Ovarian cancers can arise from the ovaries on either side of the lower abdomen, and arise primarily from cells of the ovary or secondarily from cancer spread from other cancers such as gastric and colorectal cancers. These secondary tumours are known as Krukenberg tumours.
The symptoms of an enlarging ovarian cancer include lower abdominal discomfort, pain and an enlarging abdomen with increasing girth. In the late stages of the disease, shortness of breath and loss of weight are also possible symptoms.
Ovarian cancers from secondary spread may require a Gastroscopy and Colonoscopy to rule out primary tumours in these organs
Ovarian Cysts are water-filled sacs that arise from either of the ovaries. Ovarian cysts can be benign or cancerous in nature. Benign Ovarian Cysts include functional, endometriotic, corpus luteal, follicular, dermoid cysts and cystadenomas. Cancerous Ovarian Cysts are essentially ovarian cystadenocarcinomas, of which there are different subtypes.
Ovarian cysts can be diagnosed on ultrasound, CT scans and MRI scans. The characteristics of the cyst on these imaging methods coupled with the CA125 tumour marker level will often give a good idea of whether a cyst is benign or cancerous. Large cysts will often need removal as there is a risk of cyst rupture or twisting of the cyst (torsion) in addition to the risk of harbouring a cancerous component.
Ovarian Torsion refers to the twisting of the ovary around its blood supply, also known as the pedicle. Ovarian Torsion can result in the death of the associated ovary if the diagnosis was delayed and the torsion is not treated in time. Ovarian torsion usually occurs in the presence of a sizeable ovarian cyst or some fibrous bands (adhesions) attached to the ovary.
The initial symptom of ovarian torsion is a non-specific lower abdominal discomfort. This often progresses to a pain that is clearly localised to the lower abdomen on the affected site. This pain can last for several days and may have periods of improvement and subsequent deterioration as the ovary undergoes periodic twisting and untwisting. The pain then progresses to severe and constant pain if the ovary has subsequently died.
Ovarian torsion is a surgical emergency and requires emergency surgery. The surgery can usually be performed via a keyhole/laparoscopic approach though an open approach may be needed for severe cases
Pelvic Inflammatory Disease (PID) refers to an infection of one or more gynaecological/female reproductive organs. The infected organs include the fallopian tubes, ovaries, uterus and the lining of the pelvis (peritoneum). Pelvic Inflammatory Disease often occurs in association with a urinary tract infection. The common bacteria involved in PID include chlamydia and gonorrhoea, which are sexually transmitted. Additionally, other bacteria like Streptococcus can also cause PID but are not sexually transmitted.
Pelvic Inflammatory Disease starts off as lower abdominal discomfort which then progresses to severe pain. The pain can also localise to the centre or either side of the lower abdomen depending on the affected organs.
The treatment of Pelvic Inflammatory Disease usually involves oral or intravenous antibiotics. In cases with abscess formation, radiologically-guided tube drainage or open surgical drainage may be necessary.
An Ectopic Pregnancy refers to the implantation of the embryo outside of the uterus. The most common site of ectopic pregnancy is the fallopian tube. The ovary and other sites in the abdomen are much rarer sites of ectopic pregnancy.
An Ectopic Pregnancy invariably results in a rupture of the embryo as these sites outside of the uterus are not able to support the pregnancy till maturity. A ruptured Ectopic pregnancy will result in severe lower abdominal pain. The patient often also experiences low blood pressure, a racing heart rate and may have had fainting spells prior to admission.
Emergency surgery is needed for a ruptured Ectopic Pregnancy. This can often be done as a keyhole/laparoscopic surgery though an open surgery may be necessary if the patient is very unstable.
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