Saturday, June 25, 2016

Rupture in Large Kista Endometriosis Cyst

Rupture of the endometriotic cysts can occur any time of the cycle during the menstrual flow. Kista endometriosis is a common disease in women, the incidence varying from 10 to 50 percent in different parts of the world. Acute abdomen pain results from rupture of ovarian kista endometriosis cysts. Other symptoms are fever, vaginal bleeding. The pain was sudden, severe and continuous.

Cases of acute ovarian kista endometriosis cyst rupture are rare, but they may be associated with severe peritonitis and systemic disturbance, followed by adhesion formation. A theory on the formation of ascites in endometriosis was postulated by Bernstein, who suggested that the blood and endometrial cells shed into the peritoneal cavity may irritate and stimulate the peritoneum, thereby resulting in ascites. Other authors have reported that rupture of endometriotic cysts with subsequent peritoneal irritation and the production of reactive exudates may provide an explanation. Ruptured endometriotic cysts sometimes present a diagnostic problem and surgical challenge because patients with a ruptured cyst present with symptoms of an acute abdomen associated with severe abdominal pain and unstable vital signs. Ruptured ovarian endometriotic cysts can sometimes mimic ovarian malignancy because of the extremely elevated serum CA 125 concentration.

Emergency surgical intervention may lead to a better prognosis, particularly in patients without a history of previous endometrioma surgery.

In patients with ruptured kista endometriosis cysts, the ascites is usually confined to the pelvic cavity with a loculated contour, and this suggests associated pelvic adhesion, which is an extremely common and important complication of endometriosis. After a corpus luteal cyst ruptures, hemoperitoneum will be present within the pelvis and possibly throughout the abdomen. Higher attenuation blood is typically present within the pelvis, as compared with being present the abdomen, and blood may be present adjacent to the cystic lesion, indicating that the source of the hemoperitoneum is cyst rupture.

A Corpus luteum cyst is a type of ovarian cyst which may rupture about the time of menstruation, and take up to three months to disappear entirely. A corpus luteum cyst rarely occurs at age 50+, because eggs are no longer being produced in menopausal women. Corpus luteum cysts may contain blood and other fluids. The physical shape of a corpus luteum cyst may appear as an enlargement of the ovary itself, rather than a distinct mass -like growth on the surface of the ovary.

The CT appearance of ruptured endometriotic cysts is relatively distinctive compared to that of ruptured functional cysts, and the accurate preoperative characterization of ovarian cyst via CT will help the surgical planning. In conclusion, the diagnosis of ruptured endometriotic cyst should be suspected for a woman in whom CT reveals the presence of multilocular or bilateral ovarian cysts with a thick wall and loculated ascites confined to pelvic cavity with pelvic fat infiltrations.

This video shows how Dr Vijay removes a ruptured kista endometriosis cyst using laparascopy.

Sunday, June 12, 2016

Types of Ovarian Cysts

Physiologic (also called functional) – one kind occurs prior to ovulation and is called an ovulation or follicular cyst. Another kind occurs after ovulation and is called a corpus luteum cyst.

With few exceptions physiologic cysts go away on their own and don't require surgery.

Or Pathologic – these are abnormal and generally do not go away by their selves. 

What is a pathologic ovarian cyst?


These cysts don't serve a function–the majority of them occur in women under 50 and are benign. There are many different kinds of pathologic ovarian cysts – most are benign. You may have heard of some of these. 

Dermoid cyst is one type of pathologic ovarian cyst. These cysts contain many types of cells. They may be filled with hair, teeth, and other tissues that become part of the cyst. They too are generally painless but can become large and often show up on either a pelvic examination or a routine ultrasound. 

Endometriomas. These cysts form in women who have kista endometriosis. Kista endometriosis occurs when tissue that normally lines the inside of the uterus grows outside the uterus-often on the surface of the uterus, bowel, bladder or ovaries. When the tissue becomes attached to the ovary it tends to grow rapidly and can produce large ovarian cysts. These cysts can produce pain, infertility and even make it difficult to have sex. 

Cystadenomas. These cysts form from cells on the outer surface of the ovary. They are often filled with a watery fluid or thick, sticky gel. They can become large and cause pain. Most often, however, these cysts do not cause pain unless they twist or rupture. 

Polycystic ovaries. These cysts are caused when eggs mature within the "little balloons" but are not released. The cycle then repeats. The sacs continue to grow and many cysts form. Women with polycystic ovaries often have other issues which may include irregular periods and infertility.

What Are The Symptoms?

Dermoid cysts of the ovaries are capsules of tissue which are covered in a thick layer of leathery skin. They can grow on one or both ovaries. Most do not cause symptoms, however if the tumor grows it can result in complications. Possible complications include:

  • Abdominal pain.
  • Abnormal vaginal bleeding.
  • Difficulties in urinating if the cyst puts pressure on the bladder.
  •  Nausea, sometimes accompanied by vomiting.
  • Painful intercourse.
  • Persistent dull ache in the thighs and lower back.
  • Unexplained weight gain. Some women report bloating of the tummy, to the point where they can appear 6 months pregnant.

