Know Your Disease

It is a malignant tumor that arises from the endometrium (inner lining of the uterus).

• Endometrial cancers are usually diagnosed in the early stages because they present with menstrual irregularities.
• Post menopausal vaginal bleeding.
• Heavy and prolonged periods.
• Lower abdominal pain.
• Bleeding in between periods.

Surgery (radical hysterectomy with pelvic and para aortic lymphadenectomy) or radiation or chemotherapy or hormone therapy.

Ovarian cancer is a disease produced by the rapid growth and division of cells within one or both ovaries-reproductive glands in which the ova, or eggs, and the female sex hormones are made. The ovaries contain cells that, under normal circumstances, reproduce to maintain tissue health. When growth control is lost and cells divide too much and too fast, a cellular mass or tumor is formed. If the tumor is confined to a few cell layers, for example, surface cells, and it does not invade surrounding tissues or organs, it is considered benign. If the tumor spreads to surrounding tissues or organs, it is considered malignant, or cancerous. When cancerous cells break away from the original tumor, travel through the blood or lymphatic vessels, and grow within other parts of the body, the process is known as metastasis.

Ovarian cancer is not a single disease. There are actually more than 30 types and sub-types of ovarian malignancies, each with its own histopathology (diseased tissue) appearance and biologic behavior.

• In most cases, it gets detected in late stages.
• Abdominal distension, bloating, pain and discomfort.
• Irregular vaginal bleeding.

It depends on the stage of the disease and the type of the tumor.

Surgical or chemotherapy or both.

It is a malignant tumor of the cervix, the lowermost part of the uterus which opens into the vagina. It occurs when the tumor cells grow out of control. Pap smear test can be helpful to detect early stages of cervical cancer.

• Whitish or blood stained vaginal discharge
• Vaginal bleeding after sexual intercourse
• Post menopausal vaginal bleeding
• Intermittent vaginal bleeding
• Pelvic pain

It may remain asymptomatic during early stages and gets diagnosed during routine checkup.

• It depends on the staging of the cancer.
• Surgical, radiation therapy or chemotherapy or combinations.

Endometriosis is a disease in which the endometrial tissue, or the lining of the uterus, grows outside the uterus to its surrounding areas and even to distant parts of the body.

• Pelvic pain
• Heavy or irregular vaginal bleeding
• Infertility
• Painful bowel movements - women may experience bowel pain followed by abdominal bloating, constipation, or diarrhea.
• Rectal bleeding during menstruation

It may remain asymptomatic during early stages and gets diagnosed during routine checkup.

(a) Surgery

• Surgery is the main treatment option for women with endometriosis.
• Laparoscopic surgery can be performed to diagnose as well as, treat endometriosis at the same time.
• The aim of surgery is to diagnose the endometriosis as well as remove as much of the diseased areas as possible.

(b) Pain medication and Hormone therapy - Symptomatic treatment and have very high recurrence rate

Ovarian cysts are fluid filled sacs or pouches in the ovary. Fluid within the cyst can vary from thin and watery to thick paste-like in consistency. Cysts can vary in size, number and type. Most of the cysts are benign (non-cancerous) but some can be cancerous.

• Most of the times, cysts are asymptomatic.
• Dull aching lower abdominal pain
• Heaviness in lower abdomen
• Symptoms associated with the underlying disease like endometriosis, pcod, cancer etc.
• Sudden, severe abdominal pain with fever and vomiting if torsion of the cyst has happened.

• Observational follow up in some cases.
• Definitive treatment: Cystectomy (removal of the cyst wall)

An Ectopic Pregnancy occurs when a fertilized egg settles and grows as a pregnancy in any location other than the inner lining of the uterus. The most common site for an ectopic pregnancy is the Fallopian tube.

• Absence of periods followed by Vaginal bleeding, Abdominal pain.
• If the ectopic pregnancy ruptures, it is an acute emergency.

• Surgical treatment: Laparoscopy is the gold standard for diagnosis as well as treatment of the ectopic pregnancy. Laparoscopic salpingotomy (removal of ectopic pregnancy followed by repair of the tube) is the preferred method for un-ruptured ectopic pregnancy. Laparoscopic salpingectomy (removal of the tube) in case of ruptured ectopic pregnancy.
• Medical treatment: Medical management is possible in some cases.

Uterine fibroids are benign (non cancerous) tumors that originate within the muscular layer of the uterus.

Fibroids are classified according to their site of growth within the uterus:

• Submucous fibroids: they grow towards the inner lining of the uterus (endometrium) or just beneath to it.
• Intramural fibroids: they grow within the myometrial layer.
• Subserous fibroids: they grow towards the outer layer of the uterus (serosal layer).

Most women with uterine fibroids have no symptoms and hence the disease remains undetected.

Fibroids can also cause many symptoms according to their site, size and speed of growth such as:

• Lower abdominal pain
• Heavy and prolonged menstrual bleeding
• Pressure symptoms like difficulty in urination or defecation
• Infertility

Definitive treatment:

• Myomectomy in case of Infertility. (If patient wants pregnancy)
• Hysterectomy in case if patient does not desire fertility. (If family is complete)

Vulvar cancer is a type of cancer that affects the vulval region. It accounts for about three per cent of all gynecological cancers and is most commonly diagnosed in older women aged around 70 years or over. However, an increasing number of women aged 35-45 are being diagnosed with this form of cancer.

The most common site for vulvar cancer is the labia majora, while just one in 10 cases originates in the clitoris. The vulva has lots of blood and lymphatic vessels, which means that vulval cancer cells can easily spread to nearby body parts such as the bladder, vagina and anus. Without treatment, the patient can suffer from severe infection and pain.

The vulva is a general term that describes the external female genitals. The vulva is made of three main parts: the labia majora (outer lips), the labia minora (smaller inner lips) and the clitoris.

In its early stages, vulvar cancer often has no symptoms. This is because the cancer is so tiny. The progression of symptoms can include:

• An unusual lump or bump can be felt somewhere on the vulva.
• The lump progresses to an ulcerated sore that refuses to heal.
• There could be unusual bleeding or discharge from the vagina.
• Problems with bowel motions and passing urine may indicate the cancer has spread into these structures.
• The lump becomes itchy and painful.
• The raw-looking sore can be white, red or pink. The sore gets bigger with time.
• The lymph glands in the groin may swell.
• Secondary cancers may cause a range of symptoms, such as aching bones.

Pelvic organ prolapse occurs when a pelvic organ-such as your bladder-drops (prolapses) from its normal spot in your lower belly and pushes against the walls of your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or stretched from childbirth or surgery.

Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful. But it isn’t usually a big health problem. It doesn’t always get worse.

More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have pelvic prolapse include the: Bladder, Urethra, Uterus, Vagina, Small bowel, Rectum.

• Feeling pressure from pelvic organs pressing against the vaginal wall.
• Feeling very full in your lower belly.
• Feeling as if something is falling out of your vagina.
• Feeling a pull or stretch in your groin area or pain in your lower back.
• Releasing urine without meaning to (incontinence), or needing to urinate a lot.
• Having pain in your vagina during intercourse.
• Having problems with your bowels, such as constipation.

• Sling Surgery if conservation of uterus is desired.
• Hysterectomy with a-repair/p-repair or a-p-repair.