therapy like patches,implants and gels) *Increased risk of endometrial cancer in those taking oestrogen only HRT. *Increased risk of ovarian cancer. In the Indian scenario, 99 %of women hesitate to take HRT.for that matter,even old highly qualified persons including doctors don't prefer HRT.Dr. Suvarchala Pratap8 Likes4 Answers