Dermoid cysts are rarely a medical emergency. The only time they are likely to become so is where ovarian torsion occurs. 

Dermoid cyst of the ovary : A dermoid cyst develops from a totipotential germ cell (a primary oocyte) that is retained within the egg sac (ovary). Being totipotential, that cell can give rise to all orders of cells necessary to form mature tissues and often recognizable structures such as hair, bone and sebaceous (oily) material, neural tissue and teeth.

Dermoid cysts can range in size from a centimeter (less than a half inch) up to 45 cm (about 17 inches) in diameter. These cysts can cause the ovary to twist (torsion) and imperil its blood supply. The larger the dermoid cyst, the greater the risk of rupture with spillage of the greasy contents which can create problems with adhesions, pain etc. Although the large majority (about 98%) of these tumors are benign, the remaining fraction (about 2%) becomes cancerous (malignant).

Removal of the dermoid cyst is usually the treatment of choice. This can be done by laparotomy (open surgery) or laparascopy (with a scope). Torsion (twisting) of the ovary by the cyst is an emergency and calls for urgent surgery.

Watch how Dr Vijayavel successfully removed a large dermoid cyst using laparascopy.

Friday, June 3, 2016

Surviving Women's Cancer - Ovarian Cancer

While Ovarian Cancer in the lymph nodes is certainly not a good thing, the prognosis is not any worse than someone staged at IIIC due to the size and locations of metastasis. As a matter of fact, in some cases, disease in the lymph nodes affords a better prognosis than those staged at IIIC due to bulky disease in the upper abdomen.

There has been extensive research on this topic. Several studies indicate that ovarian cancer, even when found in the lymph nodes, is not very likely to spread via the lymphatic system. There is also studies that show that many women are upstaged to IIIC due lymph node involvement, and those that are upstaged ( not really a true stage IIIC otherwise ) have significantly better survival than those who are "true" staged IIIC. 

Survival Rates  

Ovarian Cancer Research Fund
wrote that for all types of ovarian cancer or women's cancer taken together, about 3 in 4 women with ovarian cancer live for at least 1 year after diagnosis. Almost half (46%) of women with ovarian cancer are still alive at least 5 years after diagnosis. Women diagnosed when they are younger than 65 do better than older women.

Most women diagnosed with Stage III ovarian cancer have a five-year survival rate of approximately 34%. Survival rates are often based on studies of large numbers of people, but they can't predict what will happen in any particular person's case. Other factors impact a woman's prognosis, including her general health, the grade of the cancer, and how well the cancer responds to treatment. 

Women'sCancer Staging  

Brenda B. Spriggs, MD, MPH, FACP from Healthline says "Staging is a way of describing how far the cancer has spread and how aggressive it is. This usually can't be determined until after surgery. Knowing the stage helps doctors formulate a treatment plan and gives you some idea of what to expect. These are the four stages for ovarian cancer."

Stage 1

In stage 1, the cancer has not spread outside the ovaries. Stage 1A means the cancer is only in one ovary. In stage 1B, the cancer is found in both ovaries. Stage 1C means one or both ovaries contain cancer cells, and there are cancer cells outside an ovary. 

Stage 2 

In stage 2, the cancer has occurred in one or both ovaries, and it has spread elsewhere within the pelvis. Stage 2A means it has gone from the ovaries to the fallopian tubes, the uterus, or to both. Stage 2B indicates the cancer has migrated to nearby organs like the bladder, sigmoid colon, or rectum. 

Stage 3 

In stage 3, the cancer is found in one or both ovaries and in the lining of the abdomen, or it has spread to lymph nodes in the abdomen. In Stage 3A, the cancer is found in other pelvic organs and in lymph nodes within the abdominal cavity (retroperitoneal lymph nodes), or in the abdominal lining. Stage 3B is when the cancer has spread to nearby organs within the pelvis. Cancer cells may be found on the outside of the spleen or liver, or in the lymph nodes. Stage 3C means larger deposits of cancer cells are found outside the spleen or liver or it has spread to the lymph nodes. 

Stage 4 

In stage 4, the cancer has spread to distant sites. In stage 4A, cancer cells are present in the fluid around the lungs. Stage 4B means it has reached the inside of the spleen or liver, distant lymph nodes, or to other distant organs such as the skin, lungs, or brain. This is the most advanced stage of ovarian cancer. 

Survival Rate

What affects survival 

The latest study, which was quoted by Cancer Research UK reported that your survival rate depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread.

The type and grade of ovarian cancer affects your likely survival. Grade means how abnormal the cells look under the microscope.

Your likely survival is also affected by whether the surgeon can remove all the tumour during initial surgery.

Your general health and fitness may also affect survival. Doctors have a way of grading how well you are. This is called performance status. Women who have a good performance status have a better outlook.

Age also affects outcome and survival is better for younger women. 

Judith Fox, a women's cancer survivor of stage 3C adds "You are an individual," she said, "and survival rates are statistics based on thousands of women." She continued, "The statistics will not predict how you will respond to treatment.

"When you get into treatment, you have a choice - you can dwell on where you are, or you can focus on the things you have to look forward to." said Danielle Dennis, remembering when she was diagnosed with ovarian cancer.