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.

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.

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. 

Stage	Survival Rate
1	90%
1A	94%
1B	92%
1C	85%
2	70%
2A	78%
2B	73%
3	39%
3A	59%
3B	52%
3C	39%
4	17%

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.

Severe Bloating from Fibroids

When fibroids become enlarged, they may press on the surrounding organs, including the bowel. This sometimes leads to constipation, resulting in slower bowel movements and blocked intestines. A woman may feel bloated or complain of a feeling of 'fullness'. If you do experience constipation as a result of fibroids, you may consider a stool softener.

Where a fibroids diagnosis has not be given, but you continue to experience abdominal bloating, constipation and weight gain, ask your doctor for a pelvic examination. These are also signs of ovarian cancer.

Some women may have uterus the size of a 4 to 5 month pregnancy with several large fibroids. The upper abdomen will get severely bloated and tight at times. You will feel like it is going to blowup when the pressure gets severe. Size of the fibroid can be very large fibroid making women's uterus the size of a full term pregnancy.

Some patients experience inconsistency in the sizes of fibroids. "I can put on a pair of pants in the morning, and they'll be too tight by the end of the afternoon if I'm on my feet too much. Yesterday, I scrubbed my bathtub and felt horrible for the rest of the day. One day constipation... the next diarrhea. Today I hurt all the way from my lower back all the way to my thighs... it's really gotten much worse in the last couple of weeks. And feeling like "something is going to drop out of me...." said one of the patients. 

I too feel really "full" at times. But I have found with moving or walking a bit it "moves" and the pain is easier. Not sure if this makes sense. My fibroids have my uterus about 4 months pregnant size. I also am finding I need to go to the bathroom more often, possibly pressing on my bladder now. And I too have had the diarrhea for "no reason". Mentioned another patient. 

Treatment 

Small fibroids do not usually require any treatment. If fibroids are small, they will be monitored regularly and treated only if they grow in size. If a fibroid causes a significant amount of pain, over-the-counter or prescription pain relievers may be used to reduce the severity of the pain. Low dose birth control pills may also be used to maintain hormonal balance and stop the growth of fibroids, according to Women's Health. A medication called a gonadotropin releasing hormone agonist may be given to decrease the size of fibroids. If medications are ineffective or the symptoms of fibroids interfere with daily life, surgery may be needed.

A myomectomy is used to remove only the fibroids from the affected area of the uterus. If there are a large number of fibroids present, a hysterectomy, which is the removal of the entire uterus, may be necessary.

Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended when other treatment options are not available or have failed. It is expected that the frequency of hysterectomies for non-malignant indications will fall as there are good alternatives in many cases. The video below shows how a large intramural fibroid was removed by Dr Vijayavel.

Women's cancer : Ovarian cancer

 

Overview 

Ovarian cancer accounts for approximately 3 percent of all women's cancer and is the fifth leading cause of cancer-related death among women in the United States. In 2014, it is estimated that nearly 22,000 women will be diagnosed with ovarian cancer in the United States, and approximately 14,000 will die of the disease. Ovarian cancer incidence rates declined by nearly 1 percent annually from 1987 to 2011; mortality rates fell an average of 1.6 percent each year from 2001 to 2010. White women have higher incidence and mortality rates than women of other racial/ethnic groups. To avoid these cancers, it's important to understand them.

The most common type of ovarian cancer is called ovarian epithelial cancer. It begins in the tissue that covers the ovaries. Cancer sometimes begins at the end of the fallopian tube near the ovary and spreads to the ovary. Cancer can also begin in the peritoneum and spread to the ovary. The stages and treatment are the same for ovarian epithelial, fallopian tube, and primary peritoneal cancers.

Another type of ovarian cancer is ovarian germ cell tumor, which is much less common. It begins in the germ (egg) cells in the ovary. Ovarian low malignant potential tumor (OLMPT) is a type of ovarian disease in which abnormal cells form in the tissue that covers the ovaries. OLMPT rarely becomes cancer.

Cancers of the ovaries, fallopian tubes, and primary peritoneum are the fifth leading cause of cancer death in women in the U.S. These cancers are often found at advanced stages. This is partly because they may not cause early signs or symptoms and there are no good screening tests for them.

This cancer usually occurs in women over age 50 but can affect younger women. It causes more deaths than any other women's cancer of the female reproductive system and is the leading cause of death from gynecologic cancer in the developed world. Its cause is unknown. 

Ovarian Cancer Symptoms 

Symptoms include:

• Bloating or pressure in the belly
• Pain in the abdomen or pelvis
• Feeling full too quickly during meals
• Urinating more frequently 

These symptoms can be caused by many conditions that are not cancer. If they occur persistently for more than a few weeks, report them to your health care professional.

  

Prevention

Each time you ovulate, your ovaries are damaged by the egg as it breaks through the surface of the ovary and is released into your reproductive system.

The cells that make up the surface of your ovaries divide and multiply rapidly to repair the damage caused by the egg. It's this rapid cell growth that can occasionally go wrong and result in ovarian cancer.

Anything that stops the process of ovulation can help to minimise your chances of developing ovarian cancer. This includes:

• pregnancy and breastfeeding
• the contraceptive pill
• hysterectomy surgery (removal of the ovaries)
• Tubal ligation is having the fallopian tubes tied surgically to prevent pregnancy.
• A salpingectomy, which is the removal of the fallopian tubes, is also sometimes recommended for women with a risk of ovarian cancer. 

