Laxmi Devi presented with complaints of dull aching pain and constipation for 3 months and examination and investigations revealed a diagnosis of 28 weeks (25x20x20 cm) ovarian mass. The surgical team to treat this was led by Dr. Nitin Singhal, Surgical Oncologist, Fortis Escorts Hospital Faridabad.
The patient, aged 65 years of age, was found to be having an ovarian mass that is equivalent to a big football and was completely filling the pelvic cavity. For the medical management of this large ovarian mass surgery was the only option and a staging laparotomy along with excision of mass was planned.
The challenges were multiple as the ovarian mass was adherent to rectum, sigmoid colon and bladder base along with adhesion to left ureter. Added to this was the fact that this mass solid cystic in consistency needed to be removed completely without rupturing it. Rupturing would have upstaged the disease in the patient. With a distorted anatomy due to previous laparotomies added to the difficulty quotient of the case. The patient was communicated about the possible complications including a possibility of a permanent stoma and partial bladder excision before being taken for surgery.
The surgery successfully excised the mass with negative margins dissecting it out completely of rectum and sigmoid colon ureter and pelvic vessels, and taking part of fat around bladder without injuring any of these structures. This resulted in achieving both objectives of complete oncological clearance and to prevent surgical morbidity.
Dr. Nitin Singhal, Surgical Oncologist, Fortis Escorts Hospital Faridabad said, “With the increasing incidences of women in India affected by Ovarian cancer, we should make increased efforts to create awareness and detect ovarian cancer at an early stage. This can be achieved only by educating population about the risk factors. Since ovarian cancers have predominance to environment and lifestyle factors in origin and so, at least in principle avoidable.”
Patient, Laxmi Devi, expressed her gratitude to the doctor and his team, “I was going through crucial pain and suffering due to the condition I was in. I am very grateful to Dr. Nitin and his team for treating me and giving my life back to me.”
Ovarian cancer has emerged as one of the most common malignancies affecting women in India. The present reports indicate the trends in the incidence rate of ovarian cancer for Indian women. During the period 2001-06, the incidence rates for ovarian cancer varied from 0.9 to 8.4 per 100,000 person. The highest incidence was noted in Pune and Delhi. The Age Specific Incidence Rate (ASIR) for ovarian cancer revealed that the disease increases from 35 years of age and reaches a peak between the ages 55-64. The trend analysis by period showed an increasing trend in the incidence rate of ovarian cancer. Analysis of data revealed that the mean annual percentage increase was higher for women in the middle and older age groups.
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