You cannot control some things that put you at risk for ovarian cancer, such as your family history or inheriting gene changes. But you can make some personal choices that lower your risk of cancer and other diseases.

• Eat a healthy diet with plenty of fruits, vegetables, and whole grains.
• Be active. Talk with your doctor about what kinds of activity and how much activity would be good for you.

If you are at a very high risk because of your family history, you may want to have gene testing. Women at very high risk because of inherited genes may want to have surgery to remove their ovaries and fallopian tubes. This is usually done between the ages of 35 and 40, or when women are finished having children. Having this surgery greatly reduces a woman's risk for ovarian cancer, but it will cause a woman to start menopause early, which may have other risks.  

Angiogenesis

Researchers are working on therapies that target the way ovarian cancer grows. A process called angiogenesis involves the formation of new blood vessels to feed tumors. A drug called Avastin blocks this process, causing tumors to shrink or stop growing (seen in the illustration here). Avastin is approved for other cancers, but ovarian cancer researchers are still testing this therapy, which can have serious side effects. 

According to the American Cancer Society, eating right, being active, and maintaining a healthy weight are important ways to reduce your risk of cancer as well as other diseases. For the American Cancer Society's for diet and fitness, please visit www.cancer.org.

What is the difference between Kista Endometriosis and Ovarian Cysts?

KISTA ENDOMETRIOSIS

 

Kista Endometriosis is a condition in which tissue similar to the lining of the uterus is located outside the uterus. Usually there are implants of this tissue in the pelvis. When the lining of the uterus bleeds during the menstrual cycle, these implants also bleed. This causes pain and scarring in the pelvis. The other pelvic structures react to this bleeding by becoming adherent to each other so that tubes, ovaries and intestine are stuck together. If the endometrial tissue is within an ovary, that ovary will fill with blood. These are called endometriomas and are cysts in the ovary filled with old blood. This old blood has the appearance of thin chocolate or motor oil. They are also called chocolate cysts of the ovary. Endometriomas are frequently found at surgery for ovarian cysts. An elevated Ca-125 is often associated with endometriosis. (Source: William M. Rich, M.D. Clinical Professor of Obstetrics and Gynecology, University of California, San Francisco, Director of Gynecologic Oncology, University Medical Center, Fresno, California).

A video explanation on Kista endometriosis and its symptoms:

https://www.youtube.com/watch?v=yM88T1R8HD4

OVARIAN CYSTS

 

Ovarian cysts are fluid-filled sacs in the ovary. They are common and usually form during ovulation. Ovulation happens when the ovary releases an egg each month. Many women with ovarian cysts don't have symptoms. The cysts are usually harmless. (Source: Cheryl B. Iglesia, M.D., FACOG, Professor, Department of Obstetrics and Gynecology, Georgetown University School of Medicine; Director, Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center; Food and Drug Administration Advisory Committee).

A video explanation on Ovarian Cysts and its symptoms:

https://www.youtube.com/watch?v=X8N4M_2dJh0 

Why are so few major gynaecologic procedures performed laparoscopically?

The answer is relatively simple. Major laparoscopic surgical procedures are difficult for most gynaecologic surgeons to master. The gynaecologist must perform many simple laparoscopic procedures to develop the skill necessary to perform the more complex surgeries. They must perform these procedures on a regular basis to develop and maintain expertise. As a result, unfortunately, most gynaecologic surgeries for benign disease are still performed abdominally, although experts throughout the world agree that the vast majority could safely and efficiently be performed laparoscopically. However, it is important that the patient understand that these procedures should be performed by a qualified gynaecologic oncologist who has experience in the proposed procedure either using traditional surgical methods or Laparoscopic surgery.

The surgeries shown in the video clips are entirely done by Dr Vijayavel and my experienced team at KPJ Klang Specialist Hospital.

Dr Vijayavel's laparoscopic surgery removing kista endometriosis:

https://www.youtube.com/watch?v=2GYdq72zwaY

Dr Vijayavel's laparoscopic surgery removing ovarian cyst (gangrenous):

https://www.youtube.com/watch?v=i2R61IuVHao

Further interesting viewing: 

World's largest ovarian cyst. https://www.youtube.com/watch?v=l8AvIJKBb1M

Giant ovarian cyst or pregnant? https://www.youtube.com/watch?v=rZLk0UQJVoI

Ovarian Cysts

Ovarian cysts: These growths can develop in a woman during her reproductive years. They can cause torsion (twisting), infection, rupture, and cancer. These dermoid cysts can be removed with either conventional surgery or laparoscopy (surgery that uses small incisions and specially designed instruments to enter the abdomen or pelvis).

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months. 

What causes functional ovarian cysts? 

A functional ovarian cyst forms because of slight changes in the way the ovary makes or releases an egg. There are two types of these cysts: 

• A follicular cyst occurs when a sac on the ovary does not release an egg, and the sac swells up with fluid.

• A luteal cyst occurs when the sac releases an egg and then reseals and fills with fluid.

Further viewing: 

 
Complication Ovarian Cyst (Gangrenous)
Laparascopic Endometriotic Cyst Removal
Other videos : http://www.caringgynae.com/video.html